Clinical Presentation and Patient Outcomes Following Endovascular Intervention for Venous Sinus Diverticula: A Single Center Experience.

Background: Venous diverticula are rare neurovascular anomalies consisting of outpouchings in venous sinus walls, occurring with a prevalence of 23% in the sigmoid sinus. However, venous diverticula can develop in the transverse sinus and jugular bulb, as well often with skull base bony dehiscence. Debilitating pulsatile tinnitus can be associated with the presence of venous sinus diverticula warranting open or endovascular treatment. We report our experience with patient presentation and outcomes with successful endovascular treatment modalities for diverticula cure.

Methods: 23 patient cases with confirmed diagnosis of venous sinus diverticula were reviewed. Diverticula characteristics, procedural details, and outcomes were assessed through descriptive and statistical analysis. From this analysis, prevalence of dehiscence, laterality of diverticula, predominant symptoms at presentation, and treatment modalities were determined.

Results: 69.6% (16/23) of patients had a transverse/sigmoid diverticulum and 30.4% (7/23) had a jugular bulb diverticulum. Ipsilateral stenosis was concurrently observed in 30.4% (7/23) of patients. Analysis revealed a higher likelihood 60.9% (14/23) of complete symptom resolution with diverticula located in the sigmoid and transverse sinuses compared to 52.2% (12/23) in the jugular bulb. Additionally, dominance of venous system was associated with a higher likelihood (p=0.0528) of symptomatic diverticula occurring in the dominant venous sinus. Treatment for all diverticula patients involved the use of either Precise (Cordis) stents, Luminexx Biliary stents or Zilver (Cook) stents in combination with detachable coils. 30.4% (7/23) of patients contained venous stenosis and all patients who experienced stenosis had complete symptom resolution following intervention. There were no postoperative complications, and all patients were discharged the following day.

Conclusions: Understanding clinical factors that influence venous diverticula presentation and neuro-interventional response is critical to treating and counseling patients. We present twenty-three cases of venous diverticula, contributing to the growing body of venous diverticulum literature. We conclude that venous diverticula are more likely to occur in dominant venous sinuses and respond well to treatment, particularly when located in the transverse or sigmoid sinuses, especially if accompanied by bony dehiscence or stenosis. Additionally, we identify stent-assisted coiling as a safe and reliable treatment approach for treating symptomatic venous sinus diverticula.