{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:14:02Z","timestamp":1792689242857,"version":"4.5.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2016,11,4]],"date-time":"2016-11-04T00:00:00Z","timestamp":1478217600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2016,11,4]],"date-time":"2016-11-04T00:00:00Z","timestamp":1478217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Pulsatile tinnitus (PT) is often an initial presenting symptom of dural arteriovenous fistula (dAVF), but it may be overlooked or diagnosed late if not suspected on initial diagnostic work-up. Here, we assess anatomical features, treatment outcomes, and clinical implications of patients with PT due to dAVF. Of 220 patients who were diagnosed with dAVF between 2003 and 2014, 30 (13.6%) presented with only PT as their initial symptom. The transverse-sigmoid sinus (70.0%) was the most common site, followed by the hypoglossal canal (10.0%) and the middle cranial fossa (6.7%) on radiologic evaluation. Regarding venous drainage patterns, sinus or meningeal venous drainage pattern was the most common type (73.3%), followed by sinus drainage with a cortical venous reflux (26.7%). PT disappeared completely in 21 (80.8%) of 26 patients who underwent therapeutic intervention with transarterial embolization of the fistula, improved markedly in 3 (11.5%), and remained the same in 2 (7.7%). In conclusion, considering that PT may be the only initial symptom in more than 10% of dAVF, not only otolaryngologists but also neurologists and neurosurgeons should meticulously evaluate patients with PT. In most cases, PT originating from dAVF can be cured with transarterial embolization regardless of location and venous drainage pattern.<\/jats:p>","DOI":"10.1038\/srep36601","type":"journal-article","created":{"date-parts":[[2016,11,4]],"date-time":"2016-11-04T10:03:49Z","timestamp":1478253829000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications"],"prefix":"10.1038","volume":"6","author":[{"given":"Yong-Hwi","family":"An","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungjun","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minhyung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihye","family":"Rhee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O-Ki","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyojun","family":"Hwang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheolkyu","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Jung","family":"Bae","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwang Seok","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyogu","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ja-Won","family":"Koo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Jin","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2016,11,4]]},"reference":[{"key":"BFsrep36601_CR1","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/S1474-4422(13)70160-1","volume":"12","author":"B Langguth","year":"2013","unstructured":"Langguth, B., Kreuzer, P. M., Kleinjung, T. & De Ridder, D. Tinnitus: causes and clinical management. The Lancet. Neurology 12, 920\u2013930, doi: 10.1016\/S1474-4422(13)70160-1 (2013).","journal-title":"The Lancet. Neurology"},{"key":"BFsrep36601_CR2","first-page":"39","volume":"3","author":"A Sismanis","year":"1997","unstructured":"Sismanis, A. Pulsatile Tinnitus. The international tinnitus journal 3, 39\u201340 (1997).","journal-title":"The international tinnitus journal"},{"key":"BFsrep36601_CR3","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1227\/NEU.0000000000000902","volume":"77","author":"JJ Song","year":"2015","unstructured":"Song, J. J. et al. Sinus Wall Resurfacing for Patients With Temporal Bone Venous Sinus Diverticulum and Ipsilateral Pulsatile Tinnitus. Neurosurgery 77, 709\u2013717, doi: 10.1227\/NEU.0000000000000902 (2015).","journal-title":"Neurosurgery"},{"key":"BFsrep36601_CR4","doi-asserted-by":"publisher","first-page":"e41","DOI":"10.1097\/MAO.0b013e318245cb22","volume":"33","author":"JH Wee","year":"2012","unstructured":"Wee, J. H., Song, J. J., Koo, J. W. & Kim, C. S. Increased intracranial pressure after surgical treatment of pulsatile tinnitus from a prominent sigmoid sinus. