목적: Pulsatile tinnitus (PT) is often associated with anomalies such as sigmoid sinus dehiscence (SS-Deh). Although sigmoid sinus resurfacing (SSR) surgery has been proven to be effective in subjects with SS-Deh, there are still cases of insufficient improvement after surgery. Based on the fact that SS-Deh frequently accompanies adjacent diverticulum (Div), we modified the surgical principle in subjects with combined SS-Deh/Div and report the preliminary surgical outcomes. 방법:A retrospective case series of patients undergoing SSR at a single tertiary center by a single surgeon was reviewed. A total of 54 patients with SS-Deh were reviewed, of which 33 patients were treated with previously reported SSR with bone chip insertion and 21 patents treated SSR with smoothing of adjacent Div. Pre- and postoperative visual analog scale (VAS) loudness, VAS distress, and Tinnitus Handicap Inventory (THI) scores were compared. 결과:In the bone chip insertion group, the mean VAS loudness, VAS distress, and THI scores improved from 6.8 to 2.0, from 6.9 to 2.1, and from 51.7 to 16.8, respectively (all P<0.001). Meanwhile, in the SSR with adjacent Div smoothing group, the mean VAS loudness, VAS distress, and THI scores decreased from 7.5 to 1.6, from 7.4 to 1.7, and from 63.3 to 21.9, respectively (all P<0.001). Although the RM-ANOVA analysis did not reveal any statistically significant differences between the two groups, SSR with adjacent Div smoothing was superior to previous SSR with bone chip insertion because the latter had a higher rate of partial remission compared to the former. 결론:Judging from the current preliminary analysis, resurfacing the Deh and reducing the adjacent Div to the normal contour of the SS provides more stable surgical outcome probably because this novel surgical method removes the source of PT and blocks the route of PT transmission simultaneously.