1218. Stent-Assisted Coiling of Symptomatic Dural Sinus Diverticula: A Case Series

Authors: Anthony Alvarado, MD; Michael Abraham, MD (Kansas City, KS)

Introduction: Dural venous sinus diverticula are a rare vascular etiology of pulsatile tinnitus which can be potentially disabling. Multiple endovascular approaches have been suggested in the literature, including stenting, coiling, balloon-assisted coiling, and stent-assisted coiling, with a lack of consensus regarding the optimal treatment approach. Existing literature regarding the endovascular management of dural sinus diverticula exist mainly as single case reports. The authors present a case series illustrating successful use of stent-assisted coiling for endovascular management of symptomatic dural sinus diverticula. Methods: A retrospective chart analysis identified three consecutive patients who presented for evaluation of pulsatile tinnitus from May to September 2016. All three patients were female aging from 19 to 61 years of age. Symptom duration ranged from eight to seventeen months. Cerebral imaging demonstrated dural sinus diverticula in the setting of underlying dural venous sinus stenosis in all patients. Two patients demonstrated right transverse-sigmoid sinus junction diverticula with one patient exhibiting bilateral transverse-sigmoid sinus diverticula. All patients were treated with endovascular stent-assisted coiling with venous stenting performed first followed by trans-stent coil embolization in all cases. Results: All patients reported resolution of pulsatile tinnitus. No perioperative complications were experienced, and all patients were discharged on dual anti-platelet therapy for six-months. At three-month follow-up visits, all patients remained asymptomatic. Follow-up cerebral venography demonstrated regression of the outpouching and resolution of venous sinus stenosis. Conclusion: Dural sinus diverticula are a documented vascular etiology associated with disabling pulsatile tinnitus. Endovascular management techniques have emerged as a promising therapeutic option. Our case series demonstrates successful treatment of four consecutive cases of dural sinus diverticula in three patients with stent-assisted coiling for treatment of pulsatile tinnitus secondary to dural sinus diverticula.