Treatment of dural arteriovenous fistulas presenting as pulsatile tinnitus

To describe the clinical picture and treatment of dural arteriovenous fistulas (DAVFs) presenting as pulsatile subjective tinnitus.

Review of prospectively collected data.

Academic referral center.

Fourteen patients with clinically and radiographically diagnosed DAVFs.

Treated by endovascular route.

Treatments, clinical course, complications, and evolution were evaluated.

All patients presented with sleep-disruptive pulsatile tinnitus. Other symptoms included severe headaches, papilledema, proptosis, blepharoptosis, visual disturbances, and hemiparesis. Cortical venous drainage was present in 4 cases. Endovascular treatment was performed at least once by the arterial route in 14 patients and the venous route in 4 patients. The origin of tinnitus was always a vessel in or above the petrous bone. When these arteries or veins could not be visualized in the final control, the tinnitus disappeared. In the patients whose tinnitus returned, a vessel in the petrous bone could always be seen. There was no mortality.

Endovascular treatment is an effective and safe treatment of DAVFs presenting as tinnitus.