Pulsatile Tinnitus Due to a Large Mastoid Emissary Vein: Successfully Managed with Percutaneous Embolization in a Novel Approach

Abstract

Tinnitus refers to the perception of sound without any external stimuli which can be pulsatile or non-pulsatile. Dilated mastoid emissary vein (MEV) can cause pulsatile tinnitus. Herein, we report a case of persistent pulsatile tinnitus with dilated MEV managed successfully with percutaneous coiling of MEV in a 36 years male.

Keywords: Dilated sigmoid sinus; Mastoid emissary canal; Mastoid emissary vein; Percutaneous embolization; Pulsatile tinnitus; Sigmoid sinus stenting.

Fig. 1

Ultrasound (US) and computed tomography (CT) scan of the patient with dilated mastoid emissary vein (MEV). Ultrasound imaging over left mastoid region (A) and (B) showed dilated left mastoid emissary vein with mild increase in its size on Valsalva (arrows). CT Venogram image axial (C), coronal (D) and sagittal reformatted image (E) showed dilated mastoid emissary vein running through prominent mastoid emissary canal (arrows). CT Venogram VRT image (F) showed dilated left sigmoid sinus (white arrow), however dilated emissary vein was not appreciated. Sagittal reformatted image (G, H) showed dilated emissary vein (white arrow in G), previously placed sigmoid sinus stent (white arrow in H) and bone cement in the mastoid region anterior to sigmoid sinus (blue arrow in H)

Fig. 2

Clinical picture, digital subtraction angiography (DSA) and Computed tomography (H) of the patient showing percutaneous coiling of dilated mastoid emissary vein (MEV). Clinical picture (A) showed the percutaneous puncture of the MEV (arrow). Fluoroscopic DSA image (B) showed the previously placed sigmoid sinus stent (arrow). DSA run (C, D) showed MEV communicating into sigmoid sinus (arrow). DSA roadmap image (E) showed the coiling of the MEV (arrow). Post procedure angiogram (F,G) showed complete blockade of the MEV (arrow). Exper CT (H) showed coiling of the MEV in the intradiploic space with intact stent (arrow)