| OBJECTS: sinus pericranii is only a symptom complex, and it can have a variety of etiologies. Therefore, it is important to differentiate these etiologies preoperatively by means of radiological examinations. A 5-year-old boy was admitted with a soft and fluctuant tumor in the right parietal region near the midline. The tumor appeared when the child was in a recumbent position, distending noticeably with the valsalva maneuver and disappearing completely when the patient was in the sitting position. methods: magnetic resonance imaging showed the lesion with honeycomb-like heterogeneous iso- and low-intensity signals on the T1-weighted image and with heterogeneous high- and isointensity signal on the T2-weighted image. Dynamic study with an injection of gadolinium diethylene-triaminopentaacetic acid demonstrated and nodular peripheral enhancement at early phase and subsequent progressive enhancement towards the center of tumor. The internal carotid angiogram was normal. The external carotid angiogram, however, showed a tumor stain fed by the superficial temporal arteries. The stain was retained until the late phase and drained into the scalp veins and into the superior sagittal sinus. Following direct injection of contrast medium into the tumor there was prolonged retention of the medium in the tumor and leakage into scalp veins and the superior sagittal sinus. The mass under the periosteum was totally removed and proved to be a cavernous angioma. CONCLUSIONS: scalp cavernous angioma is one of the etiologies of sinus pericranii and may be diagnosed preoperatively by cerebral angiography or magnetic resonance imaging. Serial dynamic magnetic resonance imaging will be particularly helpful for this diagnosis. ( info) |
2/10. Parietal sinus pericranii: case report and technical note. BACKGROUND: sinus pericranii is a rare vascular anomaly that is defined as a group of abnormal communications between the extracranial and intracranial venous systems, usually involving the superior sagittal sinus. Different surgical techniques have been used to manage this anomaly. Surgical technique and radiologic findings are discussed. CLINICAL PRESENTATION: A case of parietal sinus pericranii is presented that was developed spontaneously. This 33-year-old woman presented with a soft fluctuant mass in the right parietal region adjacent to the midline. She complained of headache and dizziness. The preoperative radiologic findings of simple skull X-ray, computed tomography, bone scan, and direct venogram are presented.The lesion was removed completely and then multiple small vascular channels through the underlying skull were obliterated by air-powered diamond drilling. The presence of vascular endothelium in the pathologic specimen suggested a congenital origin. CONCLUSION: We think this method is very easy and useful for managing the multiple small fenestrations of the sinus pericranii without recurrence. ( info) |
3/10. Usefulness of MR venography in diagnosing sinus pericranii: case report. A case of sinus pericranii communicating with the superior sagittal sinus is reported. Computed tomography (CT), magnetic resonance (MR) imaging, and angiography showed characteristic findings of sinus pericranii. However, MR venography was useful to visualize the entire lesion. ( info) |
4/10. Giant temporo-occipital sinus pericranii. A case report. A rare case of a giant, temporo-occipital sinus pericranii is presented. A 38-year-old male presented with minor symptoms of headache and heaviness over an enlarging temporo-occipital bone defect. Within the defect a soft, compressible, mass lesion was observed, which varied in size with changes in intracranial pressure. Radiological imaging demonstrated bone erosion around a fluid filled mass, which on angiography communicated via a series of channels with the transverse sinus. A diagnosis of sinus pericranii was made. Due to the risk of future complication the patient elected to undergo surgery, which successfully resected the mass and obliterated the venous communications with the diploic veins and transverse sinus. The classification, aetiology, differential diagnosis, radiological characteristics and management options relating to sinus pericranii are discussed. ( info) |
5/10. sinus pericranii in the frontal region: a case report. sinus pericranii is a rare vascular anomaly. A case of sinus pericranii at the nasion with an orbital extension is presented. The drainage was into the superior sagittal sinus. The pathogenesis is discussed and the literature is reviewed. ( info) |
