Sinus Stenting Research Articles

Disability and Patient-Reported Satisfaction in Women with Idiopathic Intracranial Hypertension: A Comparative Study of Venous Sinus Stenting and Medical Management

Objective: Patients with chronic idiopathic intracranial hypertension (IIH) commonly experience a high level of disability and low satisfaction with medical treatment. We aim to evaluate long-term functional improvement and patient satisfaction in IIH patients with similar symptoms by comparing venous sinus stenting (VSS) to standard medical therapy. Methods: We conducted a cross-sectional questionnaire study of 111 IIH patients, comparing 37 adult female patients who underwent venous sinus stenting with 74 patients treated medically. Propensity score matching was used to balance age and presence of papilledema at presentation between groups. Headache-related disability was evaluated using the Migraine Disability Assessment Scale (MIDAS), while general function and treatment satisfaction were assessed using custom questionnaires. Electronic medical records and the results of imaging upon diagnosis were reviewed retrospectively. Results: The stented group reported significantly better outcomes in physical well-being (median 4.0 vs. 1.0, p < 0.001), task completion (4.0 vs. 1.0, p < 0.001), work/school persistence (5.0 vs. 1.0, p < 0.001), and mental well-being (4.0 vs. 1.0, p < 0.001). Additionally, the stented group had a lower proportion of patients with severe MIDAS (MIDAS > 4, 24.3% vs. 47.9%, p = 0.017). Logistic regression suggested venous stenting as a protective factor against severe MIDAS scores (OR = 0.174, p = 0.004). Conclusion: Cerebral venous stenting in patients with IIH is associated with lower disability and higher patient satisfaction from medical treatment compared to those treated with medications only. These findings suggest that venous sinus stenting may be a valuable treatment option for selected IIH patients. However, larger prospective studies are needed to further validate our results.

The Impact of Venous Stenting for Patients with Idiopathic Intracranial Hypertension and Spontaneous Cerebrospinal Fluid Leak on Symptoms and Quality of Life

BACKGROUND: Elevated intracranial pressure can cause skull base defects and a spontaneous cerebrospinal fluid leak (CSF). Venous sinus stenting (VSS) has emerged as a promising treatment option for patients with a CSF leak in the setting of idiopathic intracranial hypertension (IIH). There is a lack of literature on symptomatology and quality of life (QOL) after VSS for IIH patients with a CSF leak. This study explores the effects of VSS on symptoms and QOL in IIH patients with a CSF leak. METHODS: This is a retrospective study on patients who have IIH complicated by a CSF leak and underwent VSS. A QOL questionnaire was developed from the migraine disability assessment test and the PROMIS-PI was given to patients included in this study. RESULTS: Ten patients were included in this study. Nine patients underwent endoscopic closure of CSF prior to stent placement and one patient was treated with VSS only. There was no evidence of CSF leak recurrence in this population following VSS. Headaches improved in 5/8, tinnitus in 5/6, and visual disturbance in 4/5 patients. Diamox was discontinued in 7 out of 8 patients after VSS. There was an improvement in headache (p=0.0140) specific questions and overall QOL (p=0.0061) on the QOL questionnaire. DISCUSSION: This preliminary study demonstrates that VSS is effective in alleviating many symptoms in IIH patients with a CSF leak, especially headaches. Diamox may be able to be discontinued in many patients following VSS. No CSF leak recurrence was noted in this patient population.

A systematic review of surgical and interventional radiology procedures for pediatric idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is defined as elevated intracranial pressure and consequent symptoms (mainly headache and visual deterioration) occurring in the absence of secondary causes. Surgical and interventional radiology procedures should be considered for refractory IIH and mainly include cerebrospinal fluid (CSF) diversion techniques, optic nerve sheath fenestration (ONSF), and venous sinus stenting (VSS). Our study aims to review the current literature on the application of these techniques in clinical practice. A systematic literature review on the surgical and interventional radiology treatment of IIH was conducted, focusing on ONSF, VSS, and CSF diversion techniques. According to PRISMA guidelines, all reports published in PubMed in the last 30 years (1993-2023) were considered, and among 722 papers, 48 were included in the present study, resulting in a total study population of 454 children or adolescents (11 months-17 years old). Among 454 patients, 193 underwent an invasive approach, divided into CSF diversion (115/193), ONSF (65/193), VSS (11/193), cranial subtemporal decompression (8/193), and internal cranial expansion (9/193). Sixteen of the 193 patients (8%) required reintervention due to relapsing symptoms or surgical complications, particularly those who underwent CSF diversion. Furthermore, 9/115 required shunt revision due to shunt obstruction or malfunction. We extracted data on the outcome of each procedure: of the 193 patients, 71 experienced a positive outcome with symptom resolution or improvement, while 27 demonstrated a negative outcome. Severe and refractory cases of IIH are eligible for invasive treatments. CSF diversion is the most frequently used technique, despite its high failure risk and need for reintervention. ONSF has shown good results in terms of outcome and safety, particularly in children with visual symptoms. VSS is the most recent approach, indicated in children with stenosis of the venous sinus. In our study population, VSS demonstrated good results in terms of symptom resolution and need for reintervention, but its use remains limited to a few centers. https://www.crd.york.ac.uk/, PROSPERO (CRD42024504244).

