Promising surgical technique for pulsatile tinnitus caused by sigmoid sinus dehiscence?
Reviewed by Sangeeta Maini and Bhaskar Ram

Pulsatile tinnitus (PT) can be caused by sigmoid sinus dehiscence (SSD). The authors report the results of 17 patients who underwent sandwich surgical technique for sigmoid sinus (SS) wall reconstruction for the treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum or dehiscence over a five-year period. Transmastoid reconstruction of the SSD was performed without obliterating the sigmoid sinus. The aim of this method is to eliminate vascular turbulence and decrease transmission of vibrations through the mastoid air cells. The surgery involved a postauricular incision and a posteriorly based periosteal flap to expose the mastoid cortex. After simple mastoidectomy was performed, the SS diverticulum was identified and, along with a small circumferential area of normal sinus, was skeletonised. The surgical technique used for the SS reconstruction surgery involved three layers: temporalis fascia between the dura of the diverticulum of the SS and its bony wall; extraluminal placement of bone wax; and finally a posteriorly based periosteal flap. The skin was then closed, and a compressive mastoid dressing was applied. The mean follow-up time was 25 months (a range of 8-55 months) and 100% success rate was achieved in all patients, with an average 25-month follow-up period. Though the technique seems promising, long-term benefits with larger numbers is awaited. The placebo benefit of surgery cannot be excluded.

Sandwich technique for sigmoid sinus wall reconstruction for treatment of pulsatile tinnitus caused by sigmoid sinus diverticulum/dehiscence.
Sun J, Sun J.
ACTA OTO-LARYNGOLOGICA
2019;139(12):1063-6.