Awake embolization of sigmoid sinus diverticulum causing pulsatile tinnitus: simultaneous confirmative diagnosis and treatment

Abstract

Sigmoid sinus diverticulum, a rare dural sinus anomaly, is regarded as one of the very rare causes of pulsatile tinnitus, and there have been only a few reports on their surgical or endovascular management. We describe a 31-year-old woman presenting with a three-year pulsatile tinnitus in her right ear. After finding the small bony defect in her right temporal bone on CT which was filled with contrast after enhancement, we confirmed the presence of sigmoid sinus diverticulum with the cerebral angiogram and embolized it with two detachable coils in awake status. Right after filling the two coils into the sac, thanks to her alert consciousness, she was able to refer the disappearance of her tinnitus. The operation was finished only with the detachment of the coils.

Figure 1

Axial (A) and coronal (B) temporal bone CTs which show the cavity (arrow) in the right temporal bone. After enhancement (C,D), we can confirm that the cavity is connected with the dural sinus.

Figure 2

A) AP projection of venous phase of DSA shows right sigmoid sinus diverticulum (arrow). B) Obliteration of the diverticulum after coil placement.