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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
- Interventional Cardiology
- Otolaryngology
Background:
- Pulsatile tinnitus (PT) often stems from venous sinus stenosis, frequently linked to idiopathic intracranial hypertension (IIH).
- Venous sinus stenting (VSS) is a therapeutic option for venous outflow obstruction causing PT, but outcomes vary.
- Existing data on VSS for PT require updated synthesis to clarify efficacy and durability.
Purpose of the Study:
- To conduct a systematic review and meta-analysis evaluating the efficacy and durability of VSS for PT.
- To compare outcomes of VSS between patients with IIH-associated PT and isolated PT.
Main Methods:
- Systematic literature search of MEDLINE, Scopus, and Web of Science (inception to December 2025) following PRISMA guidelines.
- Inclusion of clinical studies reporting PT outcomes post-VSS.
- Random-effects meta-analyses to determine pooled rates of improvement, resolution, and recurrence, with subgroup analyses for IIH vs. isolated PT.
Main Results:
- Thirty-two studies (850 patients: 641 IIH, 209 isolated PT) were analyzed; venous sinus stenosis was the primary etiology (90.3%).
- Pooled overall PT improvement was 89.8%, with complete resolution in 87.1%.
- Recurrence rate was 10.9%; improvement and resolution did not significantly differ between IIH and isolated PT groups, though recurrence was higher in IIH (12.0% vs. 5.7%).
Conclusions:
- VSS demonstrates high efficacy in improving and resolving PT, with a low overall recurrence rate.
- The trend of higher recurrence in IIH patients suggests that underlying pathophysiology may impact long-term durability.
- Further research into the mechanisms of recurrence in IIH-associated PT is warranted.
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