Objective To observe the surgical effect of sigmoid sinus repayment and sinus wall reconstruction for vascular pulsatile tinnitus caused by sigmoid sinus diverticulum and bone wall defect.Methods It was analyzed retrospectively for the clinical data of 7 patients with vascular pulsating tinnitus admitted to the Department of Otolaryngology Head and Neck Surgery of Weihai Municipal Second Hospital affiliated from January 2019 to September 2021. It was observed for the changes of tinnitus on the day, one month,six months and one year after operation.Results All of the 7 patients were female. Six patients of them were on the right side and 1 patient on the left side. After clinical manifestations, thin slice CT of temporal bone, brain MRA and MRV examination, the patients were confirmed pulsatile tinnitus caused by sigmoid sinus origin. Tinnitus handicap inventory (THI) scores of all patients were grade III or above. All patients were operated under general anesthesia, of which 6 patients with sigmoid sinus diverticulum accompanied by sigmoid sinus bone defect received sigmoid sinus diverticulum repayment and sinus wall reconstruction, and 1 patient with transverse sinus diverticulum received sigmoid sinus and transverse sinus repayment and sinus wall reconstruction. After 1 year follow-up, 5 cases were cured,1case was markedly effective and 1 case was effective.Conclusion The effect of sigmoid sinus plasty for pulsatile tinnitus caused by sigmoid sinus diverticulum or bone wall defect are effective and worthy of clinical reference.