Idiopathic Intracranial Hypertension Induced Cervical Syringomyelia and Cerebellar Tonsillar Ectopia Reversed With Venous Sinus Stenting.

Idiopathic Intracranial Hypertension Induced Cervical Syringomyelia and Cerebellar Tonsillar Ectopia Reversed With Venous Sinus Stenting.

The use of balloon guide catheters during venous sinus stenting: A case series.

Venous sinus stenting (VSS) is a safe and effective treatment strategy for pulsatile tinnitus (PT) and idiopathic intracranial hypertension (IIH). Although complications are rare, the morbidity associated with the complications is high. Navigating through the venous sinuses poses unique challenges to the interventionalist. There is limited literature regarding device selection to maximize safety and efficiency. We report on the safety and advantages of using a balloon guide catheter (BGC) for venous access in VSS. Retrospective analysis of all patients undergoing VSS using a BGC over a three-month period. A total of 22 patients were included in the analysis (median age 35; 21 female). The indication for treatment was PT in 10 patients and IIH in 12 patients. The BGC was navigated into the sigmoid and transverse sinuses, enabling successful delivery of the stent in all cases. The BGC balloon was inflated 23 times for navigating past tortuosity or obstructions, and for anchoring. There were no intraprocedural complications. The use of BGC in VSS is safe and feasible. BGCs have features that can be utilized to overcome the unique challenges encountered during VSS.

Adjunctive venous sinus stenting in transvenous embolization of vein of Galen malformations.

Vein of Galen malformations are congenital arteriovenous malformations primarily treated by endovascular embolization via transarterial or transvenous approaches. transvenous embolization can be utilized to close the malformation but may be difficult in patients with venous stenosis or blockages, which drive venous hypertension and lead to significant neurologic consequences. Here, we illustrate the atypical placement of an intracranial venous sinus stent to improve outflow after transvenous embolization in pediatric patients with the vein of Galen malformation. A retrospective review of clinical databases at two high-volume endovascular centers from January 2018 to March 2023 identified all vein of Galen malformation patients who received a venous sinus stent during transvenous embolization. Clinical data, imaging, angioarchitecture, operative details, postoperative management, and follow-up were reviewed. Three patients presented for transvenous embolization after multiple staged transarterial embolizations of their vein of Galen malformation. Transvenous access was complicated by lateral sinus stenosis, which was temporarily relieved by balloon angioplasty. After transvenous embolization by pressure cooker technique, the dural sinuses were stented using the existing venous guide catheter. Venous angiography demonstrated improved flow across the stenosed areas and post-embolization angiography demonstrated normalized venous drainage with widely patent stents. One patient experienced postoperative oculomotor nerve palsy unrelated to the stent placement. All patients demonstrated a complete cure of their vein of Galen malformations with patent venous sinus stents on follow-up. In patients with the vein of Galen malformation and venous hypertension receiving transvenous embolization, venous sinus stenting may be a safe and effective option to reduce aberrant cortical venous drainage and improve normal outflow. Further studies are warranted to investigate its benefit in high-flow vascular malformations.

The correlation between intracranial pressure and venous sinus pressures changes after venous sinus stenting

BackgroundThe pathophysiology of idiopathic intracranial hypertension (IIH) and other cerebral venous outflow disorders (CVD) has largely been unexplored. While a correlation between venous sinus pressure and opening pressure (OP) has...

