ArticleEuropean radiology2026
Transverse sinus dominance predicts outcome after venous sinus stenting for pulsatile tinnitus.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesVenous sinus stenting (VSS) is highly effective for pulsatile tinnitus (PT), yet up to 20% of patients experience incomplete relief. We aimed to investigate whether transverse sinus dominance could serve as a non-invasive imaging biomarker for clinical risk stratification. MATERIALS AND
methodsPreoperative transverse sinuses were classified into balanced or non-balanced dominance via qualitative visual assessment on CTV/MRV. The primary endpoint was an unfavorable outcome (residual tinnitus, defined as postoperative tinnitus handicap inventory (THI) > 16) at 3-month follow-up. Multivariable analysis utilized Firth's penalized logistic regression to account for zero-event cells.
resultsThis retrospective study included 58 consecutive patients who underwent VSS for unilateral venous PT. Overall, 49 patients (84.5%) achieved a favorable outcome. Transverse sinus dominance was strongly associated with clinical efficacy: all 9 unfavorable outcomes occurred in patients with non-balanced dominance (9/38, 23.7%), whereas balanced dominance yielded a 0% unfavorable outcomes (0/20) (Absolute Risk Difference: 23.7%; p = 0.021). Following adjustment, non-balanced dominance remained a robust independent risk factor for an unfavorable outcome, whereas the trans-stenotic pressure gradients (TPG) showed no significant association. Conversely, the absolute reduction in THI was independently associated with higher preoperative THI (p < 0.001) and female sex (p = 0.045).
conclusionBalanced transverse sinus dominance is associated with a significantly lower risk of residual tinnitus after VSS. Preoperative evaluation of sinus dominance offers a practical approach for patient risk stratification and expectation management. KEY POINTS: Question Balanced transverse sinus dominance is strongly associated with complete symptom resolution after venous sinus stenting. Findings Non-balanced dominance carries a 23.7% risk of residual low-grade pulsatile tinnitus despite successful stenting. Clinical relevance Preoperative evaluation of sinus dominance serves as a practical, non-invasive imaging biomarker for clinical risk stratification.
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