Endovascular treatment of pulsatile tinnitus associated with venous sinus diverticulum: a scoping review

Venous sinus diverticula are a recognised and potentially treatable cause of pulsatile tinnitus. While surgical resurfacing has traditionally been employed, a range of endovascular approaches-including coil embolization, venous sinus stenting, and intrasaccular devices-have emerged as less invasive alternatives. The scope and quality of evidence supporting these interventions, however, remain poorly defined.

PubMed, Embase, Scopus, and Web of Science were systematically searched for studies reporting endovascular treatment of pulsatile tinnitus caused by venous sinus diverticula. Eligible observational studies, case series, and case reports were selected using a Population-Concept-Contextframework. Data extraction and screening were independently performed by multiple reviewers, and findings were synthesised descriptively with quality appraisal to contextualise the evidence.

A total of 23 studies comprising 78 patients were included, predominantly single-centre case reports (n = 18) and case series (n = 3), with two retrospective cohort studies. Patients were mainly female (84%), with a mean age of 45 years and a mean symptom duration of 4.6 years. Pulsatile tinnitus was most frequently right-sided (53.8%), followed by left-sided (26.9%) and bilateral symptoms (19.2%). Endovascular strategies included stent-assisted coil embolization (60.0%), venous sinus stenting alone (22.5%), coil embolization alone (12.5%), and, less commonly, intrasaccular devices or balloon-assisted techniques (each 2.5%). Complete resolution of symptoms was reported in 84.4% of patients, partial improvement in 10.4%, and no improvement in 5.2%. Follow-up was reported in 19 studies, ranging from 4 weeks to 2 years. Procedural complications were uncommon and generally transient, with no reported mortality or permanent neurological morbidity.

Endovascular treatment shows high symptomatic response rates in selected patients with venous sinus diverticulum-related pulsatile tinnitus, but evidence is limited by small retrospective studies and heterogeneous reporting of outcomes. Prospective studies with standardised diagnostics and validated tinnitus measures are required.