| sinus pericranii is a rare disorder characterized by a congenital or acquired epicranial blood-filled nodule of the scalp that is in communication with an intracranial dural sinus through dilated diploic veins of the skull. We describe two patients with sinus pericranii: a 3-year-old boy with a congenital lesion and a 3-year-old girl whose lesion appeared after head trauma. We discuss the clinical presentation, dermatologic manifestations, differential diagnosis, and management as described in the available published literature. patients with sinus pericranii may be brought to the attention of dermatologists and dermatopathologists because of skin changes in the scalp or forehead. The diagnosis is difficult to make clinically, because the skin manifestations are highly variable and may resemble other disorders of the scalp and cranium. The potentially lethal complications including hemorrhage, infection, and air embolism warrant a high index of suspicion for sinus pericranii. ( info) |
7/10. sinus pericranii: clinical and imaging findings in two cases of spontaneous partial thrombosis. sinus pericranii is an unusual venous anomaly characterized by communication of pericranial varicosities with an underlying dural sinus. We report two cases of spontaneous partial thrombosis of sinus pericranii presenting as focally tender, nonreducible mass lesions different in character from the baseline venous abnormality. CT, CT angiography, and CT venography (CTV) were performed in both cases. CTV was essential in depicting thrombi within the varicosities. MR (in one case) demonstrated the anomaly well, but the thrombus was not evident. Conservative therapy was instituted in both cases. ( info) |
8/10. sinus pericranii: from gross and neuroimaging findings to different pathophysiological changes. case reports: We report two girls with a typical presentation of sinus pericranii. Both patients received total excision of the subgaleal masses with complete obliteration of the communications to the intracranial portion. However, different gross appearances, neuroimaging findings and intraoperative findings were found. It took more time and attention to control the bleeding due to the large communication between the extracranial and intracranial components in the second case. DISCUSSION: sinus pericranii is composed of abnormal extracranial vascular tissues that communicate directly with intracranial dural sinuses or veins. A review of the literature showed that 13 out of 31 patients with sinus pericranii had a high-flow pattern. Detailed physical examination and imaging studies to detect dilated scalp veins and a large bony defect should remind surgeons of the presence of large venous communications. Meticulous treatment of the large communication during surgery can avoid massive bleeding. ( info) |
| BACKGROUND: In the majority of cases, infantile hemangiomas are not associated with any other abnormalities. Occasionally, they may indicate the presence of systemic malformations. PHACE syndrome includes the coexistence of hemangioma, posterior fossa brain abnormalities, arterial anomalies, coarctation of the aorta, cardiac defects, and eye abnormalities. We report a case of a 2-month-old female with PHACE syndrome who also had sinus pericranii. CLINICAL CASE: A 2-month-old girl was seen for a plaque-like, segmental, midfacial hemangioma, with recurrent hemorrhages, noted at birth. As part of the PHACE syndrome, she had a midline facial hemangioma, absent corpus callosum, hypoplastic internal carotid artery, and an abnormal tortuous dysplastic basilar artery. Digital subtraction angiography showed sinus pericranii. The patient underwent successful endovascular embolization of the hemangioma that prevented further bleeding. CONCLUSION: sinus pericranii is a rare finding that has not, to our knowledge, been previously associated with PHACE syndrome. central nervous system, not only posterior fossa, abnormalities are frequently encountered in PHACE syndrome. Endovascular embolization of the facial hemangioma in our patient was a useful therapy. ( info) |
10/10. Diagnostic and therapeutic considerations for sinus pericranii. sinus pericranii is one of the differential diagnoses which should be considered when a physician encounters a patient with a subcutaneous soft scalp mass. Sinus pericranii is a rare vascular anomaly of the venous drainage between the intracranial and extracranial systems via the diploe of the skull. We describe here a 16-year-old female with sinus pericranii following minor head trauma four years prior. CT and MRI scans revealed heterogeneous enhancement of the lesion and three-dimensional CT showed a crater-like depression and multiple honeycomb diploic holes in the skull. Angiography was normal, whereas percutaneous sinusography revealed a connection between the lesion and the superior sagittal sinus. The patient underwent surgery to disconnect her diploic veins from the lesion under general anaesthesia, and her postoperative course was uneventful after six months follow-up. To avoid profuse bleeding and air emboli and to ameliorate cosmetic problems, a specific diagnosis should be made to plan appropriate treatment. ( info) |