Successful treatment of pulsatile tinnitus caused by jugular bulb diverticula using stent-assisted volumetric coil...

Pulsatile tinnitus (PT) is a distressing auditory symptom, frequently caused by vascular anomalies near the temporal bone. Among the rarer venous causes are jugular bulb diverticula, which can be difficult to diagnose and manage.

We report the case of a patient in their 40s with persistent right-sided pulsatile tinnitus significantly impairing daily functioning. Imaging revealed two diverticula in the right jugular bulb and an enlarged nuchal emissary vein. Conservative treatment was ineffective. Digital subtraction angiography confirmed the venous origin of the tinnitus through provocation testing and temporary balloon occlusion. A novel endovascular approach using volumetric coils and venous double-jailing technique was pursued.

Stent-assisted coil embolization was performed using a double-jailing technique. Two PX-SLIM™ microcatheters were jailed through a single ACCERO^® Rex stent, enabling precise deployment of Penumbra PC400 volumetric coils into both diverticula and the enlarged nuchal emissary vein. The procedure was completed without complications under general anesthesia.

Symptoms resolved immediately and remained absent at follow-up. Dual antiplatelet therapy was tapered to aspirin monotherapy after 12 weeks.

This is the first reported case employing volumetric coils in combination with a venous double-jailing technique for treating jugular bulb diverticula. This approach enabled precise and efficient embolization of multiple venous outpouchings through a single stent construct. The procedure was safe, minimally invasive, and led to complete symptom relief. These findings highlight a promising treatment strategy for selected cases of venous pulsatile tinnitus with complex anatomy.