Treatment of Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus

Objective To describe the clinical picture and treatment of dural arteriovenous fistulas (DAVFs) presenting as pulsatile subjective tinnitus. Study design Review of prospectively collected data. Setting Academic referral center. Patients Fourteen patients with clinically and radiographically diagnosed DAVFs. Interventions Treated by endovascular route. Main outcome measures Treatments, clinical course, complications, and evolution were evaluated. Results All patients presented with sleep-disruptive pulsatile tinnitus. Other symptoms included severe headaches, papilledema, proptosis, blepharoptosis, visual disturbances, and hemiparesis. Cortical venous drainage was present in 4 cases. Endovascular treatment was performed at least once by the arterial route in 14 patients and the venous route in 4 patients. The origin of tinnitus was always a vessel in or above the petrous bone. When these arteries or veins could not be visualized in the final control, the tinnitus disappeared. In the patients whose tinnitus returned, a vessel in the petrous bone could always be seen. There was no mortality. Conclusion Endovascular treatment is an effective and safe treatment of DAVFs presenting as tinnitus.