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 33, e41\u2013e42, doi: 10.1097\/MAO.0b013e318245cb22 (2012).","journal-title":"Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology"},{"key":"BFsrep36601_CR5","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1056\/NEJMra-013395","volume":"347","author":"AH Lockwood","year":"2002","unstructured":"Lockwood, A. H., Salvi, R. J. & Burkard, R. F. Tinnitus. The New England journal of medicine 347, 904\u2013910, doi: 10.1056\/NEJMra-013395 (2002).","journal-title":"The New England journal of medicine"},{"key":"BFsrep36601_CR6","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1044\/jshd.5503.439","volume":"55","author":"JL Stouffer","year":"1990","unstructured":"Stouffer, J. L. & Tyler, R. S. Characterization of tinnitus by tinnitus patients. The Journal of speech and hearing disorders 55, 439\u2013453 (1990).","journal-title":"The Journal of speech and hearing disorders"},{"key":"BFsrep36601_CR7","first-page":"879","volume":"15","author":"RR Dietz","year":"1994","unstructured":"Dietz, R. R., Davis, W. L., Harnsberger, H. R., Jacobs, J. M. & Blatter, D. D. MR imaging and MR angiography in the evaluation of pulsatile tinnitus. AJNR. American journal of neuroradiology 15, 879\u2013889 (1994).","journal-title":"AJNR. American journal of neuroradiology"},{"key":"BFsrep36601_CR8","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s004150050193","volume":"245","author":"D Waldvogel","year":"1998","unstructured":"Waldvogel, D., Mattle, H. P., Sturzenegger, M. & Schroth, G. Pulsatile tinnitus\u2013a review of 84 patients. Journal of neurology 245, 137\u2013142 (1998).","journal-title":"Journal of neurology"},{"key":"BFsrep36601_CR9","first-page":"2500","volume":"26","author":"BJ Kwon","year":"2005","unstructured":"Kwon, B. J., Han, M. H., Kang, H. S. & Chang, K. H. MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns. AJNR. American journal of neuroradiology 26, 2500\u20132507 (2005).","journal-title":"AJNR. American journal of neuroradiology"},{"key":"BFsrep36601_CR10","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1148\/93.5.1071","volume":"93","author":"TH Newton","year":"1969","unstructured":"Newton, T. H. & Cronqvist, S. Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93, 1071\u20131078, doi: 10.1148\/93.5.1071 (1969).","journal-title":"Radiology"},{"key":"BFsrep36601_CR11","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1148\/rg.246045026","volume":"24","author":"H Kiyosue","year":"2004","unstructured":"Kiyosue, H. et al. Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics: a review publication of the Radiological Society of North America, Inc 24, 1637\u20131653, doi: 10.1148\/rg.246045026 (2004).","journal-title":"Radiographics: a review publication of the Radiological Society of North America, Inc"},{"key":"BFsrep36601_CR12","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.3174\/ajnr.A2798","volume":"33","author":"D Gandhi","year":"2012","unstructured":"Gandhi, D. et al. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR. American journal of neuroradiology 33, 1007\u20131013, doi: 10.3174\/ajnr.A2798 (2012).","journal-title":"AJNR. American journal of neuroradiology"},{"key":"BFsrep36601_CR13","doi-asserted-by":"publisher","first-page":"2619","DOI":"10.1002\/lary.22350","volume":"121","author":"HJ Shim","year":"2011","unstructured":"Shim, H. J., Song, S. J., Choi, A. Y., Hyung Lee, R. & Yoon, S. W. Comparison of various treatment modalities for acute tinnitus. The Laryngoscope 121, 2619\u20132625, doi: 10.1002\/lary.22350 (2011).","journal-title":"The Laryngoscope"},{"key":"BFsrep36601_CR14","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1097\/MAO.0000000000001005","volume":"37","author":"JJ Song","year":"2016","unstructured":"Song, J. J. et al. Objectification and Differential Diagnosis of Vascular Pulsatile Tinnitus by Transcanal Sound Recording and Spectrotemporal Analysis: A Preliminary Study. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 37, 613\u2013620, doi: 10.1097\/MAO.0000000000001005 (2016).","journal-title":"Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology"},{"key":"BFsrep36601_CR15","doi-asserted-by":"publisher","first-page":"e0157722","DOI":"10.1371\/journal.pone.0157722","volume":"11","author":"SH Kim","year":"2016","unstructured":"Kim, S. H. et al. Pre-Treatment Objective Diagnosis and Post-Treatment Outcome Evaluation in Patients with Vascular Pulsatile Tinnitus Using Transcanal Recording and Spectro-Temporal Analysis. PLoS One 11, e0157722, doi: 10.1371\/journal.pone.0157722 (2016).","journal-title":"PLoS One"},{"key":"BFsrep36601_CR16","doi-asserted-by":"publisher","first-page":"166","DOI":"10.3171\/jns.1995.82.2.0166","volume":"82","author":"JA Borden","year":"1995","unstructured":"Borden, J. A., Wu, J. K. & Shucart, W. A. