Although a variety of intracranial and skull base vascular pathologies can lead to a wide range of clinical manifestations, a common feature is a pulsatile murmur that is consistent with the beating of the heart, making tinnitus, which is difficult to eliminate, the most distressing reason for patients to visit the clinic until other signs of physical damage are fully manifested. In particular, venous pulsatile tinnitus is easy to be neglected in diagnosis because it is clinically subjective and there is no ideal way and equipment to record the murmur or tinnitus as objective graphics and images for clinical judgment; three cases in this group were misdiagnosed as “depression” and received wrong treatment, making the patients seriously ill. Patients were troubled by annoying murmurs for a long time, and some of them even had suicidal thoughts of light-heartedness many times. Therefore, understanding the diagnostic and differential diagnostic features of the lesions and individualized treatment of different vascular sources of pulsatile tinnitus can lead to satisfactory results and provide reference values for clinical diagnosis and treatment of various types of pulsatile tinnitus. Tinnitus is a large group of diseases with multiple causes and can occur in multiple neural tissues and vascular systems, so the treatment of most tinnitus requires interdisciplinary and comprehensive treatment. This will help reduce misdiagnosis and underdiagnosis due to the limitations of a single specialty, thus enhancing accurate diagnosis of the cause of pulsatile tinnitus and providing reliable evidence for effective treatment.