FLEX January 2024

Systematic Review/Meta-analysis

Otolaryngology– Head and Neck Surgery

Systematic Review of Temporal Bone–Resurfacing Techniques for Pulsatile Tinnitus Associated with Vascular Wall Anomalies

2019, Vol. 160(5) 749–761 American Academy of Otolaryngology–Head and Neck

Surgery Foundation 2019 Reprints and permission:

sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599818823205 http://otojournal.org

George S. Liu 1,2 , Brian C. Boursiquot 2 , Nikolas H. Blevins, MD 1 , and Yona Vaisbuch, MD 1

carotid artery, jugular bulb, sigmoid sinus, surgical technique, hypotympanic approach

No sponsorships or competing interests have been disclosed for this article.

Abstract Objective. To systematically review literature evidence on temporal bone–resurfacing techniques for pulsatile tinnitus (PT) associated with vascular wall anomalies. Data Sources. We searched PubMed, Embase, and the Cochrane Database. The period covered was from 1962 to 2018. Review Methods. We included studies in all languages that reported resurfacing outcomes for patients with PT and radiographic evidence or direct visualization of sigmoid sinus wall anomaly, jugular bulb wall anomaly, or dehiscent or aberrant internal carotid artery. Results. Of 954 citations retrieved in database searches and 5 citations retrieved from reference lists, 20 studies with a total of 141 resurfacing cases involving 138 patients were included. Resurfacing outcomes for arterial sources of PT showed 3 of 5 cases (60%) with complete resolution and 2 (40%) with partial resolution. Jugular bulb sources of PT showed 11 of 14 cases (79%) with complete resolution and 1 (7%) with partial resolution. Sigmoid sinus sources of PT showed 91 of 121 cases (75%) with complete resolution and 12 (10%) with partial resolution. Symptoms occurred more in females and on the right side. Most cases (94%) used hard density materials for resurfacing. Material density did not appear to be associated with resurfacing outcomes. Use of autologous materials was associated with improved outcomes for arterial sources resurfacing. Major complications involving sigmoid sinus thrombosis or compression were reported in 4% of cases without long-term morbidity or mortality. Conclusions. Resurfacing surgery is likely effective and well tolerated for select patients with PT associated with various vascular wall anomalies.

Received September 14, 2018; revised November 20, 2018; accepted December 14, 2018. T innitus is a common problem worldwide, with a pre valence of 15% to 20%, 1,2 and it is pulsatile in approximately 4% of cases. 3 Pulsatile tinnitus (PT) has been associated with major vascular wall anomalies in the temporal bone, affecting the sigmoid sinus, jugular bulb, and internal carotid artery (ICA). Specific associated anomalies include sigmoid sinus dehiscence, 4 sigmoid sinus diverticulum, 5 dehiscent high-riding jugular bulb, 6 jugular bulb diverticulum, 7,8 ICA dehiscence, 9 and ICA aber rancy. 10 Unfortunately, PT can considerably reduce quality of life in a subset of patients and be difficult to manage because of the lack of effective medications for reducing PT symptoms. Treatment of PT is directed toward alleviating the underlying cause. 11 When PT is associated with vascular wall anomaly, surgical treatment options have historically been limited. Attempts at vascular occlusion for treating PT have been associated with considerable morbidity and thus discouraged. 12,13 Resurfacing is an emerging surgical procedure for alle viating vascular PT associated with major vessel wall anom aly or aberrancy. Resurfacing applies layers of autologous or artificial material to insulate an abnormal vessel and restore the bony canal, thereby eliminating or reducing areas of soft tissue vibration. Resurfacing can be combined with nonocclusive measures to reduce the size of diverticula or improve their contour with external packing or

1 Department of Otolaryngology–Head and Neck Surgery, Stanford University, Stanford, California, USA 2 School of Medicine, Stanford University, Stanford, California, USA

Corresponding Author: Yona Vaisbuch, MD, Department of Otolaryngology–Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94305, USA. Email: yona@stanford.edu

Keywords systematic review, pulsatile tinnitus, resurfacing, vascular wall anomaly, hydroxyapatite, dehiscence, diverticulum,