Analysis of cerebral venous sinus stenosis by flat panel angiographic CT (FP-CT) to guide treatment for idiopathic intracranial hypertension.

Cerebral venous sinus stenting (CVSS) is an effective treatment for idiopathic intracranial hypertension (IIH) secondary to dural venous sinus stenosis. Traditional selection of patients for CVSS has been made by microcatheter manometry, but pressure measurements are often equivocal. Here we present the results of a series of cases in which venous flat-panel CT (FP-CT) was used as an adjunct to microcatheter manometry to improve decision making and precise stent placement during CVSS. Ten consecutive patients with IIH underwent angiography with microcatheter manometry and venous FP-CT, with CVSS if indicated by the results. Cross-sectional measurements of the narrowed sinus were obtained on FP-CT before and after stenting. After the procedure, clinical outcomes were tracked. Follow-up with quantitative MRA with sinus flow measurements was also performed, when available. There was an exponential correlation between measured pressure gradient and degree of stenosis calculated using venous FP-CT. All patients with both a high degree of stenosis measured by FP-CT and a high pressure gradient across the stenosis showed a clinical benefit from stenting. True measurement of the cross-sectional area of the dural sinus, made by venous phase FP-CT, has a high degree of correlation with elevated venous pressure gradient across the point of stenosis. Even in a limited series of cases, we found an exponential decrease in flow with increasing severity of stenosis. Furthermore, patients with both an elevated venous pressure gradient and critical stenosis of the sinus on FP-CT showed symptomatic improvement after stenting.

Venous sinus stenting versus ventriculoperitoneal shunting: comparing clinical outcomes for idiopathic intracranial hypertension

BackgroundVenous sinus stenting (VSS) has been shown to reduce intracranial venous pressures and improve symptoms in patients with idiopathic intracranial hypertension (IIH). However, long-term follow-up data are limited, raising concerns...

Reconstructive treatment using stent placement for type IIa+b lateral sinus dural arteriovenous fistulas complicated with sinus occlusion

BackgroundCognard type IIa+b dural arteriovenous fistulas (DAVFs) in the lateral sinuses are often complicated with venous sinus obstruction and accompanied by clinical symptoms and a risk of hemorrhage. The purpose of this study was to assess venous sinus stenting as a viable alternative treatment in complex lateral sinus DAVFs and examine its efficacy and safety. MethodsWe retrospectively examined patients diagnosed with type IIa+b DAVF in the transverse or sigmoid sinus with associated venous sinus occlusion who were treated via stent placement between April 2017 and June 2019. ResultsSix patients were included in this study. Three patients had DAVFs in both the transverse and sigmoid sinuses, two in the transverse sinus and confluence of sinuses, and one in the transverse sinus. The most common symptoms were headache, dizziness, and limb weakness. At the last follow-up, three patients had significant improvement, and three were asymptomatic. Angiograms performed immediately after the surgery showed restoration of the anterograde venous drainage in all patients. According to the follow-up angiography results, two DAVFs were completely obliterated, and four remained as stable type I DAVFs. Most patients had satisfactory venous sinus drainage, except one who had in-stent stenosis. ConclusionsStent placement can restore sinus patency, improve clinical symptoms, and decrease intracranial hemorrhage risk. This approach may be an effective option for treating type IIa+b lateral DAVFs complicated by sinus occlusion.

Outcomes of Pulsatile Tinnitus After Cerebral Venous Sinus Stenting: Systematic Review and Pooled Analysis of 616 Patients

Pulsatile tinnitus (PT) is a debilitating condition with substantial morbidity related to quality of life. Cerebral venous sinus stenosis has recently emerged as a noninfrequent cause of PT, either in the setting of concurrent idiopathic intracranial hypertension (IIH) or due to primary venous stenosis. Venous sinus stenting (VSS) is an endovascular technique that can be used to treat venous stenosis. However, it is unclear if outcomes are different between patients with primary venogenic PT and IIH associated PT. A systematic literature review and pooled analysis was completed to evaluate the clinical outcomes of PT in patients undergoing cerebral VSS. Outcome measures included: Improved PT, complete resolution of PT, and PT recurrence at follow-up. Subgroup analysis between patients with IIH and primary PT was completed. In total, 28 studies were identified with 616 patients. The proportion of improved PT symptoms after VSS had an overall pooled rate of 91.7% (confidence interval [CI]:88.1%-95.2%; I2= 65%) and no difference between subgroups (P= 0.12). Complete resolution after VSS had an overall pooled rate of 88.6% (CI: 84.0%-93.3%; I2= 68%) and no significant difference between subgroups (P= 0.35). Recurrent PT after stenting occurred in 6.5% of cases (CI: 1.7%-11.3%; I2= 62%). Furthermore, subgroup analysis demonstrated that IIH patients had a significantly higher recurrence rate (10.6%; CI: 5.2%-16.1%; I2= 26%) compared to patients treated with venous stenting for PT as the primary indication (2.0%; CI: 0.8%-4.7%; I2= 0%) (P < 0.0001). Venous stenting in patients with PT results in a substantial decrease and often complete resolution of symptoms. PT is more likely to recur in patients with IIH-associated PT.

