목적: A dominant sigmoid sinus with focal dehiscence or thinning (DSSD/T) of the overlying bone wall is one of the most commonly encountered, but frequently overlooked vascular causes of the vascular pulsatile tinnitus (VPT). Also, the pathophysiologic mechanism of sound perception is not fully understood yet. The present study introduces a novel surgical method of the transmastoid SS reshaping surgery to ameliorate the PT in patients with DSSD/T. By reviewing the cases series, we analyze the surgical outcome and postulate the pathophysiologic mechanism of sound perception and the theoretical background of VPT improvement after performing transmastoid SS reshaping surgery. 방법:Ten patients with VPT presumably due to DSSD/T underwent the transmastoid SS reshaping surgery from February 2010 to February 2015 at Seoul National University Bundang Hospital. The mean postoperative follow-up period was 8.5 months (range, 3 24 months). The transmastoid SS reshaping surgery was comprised of simple mastoidectomy, partial compression of the SS, and reinforcement of the bony SS wall with bone cement. Perioperative medical records, imaging findings, and audiologic findings of the patients were comprehensively reviewed. 결과:In 9 of 10 patients (90 %) VPT abated immediately after the operation. Three patients with preoperative low-frequency hearing loss showed postoperative hearing gain in the low-frequency region. There were no major postoperative complications, except for the first case with postoperative increased intracranial pressure that subsided after partial decompression of the SS. 결론:The transmastoid SS reshaping surgery may be a good surgical option in patients with DSSD/T. Redistributing severely asymmetric blood flow, making a sound-proof wall with bone cement, and partially disconnecting the conduction route by simple mastoidectomy may help in quieting VPT.