This interesting retrospective case series analyses the effectiveness of a modified surgical technique with retromastoid reconstruction of the sigmoid sinus by mechanical compression with Surgicel and bone wax packing under local anaesthesia for patients with venous pulsatile tinnitus related to radiological evidence of sigmoid sinus diverticulum or dehiscence (SSDD), high dehiscent/diverticulum jugular bulb or internal jugular venous anomalies. A total of 41 patients underwent compression reconstruction of sigmoid sinus (SSCR), and three patients simultaneously received mastoid emissary vein ligation (MEVL) by the same surgeon. The procedure was performed under local anaesthia, via a post-aural approach, the sigmoid sinus was exposed at its junction with the transverse sinus. Surgicel and bone wax packing were used to gently compress the sigmoid sinus wall until the disappearance of tinnitus as described by the patient. All patients were followed up regularly by telephone or clinic visit for a period ranging from nine months to eight years. Five patients were lost to follow-up and not analysed in the results. Thirty-one patients (86%) benefitted, of which 18/36 (50%) noticed complete remission and only 5/36 (14%) patients had no benefit. The study certainly has its shortcomings considering it is a small numbers case series with a lack of any controls, assessing a surgical procedure which can have placebo benefits. However, it certainly is an impressive result with few complications for a condition that is rarely treated surgically (at least in UK) due to the poor surgical success outcomes of this distressing condition.