Symptomatic Sinus Pericranii with Adult Onset Headache: A Case Report with Pathologic Perspective

Sinus pericranii (SP) is a rare vascular anomaly of the scalp that consists of an abnormal pericranial venous channel connected to adjacent dural venous sinuses. Most SP are asymptomatic and are found in the pediatric age group. We aim to report a case of symptomatic SP in adult and describe the clinical, radiological, and pathohistological findings to help understand and differentiate this lesion from other scalp lesions. A 40-year-old man with a scalp mass was admitted to our hospital complaining of headache. The lesion enlarged when the patient was in a recumbent position or during Valsalva maneuver. The radiologic imaging suggested its diagnosis as an accessory type of SP with bone erosion. Surgical resection and cranioplasty were successfully performed, and the related headache also gradually subsided. At the 3-year follow-up, there was no recurrence on magnetic resonance imaging.

Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

OBJECTIVE: Cerebral varices (CVs) without an arteriovenous shunt, so called nonfistulous CVs, are very rare, and their etiology and natural course are not well understood. The aim of this study is to evaluate the clinical outcomes of nonfistulous CVs by the analysis of 39 cases.METHODS: From 2000 to 2015, 22 patients with 39 nonfistulous CVs (≥5 mm) were found by searching the medical and radiologic records of our institute. Clinical data and radiological data including numbers, sizes and locations of CVs and associated anomalies were retrospectively collected and analyzed. Previously reported cases in literature were reviewed as well.RESULTS: The mean age of the patients was 21 years (range, 0–78 years). On average, 1.8±1.2 CVs were found per patient. CVs were categorized as either fusiform or saccular depending on their shapes. Two patients had saccular type CVs, seventeen patients had fusiform types, and three patients had both fusiform and saccular CVs. Eight patients had associated compromise of the vein of Galen and the straight sinus. Four of those patients had sinus pericranii, as well. Five patients had CVs that were distal draining veins of large developmental venous anomalies. One patient had associated migration anomaly, and two patients had Sturge- Weber syndrome. Six patients with an isolated cerebral varix were observed. Of the 39 CVs in 22 patients, 20 lesions in 14 patients were followed up in outpatient clinics with imaging studies. The average follow-up duration was 6.6 years. During this period, no neurological events occurred, and all the lesions were managed conservatively.CONCLUSION: Nonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.

Clinical Outcome of Nonfistulous Cerebral Varices: the Analysis of 39 Lesions

OBJECTIVE: Cerebral varices (CVs) without an arteriovenous shunt, so called nonfistulous CVs, are very rare, and their etiology and natural course are not well understood. The aim of this study is to evaluate the clinical outcomes of nonfistulous CVs by the analysis of 39 cases. METHODS: From 2000 to 2015, 22 patients with 39 nonfistulous CVs (≥5 mm) were found by searching the medical and radiologic records of our institute. Clinical data and radiological data including numbers, sizes and locations of CVs and associated anomalies were retrospectively collected and analyzed. Previously reported cases in literature were reviewed as well. RESULTS: The mean age of the patients was 21 years (range, 0–78 years). On average, 1.8±1.2 CVs were found per patient. CVs were categorized as either fusiform or saccular depending on their shapes. Two patients had saccular type CVs, seventeen patients had fusiform types, and three patients had both fusiform and saccular CVs. Eight patients had associated compromise of the vein of Galen and the straight sinus. Four of those patients had sinus pericranii, as well. Five patients had CVs that were distal draining veins of large developmental venous anomalies. One patient had associated migration anomaly, and two patients had Sturge- Weber syndrome. Six patients with an isolated cerebral varix were observed. Of the 39 CVs in 22 patients, 20 lesions in 14 patients were followed up in outpatient clinics with imaging studies. The average follow-up duration was 6.6 years. During this period, no neurological events occurred, and all the lesions were managed conservatively. CONCLUSION: Nonfistulous CVs seemed to be asymptomatic in most cases and remained clinically silent. Hence, we suggest conservative management.

Comparative study of tissue reactivity to n-butyl-2-cyanoacrylate and nylon monofilament thread on pericranium-cutaneous flaps in rats

To study the repair of pericranium-cutaneous flaps fixed with suture anchored in a skull bone tunnel or N-butyl-2-cyanoacrylate adhesive in Wistar rats with emphasis on the cellular inflammatory response and the production of types I and III collagen. The operated region in the cephalic region of Wistar rats was removed minutes before euthanasia, fixed in formalin, and subjected to histological preparation. Slides were stained with hematoxylin-eosin and Picrosirius. Standardized counts of polymorphonuclear and mononuclear cells, fibroblasts, and macrophages were performed, and the percentages of types I and III collagen were determined. Data collection occurred on days 3, 7, 14, 21, and 45 postoperatively. A value of p<0.05 was considered statistically significant. Quantitative analysis of the data showed more fibroblasts in the surgical adhesive group than in the nylon monofilament thread groups (p=0.0211). Qualitative analysis showed higher reactivity in the adhesive group, with a predominance of polymorphonuclear cells from days 3-45 and macrophages from days 3-7. The amount of type I collagen exceeded 80% in the treated and control groups at the end of the experiment. CONCLUSIONS: Subperiosteal detachment triggers a cellular inflammatory response that is amplified using soft tissue fixation methods. The adhesive n-butyl-2-cyanoacrylate was more reactive than the nylon monofilament thread anchored in the skull bone tunnel.

