Bone Regrowth Observed After Transverse Sinus Stenting in Pulsatile Tinnitus Patients

Background Sigmoid plate dehiscence (SPD) is a common finding in patients with pulsatile tinnitus (PT). The etiopathogenesis of SPD and its relationship with other cerebral venous anomalies is controversial. However, increasing evidence suggests SPD may be due to hemodynamic changes caused by the upstream transverse sinus stenosis (TSS). We sought to assess the evolution of SPD following transverse sinus stenting in patients with PT and SPD. Methods We conducted a retrospective cohort study of consecutive patients who underwent unilateral transvenous endovascular treatment for PT with venous sinus stenosis at a large academic medical center, had sigmoid plate dehiscence at baseline, and had CT imaging performed both before and after intervention. Clinical, procedural, and radiographic data were abstracted from the electronic medical record. Qualitative assessment of sigmoid plate thickness was based upon review of CT images before and after intervention. Results Between 2020 and 2024, 15 patients met inclusion criteria. All patients were female and the median age was 42.0 years [IQR 34.0‐47.0]. Bilateral sigmoid plate dehiscence was most common (8/15, 53.3%) followed by unilateral right (5/15, 33.3%) then unilateral left (2/15, 13.3%). TSS was present in all patients. All patients experienced complete resolution of PT following intervention. Bone regrowth of the sigmoid plate was noted in 66.7% (10/15) of patients. Among patients who experienced regrowth, the regrowth occurred ipsilateral to the intervention in 80.0% (8/10), contralateral to the intervention in 10.0% (1/10), and bilaterally in 10.0% (1/10). Conclusion Regrowth of sigmoid plate bone was observed in the majority of patients following endovascular treatment of PT. This demonstration that SPD is reversible following endovascular treatment suggests the presence of SPD may not be a surgical indication. image Figure. Sigmoid Plate Dehiscence and Bone Regrowth. Baseline (A) and post‐procedural (B) CT images demonstrating sigmoid plate bone regrowth.