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Sigmoid sinus diverticulum and dehiscence: Diagnosis and management

Introduction: Sigmoid sinus diverticulum (SSD) is a relatively rare vascular disorder characterized by a dilated sac in the sinus wall protruding into the mastoid cells. It may be associated with SSDe-Sigmoid sinus plate dehiscence (SSDe); however, SSDe can occur in isolation too. SSD may be associated with prediverticular venous sinus stenosis (SS) and commonly presents as pulsatile tinnitus (PT). Aim: This study aims to present a series of patients who were diagnosed and managed for SSD and SSDe and discuss their treatment options. Methods: A retrospective chart review was carried out between January 2016 and August 2018, and all patients presenting with PT and diagnosed with SSD and or SSDe were included in this study. Results: We had six patients who were diagnosed with SSD and SSDe during this time frame. High-resolution computed tomography and magnetic resonance venogram were used for the diagnosis. In addition, cerebral angiogram was done for 2 patients who had prediverticular stenosis of the sinus. Transmastoid decompression and repair of SSD gave excellent relief from tinnitus in one patient. Conclusion: SSD and SSDe are treatable causes of PT. SSD may be associated with a prediverticular venous SS. A prediverticular high-pressure gradient stenosis should be managed before decompression and repair of SSD.