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Novel grading system of sigmoid sinus dehiscence for radiologic evaluation of pulsatile tinnitus

  • Shelby Willis
    Affiliations
    Department of Head & Neck Surgery, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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  • Courtney Duong
    Affiliations
    Department of Neurosurgery, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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  • Isaac Yang
    Affiliations
    Department of Head & Neck Surgery, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States

    Department of Neurosurgery, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States

    Department of Radiation Oncology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States

    Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States

    Department of Neurosurgery, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States

    Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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  • Quinton Gopen
    Correspondence
    Corresponding author at: Department of Head and Neck Surgery, 200 UCLA Medical Plaza, Suite 550, Los Angeles, CA 90095, United States.
    Affiliations
    Department of Head & Neck Surgery, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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      Highlights

      • Novel grading system for sigmoid sinus dehiscence based on size and location.
      • Sigmoid sinus dehiscence up to 7.5 mm may be a normal variant in asymptomatic patients.
      • Sigmoid sinus dehiscence found on CT scan in 34% of asymptomatic cohort.

      Abstract

      Background

      Sigmoid sinus dehiscence (SSD) is an important etiology of pulsatile tinnitus (PT) though there is currently no consensus on the prevalence of SSD in non-PT populations. This study establishes a grading system of SSD and analyzes a non-PT cohort for prevalence of SSD.

      Methods

      In this retrospective study temporal bone CT scans of 91 patients without PT were analyzed for SSD. The dehiscence was divided into three grades: Grade 1 indicating a micro dehiscence of <3.5 mm with an opening to the mastoid air cells, Grade 2 indicating a major dehiscence of >3.5 mm with an opening to the mastoid air cells, and Grade 3 indicating a sigmoid sinus wall dehiscence opening directly to the underlying tissue.

      Results

      In patients without PT, SSD occurred in 34% of the cohort. Of these, 75% were Grade 1 and 25% were Grade 2. The range of dehiscence measurements for Grade 1 dehiscences was 0.9–3.4 mm. The range of dehiscence measurements for Grade 2 was 4–7.5 mm. There were no cases of Grade 3 dehiscence among this cohort.

      Conclusions

      SSD occurred in over a third of our non-symptomatic cohort. While all grades of SSD may currently be treated surgically, a large portion of non-PT patients may have these sigmoid sinus anomalies asymptomatically. This grading system allows for the standardization of SSD definition and severity in future studies. Grade 3 dehiscences were completely absent in this cohort of non-PT patients.

      Keywords

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