Abstract:Objective This study aimed to report the treatment strategy and clinical effect of a rare case of pulsatile tinnitus caused by sigmoid sinus double diverticula and to review the clinical manifestations, imaging diagnosis, and treatment strategy for sigmoid sinus double diverticula. Methods Clinical data of a patient with sigmoid sinus double diverticulum in the First Affiliated Hospital of Bengbu Medical College at September 2021 were retrospectively analyzed. The key words "sigmoid sinus diverticulum," "pulsating tinnitus," "sigmoid sinus diverticulum," and "pulsatile tinnitus" were used in Chinese and English. The literature related to sigmoid diverticulum after 2002 was searched in CNKI, Wanfang Data, VIPP database, and PubMed. A total of six cases in five English reports were included. Combined with one case reported in this paper, the clinical manifestations, imaging diagnosis, and treatment strategies of sigmoid sinus double diverticulum were summarized. Results The patient was a 49-year-old female. The clinical manifestation included pulsating tinnitus in the right ear. The shiatsu test and head turning test also obtained positive results. High-resolution computed tomography (HRCT) of the temple bone showed double diverticulum of the right sigmoid sinus with a thin bone wall on the front wall of the diverticulum. 3D reconstruction showed that the double diverticulum of the right sigmoid sinus was located round the bend from the transverse sinus to the sigmoid sinus. The sigmoid diverticulum was returned, and bone wall reconstruction of the sigmoid sinus was performed. No recurrence was observed after 12 months of follow-up. Combined with the six cases reported in the literature, a total of seven patients with double diverticulum of sigmoid sinus were female, aged 43(34,49) years. All seven patients were treated for pulsating tinnitus, and the shiatsu test and head turning test obtained positive results. Imaging findings showed double diverticula of sigmoid sinuses and/or peripheral bone wall defects, transverse sinus stenosis, and abnormal barrier venous ring. All the seven patients underwent sigmoid sinus bone wall reconstruction, of which three patients underwent sigmoid diverticulum restoration, one patient underwent abnormal barrier venous ring occlusion, and one patient underwent enlarged occipital oblique sinus. Among them, five cases had complete remission, no recurrence was observed during follow-up; one case had partial remission, and one case had no remission. Conclusion The main clinical manifestations of double diverticulum of sigmoid sinuses include pulsating tinnitus as well as positive shiatsu and turning head test results. 3D reconstruction of temporal bone HRCT or CT angiography can be used for the diagnosis of this disease. Furthermore, the sigmoid diverticulum retraction and bone wall reconstruction of sigmoid sinus are considered practical and effective methods.
朱慧慧, 王小林, 韩跃峰. 乙状窦双憩室致搏动性耳鸣1例报道并文献复习[J]. 中华解剖与临床杂志, 2023, 28(10): 667-671.
Zhu Huihui, Wang Xiaolin, Han Yuefeng. Pulsatile tinnitus induced by sigmoid sinus double diverticula: a case report and literature review. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 667-671.
Sanchez TG, Murao M, de Medeiros IR, et al. A new therapeutic procedure for treatment of objective venous pulsatile tinnitus[J]. Int Tinnitus J, 2002, 8(1): 54-57
Li D, Wang G, Zeng R, et al.Analysis of revision surgery following surgical reconstruction of the sigmoid sinus wall in patients with pulsatile tinnitus[J]. J Int Adv Otol, 2022,18(4): 358-364. DOI: 10.5152/iao.2022.21471
[4]
Yeo WX, Xu SH, Tan TY, et al.Surgical management of pulsatile tinnitus secondary to jugular bulb or sigmoid sinus diverticulum with review of literature[J]. Am J Otolaryngol, 2018, 39(2): 247-252. DOI: 10.1016/j.amjoto.2017.12.019
[5]
Otto KJ, Hudgins PA, Abdelkafy W, et al.Sigmoid sinus diverticulum: a new surgical approach to the correction of pulsatile tinnitus[J]. Otol Neurotol, 2007, 28(1): 48-53. DOI: 10.1097/01.mao.0000247814.85829.f6
[6]
Hsieh YL, Wang S, Wang W.Case report: venous pulsatile tinnitus induced by enlarged oblique occipital sinus and resultant diverticulum/dehiscence of the sigmoid-jugular wall[J]. Front Surg, 2022,9:1014649. DOI: 10.3389/fsurg.2022.1014649
[7]
Wang GP, Zeng R, Ma XB, et al.Surgical treatment of pulsatile tinnitus caused by the sigmoid sinus diverticulum: a preliminary study[J]. Medicine (Baltimore), 2015,94(21):e882. DOI: 10.1097/MD.0000000000000882
[8]
徐广森, 樊军, 陶树东. 乙状窦憩室一例[J]. 听力学及言语疾病杂志, 2016,24(3):313-314. DOI:10.3969/j.issn.1006-7299.2016.03.025Xu GS,Fan J,Tao SD.A case of sigmoid sinus diverticulum[J].Journal of Audiology and Speech Pathology,2016,24(3):313-314. DOI:10.3969/j.issn.1006-7299.2016.03.025
[9]
Hertzano R, Teplitzky TB, Eisenman DJ.Clinical evaluation of tinnitus[J]. Neuroimaging Clin N Am, 2016, 26(2):197-205. DOI: 10.1016/j.nic.2015.12.004
[10]
Mattox DE, Hudgins P.Algorithm for evaluation of pulsatile tinnitus[J]. Acta Otolaryngol, 2008,128(4):427-431. DOI: 10.1080/00016480701840106
[11]
Li X, Xu N, Meng X, et al.Dual-phase contrast-enhanced CT evaluation of dural arteriovenous fistula in patients with pulsatile tinnitus as an initial symptom[J]. Eur J Radiol, 2022,148:110137. DOI: 10.1016/j.ejrad.2021.110137
[12]
Huang S, Li X, Xue X, et al.Hemodynamic study of the therapeutic effects of the different degrees of sigmoid sinus diverticulum reconstruction on patients[J]. Med Eng Phys, 2020,86:8-15. DOI: 10.1016/j.medengphy.2020.10.008
[13]
Sun J, Sun J.Sandwich technique for sigmoid sinus wall reconstruction for treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence[J]. Acta Otolaryngol, 2019,139(12):1063-1066. DOI: 10.1080/00016489.2019.1668960.