Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus

Fellows’ Journal Club

Editor’s Comment

Transmastoid sigmoid sinus wall reconstruction (SSWR) is a surgical technique used for the treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies. In 13 patients, CT and MR imaging examinations were assessed for the characteristics of the materials used for reconstruction, the impact of these on the adjacent sigmoid sinus, and complications. The various materials used for reconstruction (NeuroAlloderm, HydroSet, bone pate) showed characteristic imaging appearances and could be consistently identified. In 5/13 patients, there was extrinsic compression of the sigmoid sinus by graft material. Dural sinus thrombosis occurred in 2 patients. Symptoms requiring postoperative imaging after SSWR include headaches, visual disturbances, and persistent or recurrent tinnitus.

Abstract

Figure from Raghavan et al -- Fellows' Journal Club
CT features of sigmoid wall anomalies. A, Axial CT image of the temporal bone demonstrates dehiscence of the left sigmoid sinus wall (arrow). B, Axial CT image of the temporal bone in a different patient demonstrates a small left sigmoid sinus diverticulum (arrow). Both patients presented with left pulse synchronous tinnitus.

BACKGROUND AND PURPOSE

Transmastoid sigmoid sinus wall reconstruction is a surgical technique increasingly used for the treatment of pulsatile tinnitus arising from sigmoid sinus wall anomalies. The imaging appearance of the temporal bone following this procedure has not been well-characterized. The purpose of this study was to evaluate the postoperative imaging appearance in a group of patients who underwent this procedure.

MATERIALS AND METHODS

The medical records of 40 consecutive patients who underwent transmastoid sigmoid sinus wall reconstruction were reviewed. Thirteen of 40 patients underwent postoperative imaging. Nineteen CT and 7 MR imaging examinations were assessed for the characteristics of the materials used for reconstruction, the impact of these on the adjacent sigmoid sinus, and complications.

RESULTS

Tinnitus resolved in 38 of 40 patients. Nine patients were imaged postoperatively for suspected complications, including dural sinus thrombosis, facial swelling, and wound drainage. Two patients underwent imaging for persistent tinnitus, and 2, for development of tinnitus on the side contralateral to the side of surgery. The materials used for reconstruction (NeuroAlloderm, HydroSet, bone pate) demonstrated characteristic imaging appearances and could be consistently identified. In 5 of 13 patients, there was extrinsic compression of the sigmoid sinus by graft material. Dural sinus thrombosis occurred in 2 patients.

CONCLUSIONS

The imaging findings following sigmoid sinus wall repair are characteristic. Graft materials may result in extrinsic compression of the sigmoid sinus, and this finding may be confused with dural venous thrombosis. Awareness of the imaging characteristics of the graft materials used enables this differentiation.

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Postoperative Imaging Findings following Sigmoid Sinus Wall Reconstruction for Pulse Synchronous Tinnitus
jross
Jeffrey Ross • Mayo Clinic, Phoenix

Dr. Jeffrey S. Ross is a Professor of Radiology at the Mayo Clinic College of Medicine, and practices neuroradiology at the Mayo Clinic in Phoenix, Arizona. His publications include over 100 peer-reviewed articles, nearly 60 non-refereed articles, 33 book chapters, and 10 books. He was an AJNR Senior Editor from 2006-2015, is a member of the editorial board for 3 other journals, and a manuscript reviewer for 10 journals. He became Editor-in-Chief of the AJNR in July 2015. He received the Gold Medal Award from the ASSR in 2013.