목적: To introduce intraoperative Doppler ultrasound (IDU) as a novel and effective method for real-time assessment and guidance during surgical management of pulsatile tinnitus (PT) caused by sigmoid sinus (SS) abnormalities, such as dehiscence (SS-deh), diverticulum (SS-div), and large emissary vein (LEV). 방법:some cases of PT were successfully treated with SS wall resurfacing (SSWR) utilizing IDU. In Case 1, a 26-year-old female with SS-deh and LEV underwent SSWR with LEV compression. In Case 2, a 37-year- old female with SS-div underwent diverticulum obliteration using a periosteal flap. IDU was used intraoperatively to identify the precise location of SS abnormalities, guide surgical maneuvers, and confirm the adequacy of obliteration and resurfacing. 결과:In Case 1, IDU identified an additional SS-deh site that was not initially apparent, guided LEV compression, and confirmed complete occlusion after hemostatic material application. The patient experienced complete resolution of tinnitus postoperatively. In Case 2, IDU facilitated the safe elevation of the periosteal flap by precisely locating the SS-div, guided periosteal flap insertion for diverticulum obliteration, and confirmed sufficient obliteration. The patient reported a significant reduction in tinnitus postoperatively. At our institution, The Catholic University of Korea, Seoul, Republic of Korea, we have accumulated dozens of cases, and a statistical analysis of surgical outcomes is planned. 결론:: IDU is a valuable tool for real-time assessment of hemodynamic changes and precise localization of SS abnormalities during surgery for PT. It allows for accurate identification of SS-deh, SS-div, and LEV, guides surgical interventions such as SSWR and obliteration, and confirms the sufficiency of these procedures. IDU contributes to safer and more effective surgical outcomes in patients with PT due to SS abnormalities.