Arachnoid Granulation Causing Unilateral Pulsatile Tinnitus Treated With Dural Venous Sinus Stenting

Area of Science:

• Neurosurgery
• Vascular Neurology
• Interventional Radiology

Background:

• Large arachnoid granulations protruding into dural venous sinuses can obstruct venous outflow, presenting as a potential cause of pulsatile tinnitus (PT).
• This condition is often underappreciated, despite its significant impact on patient quality of life.

Purpose of the Study:

• To investigate the efficacy of endovascular dural venous sinus stenting in treating unilateral pulsatile tinnitus caused by large arachnoid granulations.
• To evaluate the safety and long-term outcomes of this endovascular intervention.

Main Methods:

• A cohort of four patients with unilateral PT underwent evaluation using magnetic resonance imaging and digital subtraction angiography.
• Diagnosis revealed moderate-to-severe stenoses in the transverse sinus due to large arachnoid granulations.
• Patients were treated with endovascular dural venous sinus stenting after venous manometry.

Main Results:

• All four patients experienced immediate and complete resolution of their pulsatile tinnitus following the stenting procedure.
• Significant relief of venous stenosis, averaging 93%, was achieved.
• No procedural or periprocedural complications were reported, with sustained symptom resolution at an average 8-month follow-up.

Conclusions:

• Pulsatile tinnitus secondary to arachnoid granulations represents an underrecognized pathological mechanism.
• Endovascular dural venous sinus stenting is a safe and effective treatment for unilateral PT caused by large arachnoid granulations.