Venous sinus stenting under conscious sedation

BackgroundVenous sinus stenting (VSS) is an increasingly performed procedure for the treatment of idiopathic intracranial hypertension (IIH) refractory to medical treatment. VSS is typically performed under general anesthesia.ObjectiveTo present our...

Treatment of tumor-induced cerebral venous sinus stenosis: Technical note and review of the literature.

Tumors that invade or compress the venous sinuses have the potential to impair venous drainage. Rarely, this may be so severe as to induce intracranial hypertension. Other studies have previously described venous sinus stenting (VSS) for the treatment of these symptomatic lesions. In this report, we present our series of eight cases of VSS for symptomatic tumor-induced venous sinus stenosis and review the existing literature. Eight patients with mostly intracranial tumors were found to have symptomatic venous sinus stenosis with the most common presenting symptom being elevated intracranial pressure. Six of the eight (75%) patients presented with papilledema on neuro-ophthalmological exam. The most affected locations were the transverse and sigmoid sinuses in four patients, followed by the superior sagittal sinus in three patients. All eight patients underwent VSS with no adverse events. In total, 6 out of 8 (75%) of patients had complete resolution of their symptoms, while the remaining patients experienced at least partial improvement. Tumors that cause symptomatic venous sinus stenosis may be successfully managed with VSS to improve venous drainage. This may facilitate continued conservative management of meningiomas or allow for treatment with noninvasive means, such as stereotactic radiosurgery. Depending on the size of the target stenosis, balloon-mounted coronary stents may be a suitable option to treat these lesions.

What should otolaryngologists know about dural venous sinus stenting?

Dural venous sinus stenting is an emerging and exciting area in otolaryngology in collaboration with neurosurgeons and neuroradiologists. The first cases were reported 20 years ago. It is now considered part of the routine treatment of increased intracranial pressure due to transverse sinus stenosis. ENT doctors are the first to see these patients in their clinics, as sinus headaches, pulsating tinnitus, and dizziness are the most common symptoms. Previously, with limited success, high-dose diuretics and intracranial shunts had been the only options for treating these patients. Other methods, such as covering the sigmoid sinuses with graft material, appear to cause a sudden increase in intracranial pressure that can lead to blindness and even death. This overview summarizes the clinical and imaging characteristics of patients who will benefit from endovascular sinus stenting for elevated intracranial pressure.

Dural venous sinus angioplasty and stenting for treatment of idiopathic intracranial hypertension: a single-center experience with 20 consecutive cases

Background: Dural venous sinus stenosis has been shown to be a potential cause or aggravating factor of idiopathic intracranial hypertension (IIH). Endovascular therapy for angioplasty of venous sinus stenosis is emerging as a potential alternative to treat IIH. Objective: This article aims to present the results of a cases series representing the experience of a single center in treating this disease. Materials and Methods: We retrospectively reviewed the angiographic and manometric data of patients undergoing angioplasty and stenting for the treatment of IIH with venous sinus stenosis on magnetic resonance angiography. All patients had failed conventional medical treatment. Data on demographic features, clinical and radiologic presentation, and outcomes were collected retrospectively. Results: 20 female patients, with persistent headache and papilledema, underwent venous sinus angioplasty and stenting. Mean age was 35.9 (SD, 10) years. Eighteen patients (90%) had clinical improvement after the procedure. Of these, all showed resolution (17 patients, 94%) or partial improvement (1 patient, 6%) of papilledema within 6 months. Two patients had persistent moderate-to-severe headache (intensity &gt; 6 on a 10-point pain scale), with continued papilledema despite stable visual acuity on visual field testing. The mean pre-procedure lumbar puncture opening pressure was 30.1 (SD, 4) mm Hg, decreasing to 16.2 (SD, 4) mm Hg after the procedure. Only 4 patients experienced complications directly or indirectly related to the procedure, with no impact on outcome. Conclusion: Angioplasty and stenting of the stenotic segment may effectively and safely treat IIH associated with focal venous sinus stenosis, with a high technical success rate and an acceptable complication rate.

