Article Figures & Data
Figures
- Fig 1.
CT features of sigmoid wall anomalies. A, Axial CT image of the temporal bone demonstrates dehiscence of the left sigmoid sinus wall (arrow). B, Axial CT image of the temporal bone in a different patient demonstrates a small left sigmoid sinus diverticulum (arrow). Both patients presented with left pulse synchronous tinnitus.
- Fig 2.
Intraoperative findings in sigmoid sinus wall repair. A, Appearance of a right sigmoid sinus diverticulum during transmastoid surgery. Dashed lines show the outline of a normal sigmoid sinus; the oval indicates a diverticulum. B, Postreduction of diverticulum. C, Postrepair of a sinus wall. Note the soft-tissue graft reinforcing the wall of the sigmoid sinus. Following this step, the bone defect is repaired with synthetic bone cement (HydroSet) and autologous bone pate. In all images, the left of the figure corresponds to the back of the patient (posterior head).
- Fig 3.
Postoperative CT imaging. Axial CT image of the temporal bone in a soft-tissue window (A) demonstrates relatively hypoattenuated material (arrow) lateral to the contrast-enhanced sigmoid sinus representing soft tissue graft. B, On bone window (different patient), HydroSet is identified as sharply demarcated attenuated material (asterisk) conforming to the size and shape of the dehiscence. Bone pate is identified lateral to the HydroSet as amorphous ill-defined hyperattenuation (arrow).
- Fig 4.
Postoperative MR imaging. Axial T2- (A), precontrast T1- (B), and postcontrast T1-weighted (C) images demonstrate a temporalis fascia graft (arrow) between the sigmoid sinus and the reconstructed sigmoid sinus wall. The graft demonstrates intermediate-to-high signal on both T1- and T2-weighted images and contrast enhancement. These images were obtained 28 days following surgery.
- Fig 5.
Mass effect on the sigmoid sinus following sigmoid sinus wall repair. A 46-year-old woman status post right diverticulum repair. Images were obtained 1 day following surgery. Postcontrast axial CT image (A) demonstrates significant mass effect caused by the soft-tissue graft (arrow), resulting in severe narrowing of the sigmoid sinus. Axial T2 (B) and postcontrast T1-weighted (C) images. The graft is intermediate-to-high signal on T2-weighted images. Note the lack of enhancement of the graft in the immediate postoperative period. The soft-tissue material, unlike thrombus, is not hypointense on the susceptibility-weighted image (D).
- Fig 6.
Transverse sinus thrombosis following SSWR. Images were obtained 11 days following surgery after the patient reported severe headaches. Noncontrast axial CT (A) demonstrates hyperattenuation (arrow) within the right transverse sinus. On postcontrast T1-weighted MR imaging (B), there is a filling defect (arrow) within the right transverse sinus, which is hypointense on the gradient-echo image (C). Note the presence of a soft-tissue graft lateral to the sigmoid sinus (arrowhead), which demonstrates no susceptibility. Maximum-intensity projection reconstruction (D) demonstrates right transverse sinus thrombosis.
Tables
Summary of patient demographics and clinical, imaging, and surgical features
No. Age (yr) Sex Side Indication for SSWR Indication for Postoperative Imaging Mass Effect on SS Dural Venous Sinus Thrombus Other Findings 1 59 F L Dehiscence Persistent tinnitus − − Dehiscent left jugular bulb 2 57 F L Dehiscence Persistent tinnitus +a − 3 41 F R Dehiscence + encephalocele Leak from wound − − Tegmen tympani encephalocele + fluid collection 4 62 F L Dehiscence Headache + visual changes − − 5 31 F R>L Diverticulum L tinnitus − − L dehiscence 6 37 F L Dehiscence Headache + neck pain + − 7 38 F R Diverticulum Headache − + 8 14 M R Dehiscence L tinnitus − − L dehiscence 9 21 F R Dehiscence Headache + visual changes − − 10 44 M R Diverticulum Headache − − 11 20 F L Dehiscence Headache +a − 12 46 F R Diverticulum Intraoperative diverticulum rupture + − 13 65 F R Diverticulum Right facial swelling + + Note:—SS indicates sigmoid sinus; R, right; L, left.
↵a CT was initially interpreted as dural sinus thrombosis.
