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Venous Sinus Stenting for Pulsatile Tinnitus: A Systematic Review and Meta-Analysis
Sevda Alipour Khabir1, Julien Ognard1,2, Gerard El Hajj1
1Department of Radiology, Mayo Clinic, Rochester, MN.
Summary
Venous sinus stenting (VSS) effectively treats pulsatile tinnitus (PT), offering high improvement and resolution rates. While recurrence is low, it may be higher in patients with idiopathic intracranial hypertension (IIH).
Area of Science:
- Neurology
- Vascular Surgery
- Otolaryngology
Background:
- Pulsatile tinnitus (PT) often stems from venous sinus stenosis, sometimes linked to idiopathic intracranial hypertension (IIH).
- Venous sinus stenting (VSS) is a therapeutic option for venous outflow obstruction, but its effectiveness and durability require further evaluation.
- Heterogeneous outcome data necessitate updated systematic reviews and meta-analyses.
Purpose of the Study:
- To evaluate the efficacy and durability of venous sinus stenting (VSS) for treating pulsatile tinnitus (PT).
- To compare outcomes of VSS between patients with IIH-associated PT and isolated PT.
- To provide updated pooled data on PT improvement, resolution, and recurrence after VSS.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines, searching MEDLINE, Scopus, and Web of Science.
- Included studies reported PT outcomes after VSS; random-effects meta-analyses estimated pooled proportions.
- Subgroup analyses compared outcomes between IIH-associated and isolated PT cohorts.
Main Results:
- Thirty-two studies (850 patients) were analyzed; 90.3% had venous sinus stenosis.
- Pooled overall PT improvement was 89.8%, with complete resolution in 87.1%.
- Recurrence was 10.9%; rates did not significantly differ between IIH and isolated PT, though recurrence trended higher in IIH (12.0% vs. 5.7%).
Conclusions:
- Venous sinus stenting (VSS) demonstrates high efficacy for pulsatile tinnitus (PT) improvement and resolution with low recurrence rates.
- While not statistically significant, recurrence trends suggest potentially lower durability in IIH-associated PT.
- Underlying pathophysiology in IIH may influence the long-term durability of VSS for PT.
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