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Temporal bone remodeling after venous stenting for pulsatile tinnitus: isolated dehiscence versus diverticulum
Zhiyuan Zhang1, Yanjing Han1, Tianhao Su1
1Department of Interventional Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Objectives:
To evaluate clinical outcomes and temporal bone remodeling after venous sinus stenting for pulsatile tinnitus (PT), and to compare remodeling rates between isolated sigmoid sinus wall dehiscence (SSWD) and diverticulum-associated SSWD.
Materials And Methods:
This retrospective cohort study included 70 consecutive patients who underwent venous sinus stenting for PT. Clinical success was defined as symptom improvement or complete resolution. The primary endpoints were short-term clinical success (at 3 months) and temporal bone remodeling on follow-up CT (n = 52). Long-term clinical success was evaluated as a secondary endpoint. Multivariable logistic regression, adjusted for age, sex, dehiscence size, diverticulum presence, and preoperative Tinnitus Handicap Inventory (THI) score, was used to identify predictors of temporal bone remodeling.
Results:
Short-term clinical success was achieved in 65/70 patients (92.9%). Remodeling occurred in 38/52 patients (73.1%) with follow‑up CT. Remodeling rates were significantly higher in patients with a diverticulum versus isolated SSWD (85.7% (30/35) vs 47.1% (8/17); adjusted OR, 8.08; 95% CI: 1.31-49.73; p = 0.024). Older age independently predicted temporal bone remodeling (adjusted OR per year, 1.14; 95% CI: 1.03-1.26; p = 0.012). Long-term clinical success was observed in 97.4% (37/38) of remodeled patients and 85.7% (12/14) of non-remodeled patients (p = 0.15).
Conclusion:
Venous sinus stenting for PT results in a high rate of clinical success. The presence of a diverticulum strongly predicts subsequent temporal bone remodeling, whereas SSWD appears less likely to remodel, highlighting potential pathophysiological differences between these anatomical subtypes.
Key Points:
Question Venous sinus stenting for pulsatile tinnitus results in high clinical success, but temporal bone remodeling differs by anatomical subtype. Findings Patients with a sigmoid sinus diverticulum demonstrate significantly higher rates of postoperative bone remodeling compared to those with isolated dehiscence. Clinical relevance Identifying the specific anatomical anomaly may help to predict temporal bone remodeling and facilitate individualized patient counseling regarding long-term structural outcomes.
