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

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.