Pre-operative dural sinus pressure predicts recurrence of sigmoid sinus wall reconstruction for pulsatile tinnitus

BACKGROUND: Sigmoid sinus wall reconstruction (SSWR) for unilateral pulsatile tinnitus (PT) has high initial success but a long-term recurrence rate of 13.5%-31.4%. The role of preoperative dural venous pressure in recurrence remains unclear. OBJECTIVE: To investigate the association between preoperative dural sinus pressure and long-term recurrence after SSWR. METHODS: This retrospective study included 93 patients with unilateral PT diagnosed with sigmoid sinus wall anomalies (SSWAs) with transverse sinus stenosis (TSS) using CT angiography/venography. All underwent preoperative digital subtraction angiography, manometry, and SSWR. During 12 month follow-up, patients were grouped into recurrence (n=31) and non-recurrence (n=62). Pressures were measured in superior sagittal sinus (SSS), transverse sinus (TS) origin, distal/proximal to stenosis, and the trans-stenotic pressure gradient (TPG) was calculated. Univariate and multivariate analyses identified factors independently associated with recurrence. Receiver operating characteristic (ROC) curves assessed predictive performance. RESULTS: TPG, pressures at SSS, TS origin, and distal TSS, and degree of TSS differed significantly between the two groups (P<0.001). Multivariate analysis identified TPG (OR=1.396, P=0.022), SSS pressure (OR=1.997, P=0.049), and degree of TSS (OR=0.010, P=0.030) as factors independently associated with recurrence. The area under the curve was 0.754 for SSS pressure, 0.772 for TPG, 0.779 for the degree of TSS, and 0.836 for their combination. CONCLUSION: Preoperative TPG, SSS pressure, and degree of TSS may be key factors correlated with SSWR recurrence. Patients with PT with SSWAs and more severe venous stenosis may be better treated with venous sinus stenting.