Clinical Characteristics of Patients With Idiopathic Intracranial Hypertension in China.

Introduction Idiopathic intracranial hypertension (IIH) was previously assumed to be rare in Asia. However, it has been increasingly recognized in China in recent years, likely due to pandemic obesity and greater awareness of the condition. The clinical characteristics of IIH in Chinese patients remain unexplored. This study aims to investigate the clinical characteristics of patients with IIH in China. Methods A retrospective chart review of patients diagnosed with IIH at the First Affiliated Hospital of Zhengzhou University was conducted from January 2013 to July 2021.The analysis included demographic data, presenting symptoms, comorbidities, imaging features, laboratory data, intracranial pressure (ICP), treatment modalities, and outcomes. Results The study recruited 199 participants, including 145 females and 54 males, with a mean age at onset of 36 years (range: 27 to 45 years). The participants had a mean body mass index (BMI) of 26 kg/m2 (range: 23.4 to 29.4 kg/m2). Obesity was found in 67 participants (33.7%). The most common clinical symptom reported was headache, which was experienced by 118 (59.3%) participants, followed by decreased vision, which was reported by 115 (57.8%) participants. The main comorbidity among women was anemia (54, 37.2%), while men were more likely to have severe sleep apnea (7, 13%). The most common imaging features were perioptic nerve sheath distension (159, 79.9%) and transverse sinus stenosis (147, 73.9%). Symptoms were relieved with medication in 117 (58.8%) participants, while 72 (36.2%) underwent surgeries such as venous sinus stenting and ventriculoperitoneal shunt. During follow-up, symptoms resolved in 84 (42.2%) participants, while 115 (57.8%) participants experienced symptom improvement. The ratio of decreased vision was higher in females than in males. Conclusion The results provide valuable insights into the clinical features of IIH in this region. China appears to have a lower incidence of obesity compared to Western countries. Among comorbidities related to IIH, anemia and severe sleep apnea were the most common. A significant number of IIH patients underwent surgery. It was found that women had worse visual outcomes compared to men. Further investigation is needed to determine the most effective treatment for IIH in a larger cohort of Chinese patients.

Intracranial venous manometry in patients with idiopathic intracranial hypertension

Objective ‒ to analyse the results of cerebral angiography and venography with venous manometry in patients with medically refractory sdiopathic intracranial hypertension (IIH) and venous sinus stenosis.Materials and methods. Informed consent was obtained from each patient (parent or guardian) enrolled in the study and the study protocol conforms to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the Institutional Ethical Review Board (Institution's Human Research Committee). A retrospective analysis of the clinical and neuroimaging features of 9 patients with suspected IIH was performed. All patinets were treated at the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» from January 2022 to January 2024. The criteria for inclusion in the study were: clinical symptoms of IIH without any other intracranial pathology according to imaging, lumbar pressure &gt;20 cm H2O, and symptoms refractory to medication treatment (optic disc edema, pulsatile tinnitus, etc.). Pressure gradients in contiguous sites were calculated for each patient in standard anatomical sites (superior sagittal sinus ‒ sinus drain, sinus drain ‒ transverse sinus, transverse sinus ‒ sigmoid sinus, sigmoid sinus ‒ internal jugular vein). The adjacent anatomical gradients were defined as the difference between the mean venous sinus pressure measurements in the venous sinuses where the manometry was performed. Pathological pressure gradients in the venous sinuses were defined as pressure gradients &gt;8 mm Hg based on established guidelines. Results. Out of the 9 patients with suspected IIH treated at the clinic, 2 patients were excluded. One female with combination of thrombosis in posterior third of superior sagittal sinus with left transverse sinus stenosis, the second (male) with bilateral jugular vein occlusions. Of the 7 patients (4 women and 3 men) with a mean age of 39.7 years, 4 (57.1 %) had pressure gradients &gt;8 mm Hg (transverse sine ‒ sigmoidal sine) and underwent sinus stenting. All procedures were successful. After stent implantation, control manometry was performed, which showed the gradient decreasing to 0‒2 mm Hg at the level of stenosis. The control examination after stenting was performed in all patients and showed regression of general cerebral symptoms, as well as varying degrees of ocular improvement. Conclusions. Our study evaluated the degree of pressure reduction in the anatomical sites of the cerebral venous system and showed a progressive decrease in pressure from the sigmoid sinus to the jugular vein. The venous sinus stenting leads to elimination of the pressure gradient, as well as neurological and ophthalmic improvement in carefully selected patients with refractory to conservative therapy IIH with a transstenotic pressure gradient &gt;8 mm Hg.

