목적: In recent years, the clinical diagnosis rate of pulsatile venous vascular tinnitus (PT) has been gradually increasing. In more than 250 surgical cases completed by our research team, we observed that some PT patients have multiple defects in the sigmoid sinus and jugular bulb osseous walls. Such patients require the repair of multiple osseous defects, as there is a risk of not achieving improvements in PT after surgery without addressing these defects. 방법:We included 7 patients with multiple osseous defects in the sigmoid sinus and jugular bulb regions. Through the innovative approach of combined bilateral endoscopic minimally invasive surgery, we utilized bone cement to repair the osseous defects in the sigmoid sinus wall and jugular bulb region. The effectiveness of the surgery was analyzed using the Tinnitus Handicap Inventory (THI). 결과:Among the 7 patients, 6 showed the disappearance of PT symptoms in the follow-up at 2 months after surgery, with a significant reduction in THI values (P<0.05). Moreover, two patients experienced subjective tinnitus postoperatively, which completely disappeared after 3 months. Particularly noteworthy is that two patients exhibited the transverse sinus sign, and the PT symptoms in these two patients were also relieved postoperatively. 결론:The application of combined bilateral endoscopic minimally invasive surgery with bone cement has proven to be an effective method for treating multiple osseous defects in the sigmoid sinus/jugular bulb region. The transverse sinus sign or occipital sinus stenosis is not the primary cause of PT, and successful elimination of PT symptoms can be achieved by repairing osseous defects in the jugular bulb region, avoiding the need for intravascular interventions.