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Persistent occipital sinus with absent/ hypoplastic bilateral transverse sinus is an extremely rare finding in adults; less than 10 cases have been reported. We present a case of a 28-year-old male who was brought to the emergency department in a post-ictal state associated with blurring of vision and 1 vomiting episode. Magnetic resonance imaging (MRI) with angiography and venography of the brain was advised, and the brain parenchyma was found to be anatomically normal. Incidental findings of the persistent occipital sinus with absent/ hypoplastic bilateral transverse sinus were made using venography imaging of the brain. This is a type of fetal presentation of venous blood flow. It is paramount to neurosurgeons because a prominent occipital sinus with an absent bilateral transverse sinus might change the surgical approach for the posterior fossa lesions.

Objective: The occipital sinus (OS) has many variations. It is unknown whether OS can change the angioarchitecture of torcular Herophili. Therefore, we performed magnetic resonance venography (MRV) in a cohort of Han Chinese individuals to determine whether OS can change the angioarchitecture of torcular Herophili. Methods: Participants were divided into a normal OS group and a hyperplastic OS group. Parameters of the OS and torcular Herophili and its neighboring structures were recorded. Statistical analysis was used to determine the effects of OS on torcular Herophili and neighboring structures. Results: One hundred forty-five healthy participants were enrolled. One hundred patients were in the normal OS group, and 45 were in the hyperplastic OS group. In the normal OS group, the diameters at the transverse sinus (TS) origin were 5.8 ± 2.3 mm on the left side and 7.5 ± 2.2 mm on the right side. In the hyperplastic OS group, the diameters at the TS origin were 6.0 ± 2.1 mm on the left side and 7.0 ± 2.7 mm on the right side. Fenestration was observed in 33% of the torculars in the normal OS group and 6.7% of the torculars in the hyperplastic group. An unpaired t-test revealed a significant difference between bilateral TSs in the normal OS group (P

Pulsatile tinnitus (PT) caused by enlarged oblique occipital sinus (OOS) and resultant diverticulum/dehiscence of the sigmoid-jugular wall has not been described in previous literature. This study recruits one case of PT induced by ipsilateral enlarged OOS and sigmoid-jugular wall diverticulum (case 1) alongside one case of PT induced by ipsilateral enlarged OOS and sigmoid-jugular wall dehiscence (case 2). Various radiologic and computational techniques including computed tomography (CT), magnetic resonance (MR) imaging, Doppler ultrasound, and computational fluid dynamics (CFD) simulation were implemented. Transmastoid sinus wall reconstruction was performed on case 1 with a large sigmoid-jugular diverticulum potentially traumatizing the facial nerve canal. Contrast-enhanced CT or MR venogram images coupling with three-dimensional reconstructed are advantageous in revealing the covert route of OOS that runs under the cerebellum and drains directly into jugular bulb (JB) region. PT in case 1 was successfully eliminated after transmastoid sinus wall reconstruction surgery. Tinnitus handicap inventory score in case 1 reduced from 70 to 0. The ipsilateral jugular outflow mean velocity (Vmn) and flow volume (FVOL) were 42.5 cm/s and 25.9 g/s (case 1 prior to surgery) and 56.6 cm/s and 41.2 g/s (case 2), respectively. Based on CFD simulation, the peak flow velocity in OOS was 1.85 m/s and 2.1 m/s, the wall pressure of the diverticular dome and dehiscence area of the SS-JB wall was 1724.7 Pa and 369.8 Pa in case 1 and 2, respectively. Enlarged OOS caries greater flow kinetic energy that possibly induces sigmoid-jugular wall diverticulum/dehiscence; transmastoid surgical method is safe and therapeutically effective against PT induced by enlarged OOS.