Novel Approaches to the Treatment of Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) typically affects women of childbearing age, is associated with recent weight gain, and can result in debilitating headache as well as papilledema that can cause vision loss. There have been advances in the medical and surgical treatment of affected patients with IIH that can improve outcomes and tolerability of therapy. Medical treatment with agents that lower intracranial pressure through pathways other than carbonic anhydrase inhibition are being developed, and medically-directed weight loss as well as bariatric surgery now may be considered as primary therapy. New surgical options including venous sinus stenting have shown efficacy even with cases of severe vision loss. Our treatment options for IIH patients are becoming more diverse, and individualized treatment decisions are now possible to address specific components of the patient's disease manifestations and to lead to IIH remission.

Pulsatile Tinnitus: Differential Diagnosis and Approach to Management.

The purpose of this review is to provide an updated approach to the evaluation and management of pulsatile tinnitus (PT), an uncommon but often treatable subtype of tinnitus. Secondary PT can be due to either vascular or non-vascular etiologies, including, but not limited to: neoplasm, arteriovenous malformation or fistula, idiopathic intracranial hypertension, dural venous sinus stenosis, otoacoustic etiologies (e.g., otosclerosis, patulous eustachian tube) and bony defects (e.g., superior semicircular canal dehiscence). Computed tomography (CT) and magnetic resonance imaging (MRI) imaging have comparable diagnostic yield, though each may be more sensitive to specific etiologies. If initial vascular imaging is negative and a vascular etiology is strongly suspected, digital subtraction angiography (DSA) may further aid in the diagnosis. Many vascular etiologies of PT can be managed endovascularly, often leading to PT improvement or resolution. Notably, venous sinus stenting is an emerging therapy for PT secondary to idiopathic intracranial hypertension with venous sinus stenosis. Careful history and physical exam can help establish the differential diagnosis for PT and guide subsequent evaluation and management. Additional studies on the efficacy and long-term outcome of venous sinus stenting for venous stenosis are warranted.

Endovascular stenting using a sagittal sinus approach for sigmoid sinus wall dehiscence related to intractable pulsatile tinnitus: a case series

BackgroundSigmoid sinus wall dehiscence can lead to pulsatile tinnitus with a significant decrease in quality of life, occasionally leading to psychiatric disorders. Several surgical and endovascular procedures have been described for resolving dehiscence. Within endovascular procedures, the sagittal sinus approach could be a technical alternative for tracking and accurate stent positioning within the sigmoid sinus when the jugular bulb anatomy is unfavorable.Case presentationA retrospective case series of three patients with pulsatile tinnitus due to sigmoid sinus wall dehiscence without intracranial hypertension was reviewed from January 2018 to January 2022. From the participants enrolled, the median age was 50.3 years (range 43–63), with 67% self-identifying as female and 33% as male. They self-identified as Hispanic. Sigmoid sinus dehiscence was diagnosed using angiotomography, and contralateral transverse sinus stenosis was observed in all patients. Patients underwent surgery via a navigated endovascular sagittal sinus approach for sigmoid sinus stenting. No neurological complications were associated with the procedure. Pulsatile tinnitus improved after the procedure in all patients.ConclusionsSuperior sagittal sinus resection for sigmoid sinus wall stenting is a safe and effective technique. Pulsatile tinnitus due to sigmoid sinus wall dehiscence could be treated using the endovascular resurfacing stenting technique. However, further research is needed to evaluate the potential benefit of contralateral stenting for removing sinus dehiscence when venous stenosis is detected. However, resurfacing sigmoid sinus wall dehiscence results in symptomatic improvement.