Interventionai Diagnosis and Treatment of Vasculogeneic Pulsatile Tinnitus

ObjectiveTo retrospectively study clinical features and diagnostic imaging of vasculogeneic pulsatile tinnitus, and the feasibility and efficacy of transvascular interventional treatment for this condition.MethodsData from 82 cases of arterial or venous pulsatile tinnitus were reviewed. DSA characteristics and possible pathophysiological mechanisms of pulsatile tinnitus in these cases were studied. Diagnoses in this group included intracranial arterovenous fistula (AVF) (n=3), spontaneous skull base dural AVF (n=16), traumatic carotid-cavernous sinus fistula (n=5), subclavian artery stenosis (n=2), internal carotid artery stenosis (n=3), intracranial arterial stenosis (n=1), kinked and/or elongated vertebrobasilar artery (n=2), venous sinus diverticulum (n=2), venous sinus stenosis on the dominant drainage side (n=46) and occipital sinus stenosis (n=2). Treatments included embolization and stenting using coils, NBCA glue, Balt balloons, self-expansion stents and intracranial micro-stents via either the femoral artery or femoral vein.ResultsProcedures were successful in all cases with no surgery-related complications. Tinnitus disappeared within 2 days after the procedure in all cases. Follow up duration was 5-36 months. Recurrence occurred in 4 cases of arterial tinnitus within 3 months following the initial procedure, which improved after revision embolization or symptom management. There was no recurrence in venous tinnitus cases following stent plastic or stent-coiling embolization treatments.ConclusionsEndovascular intervention provides a new approach to the diagnosis and treatment of intractable pulsatile tinnitus. It is also effective in differentiating and studying other types of tinnitus.