Sigmoid sinus diverticulum
Sigmoid sinus diverticula are venous outpouchings from the sigmoid sinus that intrude into the mastoid bone, which can occur either with an intact but remodelled sigmoid plate or with sigmoid sinus dehiscence.
The prevalence of sigmoid sinus diverticulum or dehiscence is about 1% 1.
Many patients are asymptomatic. However, sigmoid sinus diverticulum and dehiscence are among the most common causes of pulsatile tinnitus 1.
The outpouching is most directly demonstrated on MR or CT venography. The remodelling or erosion of the sigmoid plate can be demonstrated on non-contrast-enhanced temporal bone CT.
Treatment and prognosis
Endovascular treatment consists of stenting of the sigmoid sinus and coil embolization of the diverticulum 2. Open surgical treatment consists of resurfacing the sigmoid plate and extravascular reduction of the diverticulum by bone wax packing or electrocoagulation 3.
- 1. Schoeff S, Nicholas B, Mukherjee S, Kesser BW. Imaging prevalence of sigmoid sinus dehiscence among patients with and without pulsatile tinnitus. (2014) Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 150 (5): 841-6. doi:10.1177/0194599813520291 - Pubmed
- 2. Shastri RK, Chaudhary N, Pandey AS, Telian SA, Gemmete JJ. Venous Diverticula Causing Pulsatile Tinnitus Treated With Coil Embolization and Stent Placement With Resolution of Symptoms: Report of Two Cases and Review of the Literature. (2017) Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 38 (9): e302-e307. doi:10.1097/MAO.0000000000001540 - Pubmed
- 3. Liu GS, Boursiquot BC, Blevins NH, Vaisbuch Y. Systematic Review of Temporal Bone-Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies. (2019) Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. doi:10.1177/0194599818823205 - Pubmed