Abstract
ObjectiveEvaluate the role of venous sinus stenting in the treatment of pulsatile tinnitus among patients with Idiopathic Intracranial Hypertension (IIH) and significant venous sinus stenosis.Subjects and MethodsA written informed consent approved by the Weill Cornell institutional review board was signed and obtained from the study participants. Thirty-seven consecutive patients with IIH and venous sinus stenosis who were treated with venous sinus stenting between Jan.2012-Jan.2016 were prospectively evaluated. Patients without pulsatile tinnitus were excluded. Tinnitus severity was categorized based on “Tinnitus Handicap Inventory” (THI) at pre-stent, day-0, 1-month, 3-month, 6-month, 12-month, 18-month and 2-year follow-up. Demographics, body-mass index (BMI), pre and post VSS trans-stenotic pressure gradient were documented. Statistical analysis performed using Pearson’s correlation, Chi-square analysis and Fischer’s exact test.Results29 patients with a mean age of 29.5±8.5 years M:F = 1:28. Median (mean) THI pre and post stenting were: 4 (3.7) and 1 (1) respectively. Median time of tinnitus resolution post VSS was 0-days. There was significant improvement of THI (Δ Mean: 2.7 THI [95% CI: 2.3–3.1 THI], p<0.001) and transverse-distal sigmoid sinus gradient (Δ Mean: -15.3 mm Hg [95% CI: 12.7–18 mm Hg], p<0.001) post-stenting. Mean follow-up duration of 26.4±9.8 months (3–44 months). VSS was feasible in 100% patients with no procedural complications. Three-patients (10%) had recurrent sinus stenosis and tinnitus at mean follow-up of 12 months (6–30 months).ConclusionVenous sinus stenting is an effective treatment for pulsatile tinnitus in patients with IIH and venous sinus stenosis.
Highlights
Pulsatile tinnitus (PT) is described as a conscious and undesired perception of heartbeat in the ear of affected individuals
Venous sinus stenting is an effective treatment for pulsatile tinnitus in patients with Intracranial Hypertension (IIH) and venous sinus stenosis
Based on the presence of visual symptoms at presentation, the patients were either enrolled in the FDA approved prospective clinical trial of “Venous sinus stenting in patients with idiopathic intracranial hypertension refractory to medical therapy” (ClinicalTrials.gov, NCT01407809) or were enrolled in a prospective patient registry, both approved by the Institutional Review Board
Summary
Pulsatile tinnitus (PT) is described as a conscious and undesired perception of heartbeat in the ear of affected individuals. Idiopathic Intracranial Hypertension (IIH), known as pseudotumor cerebri, is by far the most common cause of pulsatile tinnitus in young and obese female patients[1]. The original criteria for diagnosis of IIH was described by Dandy in 1937[2] and a modified by Smith in 1985 to become “modified Dandy criteria” replacing ventriculography with computed tomography (CT) for imaging[3]. This was further amended by Digre and Corbett in 2001, included awake and alert patient and exclusion of venous sinus thrombosis in the diagnostic criteria[4]
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