Temporal Bone Remodeling After Transverse Sinus Stenting for Pulsatile Tinnitus: Patterns, Temporal Evolution and Relationship with Clinical Outcome

BACKGROUND AND PURPOSE: Stent placement effectively relieves venous pulsatile tinnitus caused by transverse sinus stenosis with sigmoid sinus wall dehiscence. However, the spectrum of temporal bone remodeling remains poorly characterized. MATERIALS AND METHODS: This retrospective cohort study included consecutive patients who underwent transverse sinus stenting for venous pulsatile tinnitus with ipsilateral sigmoid sinus wall dehiscence, with or without a diverticulum. Clinical outcomes were recorded. Preoperative and postoperative CT were obtained (median follow-up 7 months; 18 patients had serial scans). Bone regeneration (graded as complete, major >50%, minor <50%, or absent) and new dehiscence were evaluated bilaterally. RESULTS: Ipsilateral bone regeneration occurred in 47/50 patients (94.0%): complete in 20.0%, major in 46.0%, minor in 28.0%, and absent in 6.0%. Contralateral bone regeneration was observed in 16/17 patients (94.1%). Among 18 patients with serial postoperative scans, 13 (72.2%) showed progressive regeneration. Follow-up duration correlated positively with regeneration degree (r = 0.51, P < 0.001). New bone dehiscence on the symptomatic side developed in 7 patients (14.0%): 3 adjacent to original sigmoid sinus wall dehiscence, 4 at jugular bulb. Complete resolution was achieved in 9/10 of complete regeneration (90.0%), 22/37 of partial regeneration (59.5%). Recurrence was observed in 5 of 37 patients (13.5%) with partial regeneration; notably, 3 of these 5 recurrences occurred among the 4 patients who had new jugular bulb dehiscence. CONCLUSIONS: Bone remodeling after stenting for venous pulsatile tinnitus is a dynamic, time-dependent process encompassing bilateral temporal bone regeneration and ipsilateral new dehiscence formation and correlates with clinical outcomes.