Embolization of jugular bulb diverticula in the management of pulsatile tinnitus

Introduction Pulsatile tinnitus (PT) caused by a high riding jugular bulb or prominent diverticulum can negatively impact quality of life. This study evaluates the effectiveness of endovascular treatments, including stenting, coiling, and Woven EndoBridge (WEB; Terumo Neuro, Aliso Viejo, CA) devices, for managing jugular bulb diverticula (JBD)-induced PT. Methods A retrospective review was conducted from September 1, 2020 to April 30, 2026, identifying twelve patients diagnosed with JBD. Data extracted included demographics, PT characteristics, treatment details, and outcomes. Endovascular interventions were pursued after in depth work-up, often including balloon test occlusion. The outcomes and techniques of various interventions are described. Results Twelve patients (eight females and four males) underwent endovascular treatment for JBD, with a median age of 40.5 years and a median BMI of 25.8 kg/m 2 . Balloon-test occlusion (BTO) showed at least moderate improvement in 7/8 patients (87.5%). Stent-assisted coiling for the JBD was performed in eleven cases (91.7%), and placement of a WEB was successful in one patient. There were two unsuccessful attempts in placing a WEB device, and treatment was converted to stent-assisted coiling. At an average last follow-up of 7.25 months, nine patients (75%) had complete resolution and three (25%) had significant improvement (25%) of their symptoms. Conclusion Endovascular interventions are safe and effective for treating JBD-related PT. BTO is an important intraprocedural tool that may help predict treatment success. Further investigation into optimal patient selection and the role of specific devices in treating JBD is warranted.