Rapid Resolution of Pulsatile Tinnitus After Gamma Knife Radiosurgery for Tentorial Meningioma Involving the Transverse Sinus.

Tentorial meningiomas are rare skull base tumors that may cause pulsatile tinnitus when they compress adjacent dural venous sinuses, particularly the transverse sinus. Gamma Knife radiosurgery (GKRS) is an established modality for tumor control, but its role in relieving tinnitus has been infrequently reported. We report a 61-year-old woman with right-sided pulsatile tinnitus caused by a 2-cm tentorial meningioma compressing the right transverse sinus. She underwent GKRS with 13 Gy prescribed to the 50% isodose line, concentrating the 80% isodose volume along the sinus-abutting tumor margin. Her tinnitus resolved completely within one week and remained absent during follow-up. At seven months post-treatment, MRI showed a slight volume decrease (2.81 cm³ to 2.66 cm³), most notable along the sinus interface. The rapid symptom relief despite minimal volumetric change suggests that focused irradiation of sinus-adjacent tumor may alleviate tinnitus by modulating local venous hemodynamics. This case underscores the potential of GKRS to offer early symptomatic improvement in select patients with sinus-involving tentorial meningiomas.