Resolution of pulsatile tinnitus after coil embolization of sigmoid sinus diverticulum

Venous sinus diverticulum is a rare vascular cause for pulsatile tinnitus characterized by an out pouching of the venous sinus into the calvarium, usually involving the sigmoid venous sinus. Sigmoid sinus diverticulum is often associated with upstream sinus stenosis. While the exact mechanism of sound generation from a sinus diverticulum is unclear, several case reports have suggested that pulsatile tinnitus can resolve after remodeling of venous blood flow such that the diverticulum is excluded from the circulation. Case reports have also suggested treatment of both the sigmoid sinus diverticulum and the often-associated upstream sinus stenosis may ameliorate pulsatile tinnitus. We report a case of trans-venous coil embolization of a sigmoid sinus diverticulum without treatment of an additionally identified upstream sinus stenosis, resulting in cure of the patient’s pulsatile tinnitus. A review of endovascular and open surgical treatment of sinus diverticula in the treatment of pulsatile tinnitus is also presented.