MEDICAL NEUROTOLOGYArachnoid Granulation Causing Unilateral Pulsatile Tinnitus Treated With Dural Venous Sinus StentingGadot, Ron∗; Hoang, Alex N.∗; Raper, Daniel M.S.∗; Sweeney, Alexander D.†; Juliano, Mario‡; Lustrin, Elizabeth‡; Tanweer, Omar∗ Author Information ∗Department of Neurosurgery, Baylor College of Medicine †Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas ‡Department of Radiology, NYU Langone Health, New York City, New York Address correspondence and reprint requests to Omar Tanweer, MD, Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge St. Suite 9A, Houston, TX 77030; E-mail: [email protected] The authors disclose no conflicts of interest. Ethical approval statement: All patients consented to the use of their in this report. Baylor College of Medicine IRB approval number: H-43183. Author Contributions: R.G. and A.N.H. retrieved the data. R.G., A.N.H., and O.T. wrote the article. All authors critically revised the article. Otology & Neurotology 44(1):p 86-89, January 2023. | DOI: 10.1097/MAO.0000000000003741 Buy Metrics Abstract Background Large arachnoid granulations that protrude into dural venous sinuses and partially obstruct outflow are an underappreciated etiology of pulsatile tinnitus (PT). Endovascular dural venous sinus stenting is thought to diminish turbulent venous outflow and may relieve obstruction caused by arachnoid granulations. Methods Four patients at two institutions were evaluated for unilateral PT. Magnetic resonance imaging and digital subtraction angiography revealed moderate-to-severe stenoses from large arachnoid granulations within the implicated transverse sinus. All patients underwent venous manometry and endovascular sinus stenting. Results All patients experienced immediate and complete remission of their PT. Stenoses were relieved by a mean of 93% by Warfarin-Aspirin Symptomatic Intracranial Disease criteria. There were no procedural or periprocedural complications. All patients continued to report complete symptom resolution at a mean of 8-month follow-up. Conclusions PT from arachnoid granulations are an underappreciated pathomechanism. Endovascular dural venous sinus stenting is an effective intervention for treating unilateral PT secondary to large arachnoid granulation. © 2022, Otology & Neurotology, Inc.