Sigmoid sinus diverticulum

Last revised by Frank Gaillard on 26 Jul 2023

Sigmoid sinus diverticula are venous outpouchings from the sigmoid sinus that intrude into the mastoid bone, which can occur either with an intact but remodeled sigmoid plate or with sigmoid sinus dehiscence.

The prevalence of sigmoid sinus diverticulum or dehiscence is about 1% 1. It is also associated with stenosis of the transverse sigmoid sinus junction stenosis which may, in turn, be associated with idiopathic intracranial hypertension 4.

Many patients are asymptomatic. However, sigmoid sinus diverticulum and dehiscence are among the most common causes of pulsatile tinnitus 1.

The outpouching is most directly demonstrated on MR or CT venography. The remodeling or erosion of the sigmoid plate can be demonstrated on non-contrast-enhanced temporal bone CT.

Endovascular treatment consists of stenting of the sigmoid sinus and coil embolization of the diverticulum 2. Open surgical treatment consists of resurfacing the sigmoid plate and extravascular reduction of the diverticulum by bone wax packing or electrocoagulation 3.

If a sinus stenosis is also present, then stenting of the stenosis may be required 4.

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Cases and figures

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