Novel surgical treatment of a transverse-sigmoid sinus aneurysm presenting as pulsatile tinnitus: Technical case report

Yakov Gologorsky, Scott A. Meyer, Alexander F. Post, H. Richard Winn, Aman B. Patel, Joshua B. Bederson

Research output: Contribution to journalArticle

39 Scopus citations

Abstract

OBJECTIVE: Pulsatile tinnitus is a relatively common, potentially incapacitating condition that is often vascular in origin. We present a case of disabling pulsatile tinnitus caused by a transverse-sigmoid sinus aneurysm that was surgically treated with self-tying U-clips (Medtronic, Inc., Memphis, TN). We also review the literature and discuss other described interventions. CLINICAL PRESENTATION: A 48-year-old woman presented with a 5-year history of progressive pulsatile tinnitus involving the right ear. Her physical examination was consistent with a lesion that was venous in origin. Angiography demonstrated a wide-necked venous aneurysm of the transverse-sigmoid sinus that had eroded the mastoid bone. INTERVENTION: The patient underwent a retromastoid suboccipital craniectomy to expose the aneurysm and surrounding anatomy. The aneurysm dome was tampon-aded and the aneurysm neck was coagulated until the dome had shrunk to a small remnant. The linear defect in the transverse sigmoid junction was then reconstructed with a series of U-clips and covered with Gelfoam hemostatic sponge (Pfizer, Inc., New York, NY). The patient awakened without neurological deficit and with immediate resolution of her tinnitus. A postoperative angiogram demonstrated obliteration of the aneurysm, with minimal stenosis in the region of the repair and good flow through the dominant right transverse-sigmoid junction. CONCLUSION: This technical case report describes a novel definitive surgical treatment of venous sinus aneurysms. This technique does not necessitate long-term anticoagulation, has a low likelihood of reintervention, and provides immediate resolution of pulsatile tinnitus.

Original languageEnglish (US)
Pages (from-to)393-394
Number of pages2
JournalNeurosurgery
Volume64
Issue number2
DOIs
Publication statusPublished - Feb 1 2009
Externally publishedYes

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Keywords

  • Pulsatile tinnitus
  • U-clips
  • Venous aneurysm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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