A 33-year-old obese woman presented with right-sided pulsatile tinnitus for several months along with subsequent headaches. Symptoms were alleviated by neck turning to the right or manual compression of the jugular vein. Magnetic resonance imaging revealed a dominant right-sided sigmoid sinus which extended laterally towards the cortex of the mastoid segment of the temporal bone. Computed tomography of the temporal bone revealed significant thinning and an area of dehiscence along the posterior wall of the right mastoid bone in close association with the sigmoid sinus. Patient underwent a lumbar puncture which revealed an opening pressure of 18 cm H₂O; a trial of acetazolamide did not alleviate her symptoms.

The patient was evaluated by Otorhinolaryngology and was deemed a candidate for resurfacing of the dehiscence with an autogenous bone graft. The patient underwent complete mastoidectomy, cranioplasty, and repair of the malformation. Patient had complete resolution of symptoms in the post-operative period

Up to 25% of cases of pulsatile tinnitus may be a consequence of bony anomalies of the sigmoid sinus including dehiscence or diverticula. SSD is effectively treated with a cortical mastoidectomy with resurfacing of the dehiscence with an autogenous bone graft or bone cement. Instant alleviation of the pulsatile tinnitus have been reported in up to 80% of cases.