Sinus Wall Reconstruction for Sigmoid Sinus Diverticulum and Dehiscence: A Standardized Surgical Procedure for a Range of Radiographic Findings

Objective: To describe the radiographic presentation, surgical treatment, and complications of pulse-synchronous tinnitus (PST) due to sigmoid sinus diverticulum and dehiscence. Study Design: Retrospective case series. Setting: Tertiary care, academic medical center. Patients: Thirteen patients (14 ears) surgically treated for PST due to sigmoid sinus diverticulum and dehiscence. Intervention: Transmastoid reconstruction of the sinus wall with a standardized technique. Main Outcome Measure: Resolution of PST and complications of surgery. Results: All patients had complete resolution of their PST after surgery. There were 2 major postoperative complications, neither of which resulted in permanent morbidity. Conclusion: Sigmoid sinus diverticulum and dehiscence is a surgically treatable cause of PST, with a high rate of success. The radiographic diagnosis may be subtle and easily overlooked. Complications of surgery can be serious, and vigilance must be maintained to ensure prompt diagnosis and treatment.