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. Journal of neurosurgery 82, 166\u2013179, doi: 10.3171\/jns.1995.82.2.0166 (1995).","journal-title":"Journal of neurosurgery"},{"key":"BFsrep36601_CR17","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3342\/ceo.2015.8.1.7","volume":"8","author":"SC Bae","year":"2015","unstructured":"Bae, S. C., Kim, D. K., Yeo, S. W., Park, S. Y. & Park, S. N. Single-center 10-year experience in treating patients with vascular tinnitus: diagnostic approaches and treatment outcomes. Clinical and experimental otorhinolaryngology 8, 7\u201312, doi: 10.3342\/ceo.2015.8.1.7 (2015).","journal-title":"Clinical and experimental otorhinolaryngology"},{"key":"BFsrep36601_CR18","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1097\/00005537-199901000-00012","volume":"109","author":"SB Shah","year":"1999","unstructured":"Shah, S. B., Lalwani, A. K. & Dowd, C. F. Transverse\/sigmoid sinus dural arteriovenous fistulas presenting as pulsatile tinnitus. The Laryngoscope 109, 54\u201358 (1999).","journal-title":"The Laryngoscope"},{"key":"BFsrep36601_CR19","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1097\/MOO.0b013e3283493fd8","volume":"19","author":"A Sismanis","year":"2011","unstructured":"Sismanis, A. Pulsatile tinnitus: contemporary assessment and management. Current opinion in otolaryngology & head and neck surgery 19, 348\u2013357, doi: 10.1097\/MOO.0b013e3283493fd8 (2011).","journal-title":"Current opinion in otolaryngology & head and neck surgery"},{"key":"BFsrep36601_CR20","doi-asserted-by":"publisher","first-page":"883","DOI":"10.3171\/2014.10.JNS14377","volume":"122","author":"B Spittau","year":"2015","unstructured":"Spittau, B. et al. Dural arteriovenous fistulas of the hypoglossal canal: systematic review on imaging anatomy, clinical findings, and endovascular management. Journal of neurosurgery 122, 883\u2013903, doi: 10.3171\/2014.10.JNS14377 (2015).","journal-title":"Journal of neurosurgery"},{"key":"BFsrep36601_CR21","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1007\/s00234-008-0393-7","volume":"50","author":"S Manabe","year":"2008","unstructured":"Manabe, S. et al. Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases. Neuroradiology 50, 715\u2013721, doi: 10.1007\/s00234-008-0393-7 (2008).","journal-title":"Neuroradiology"},{"key":"BFsrep36601_CR22","first-page":"389","volume":"19","author":"A Mironov","year":"1998","unstructured":"Mironov, A. Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR. American journal of neuroradiology 19, 389\u2013391 (1998).","journal-title":"AJNR. American journal of neuroradiology"},{"key":"BFsrep36601_CR23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.nec.2011.10.002","volume":"23","author":"G Pradilla","year":"2012","unstructured":"Pradilla, G., Coon, A. L., Huang, J. & Tamargo, R. J. Surgical treatment of cranial arteriovenous malformations and dural arteriovenous fistulas. Neurosurg Clin N Am 23, 105\u2013122, doi: 10.1016\/j.nec.2011.10.002 (2012).","journal-title":"Neurosurg Clin N Am"},{"key":"BFsrep36601_CR24","first-page":"56","volume":"47","author":"M Collice","year":"2000","unstructured":"Collice, M. et al. Surgical treatment of intracranial dural arteriovenous fistulae: role of venous drainage. Neurosurgery 47, 56\u201366; discussion 66\u201357 (2000).","journal-title":"Neurosurgery"},{"key":"BFsrep36601_CR25","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s10143-011-0318-5","volume":"34","author":"D Wachter","year":"2011","unstructured":"Wachter, D., Hans, F., Psychogios, M. N., Knauth, M. & Rohde, V. Microsurgery can cure most intracranial dural arteriovenous fistulae of the sinus and non-sinus type. Neurosurg Rev 34, 337\u2013345; discussion 345, doi: 10.1007\/s10143-011-0318-5 (2011).","journal-title":"Neurosurg Rev"},{"key":"BFsrep36601_CR26","doi-asserted-by":"publisher","first-page":"1344","DOI":"10.1097\/MAO.0000000000001179","volume":"37","author":"HW Jeon","year":"2016","unstructured":"Jeon, H. W. et al. Pseudo-low Frequency Hearing Loss and Its Improvement After Treatment May Be Objective Signs of Significant Vascular Pathology in Patients With Pulsatile Tinnitus. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 37, 1344\u20131349, doi: 10.1097\/MAO.0000000000001179 (2016).","journal-title":"Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology"},{"key":"BFsrep36601_CR27","doi-asserted-by":"publisher","first-page":"441","DOI":"10.3171\/2015.6.JNS15961","volume":"125","author":"CS Kim","year":"2016","unstructured":"Kim, C. S. et al. Transmastoid reshaping of the sigmoid sinus: preliminary study of a novel surgical method to quiet pulsatile tinnitus of an unrecognized vascular origin. J Neurosurg 125, 441\u2013449, doi: 10.3171\/2015.6.JNS15961 (2016).","journal-title":"J Neurosurg"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/srep36601.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep36601","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep36601.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:47:02Z","timestamp":1672879622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/srep36601"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,4]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,12,23]]}},"alternative-id":["BFsrep36601"],"URL":"https:\/\/doi.org\/10.1038\/srep36601","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,4]]},"assertion":[{"value":"8 July 2016","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2016","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 November 2016","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"36601"}}