Aberrant Sylvian Vein Diverticulum and Tegmen Dehiscence-Induced Venous Pulsatile Tinnitus Phenotype Can Be Treated Via Transtemporal Surgery: A Case Report with 4D-Flow Magnetic Resonance Imaging.

OBJECTIVE

To report the first successful surgical treatment of a rare subtype of venous pulsatile tinnitus (PT) caused by aberrant sylvian vein and tegmen dehiscence (SVTD) with a diverticulum and soft tissue enclosing the middle ear ossicles.

PATIENTS: A 35-year-old female participant presented with more than 10-year left-side PT due to SVTD diverticulum.

INTERVENTIONS: The participant underwent transtemporal surgery with a lateral minimally invasive approach to the epitympanum and aditus ad antrum after finding SVTD and diverticulum.

MAIN OUTCOME MEASURES: Contrast-enhanced CT, various magnetic resonance (MR) techniques, including the 4D-flow MR method, and transcanal recording examinations were utilized. The Tinnitus Handicap Inventory (THI) was employed to quantify the surgical efficacy in treating PT.

RESULTS

PT was successfully resolved following resurfacing of the diverticulum located on the medial wall of the epitympanic space, with the patient achieving a THI score of 0. The 4D-flow MR indicated that the mean and largest velocities at the dehiscence area were 20.8 cm/s and 54.9 cm/s, respectively. The main frequency of PT fluctuated below 750 hz.

CONCLUSION

SVTD diverticulum-induced venous PT can be successfully treated via the transtemporal pathway. Additionally, this finding underscores the importance to carefully examine tegmen dehiscence and the exposed vasculature when managing venous PT.