Sinus pericranii. reporte de caso en Uruguay / Sinus pericranii. case report in Uruguay

Sinus pericranii es una anomalía vascular poco frecuente que consiste en conexiones anómalas congénitas o adquiridas entresistemas venosos extracraneales e intracraneales. Los lagos venosos extracraneales se conectan a los senos durales intracranealesa través de venas dilatadas diploicas y emisarias.Este trastorno es hallado generalmente en la población pediátrica y la mayoría de las veces involucra el seno sagital superiory ocasionalmente el seno transverso. Son procesos generalmente estables habiéndose publicado inclusive casos de regresiónespontánea.

Sinus Pericranii: Case Report / 대한뇌혈관외과학회지

OBJECTIVE: Sinus pericranii (SP) is a rare vascular malformation characterized by abnormal communication between the extracranial and intracranial venous systems, usually involving the superior sagittal sinus (SSS) and occasionally, the transverse sinus. CASE REPORT: A 28-year-old man was presented with a round, fluctuant, nonpulsatile scalp mass in the frontal area near the midline, the size of which changed, depending on his head position. Magnetic resonance imaging showed an extracranial vein extending through a bony defect in the vertex of the skull and draining into the superior portion of the sagittal sinus. RESULTS: The lesion was completely removed by surgery. The presence of vascular endothelium in the pathologic specimen suggests a congenital or spontaneous origin. CONCLUSION: SP is a rare vascular malformation that requires surgical or endovascular treatment for the prevention of life-threatening complications.

Diagnosis and treatment of children sinus pericranii / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis and treatment of children sinus pericranii (SP).</p><p><b>METHODS</b>From Jan. 2000 to Dec. 2008, 12 cases of SP were treated. The clinical data and CT results were studied. If the SP had no communication with the intracranial vessels, DSA was performed to know its venous drainage. The operation procedures included excision of bump, followed by hemostasis. Then the local flap was used to cover the cranial defect.</p><p><b>RESULTS</b>12 cases all had scalp bump whose size was changed with body position. Three-dimensional CT showed a crater-like depression and multiple honeycomb diploic holes in the skull. 6 cases with venous malformation received DSA. 12 patients were operated.</p><p><b>CONCLUSIONS</b>SP can be diagnosed with typical CT results and symptoms. DSA should be performed if the communication with the intracranial vessels is existed. The main methods include operation, embolization and reserved observation. Medicine injection is not recommended due to the high risk.</p>

Sinus pericranii: an uncommon tortuous vascular anomaly with traumatic origin

Sinus pericranii is an unusual venous anomaly characterized by communication of pericranial varicosities with an underlying dural sinus. The varicosities are intimately associated with the periostium, are distensible, and vary in size with changes in intracranial pressure. Symptoms are infrequent but include headache, vertigo, feelings of fullness, local pain, or dermatological lesion. It presents at the paediatric age group more than other age groups and it affects males more than females. Although its aetiology has not been settled yet, however, computerized tomography scan discloses those of traumatic nature. Although, in many instances, it raises a cosmetic concern to the patient and parents, the condition is not without possible "significant' complications, e.g., haemorrhage, infection, dermatological, and air embolism during operative intervention. We describe the clinical features, imaging and operative findings of a case of Sinus pericranii presented to our department, the reason for the surgical treatment of which was the cosmetic concern of the patient's parents

Sinus Pericranii: A Case Report and the Literature Review / 대한뇌혈관외과학회지

Sinus pericranii is a rare vascular anomaly that's characterized by an extracranial vascular mass with anastomotic connections between the intracranial and extracranial systems via the diploic veins of the skull. Preoperative evaluations for making the diagnosis are important to help prevent unexpected intraoperative bleeding. We report here on a case of surgically treated sinus pericranii in a 20-year-old female following minor head trauma. The clinical manifestations, pathogenesis and managements are discussed, and we also review the relevant literature.

Sinus Pericranii in an Infant: MR Imaging and Angiographic Findings

Sinus pericranii is a rare vascular anomaly involving abnormal communication between the intracranial and extracranial venous circulations. Although the condition can be diagnosed clinically, imaging is required to distinguish it from other entities and to identify the connection between the extracranial and intracranial dural venous sinus. We report the characteristic MR imaging and angiographic findings of a case of sinus pericranii.

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.

Radiologic Findings of Sinus Pericranii

Sinus pericranii is a rare vascular anomaly consisting of abnormal venous communication between intra- andextracranial circulation. We report one case, confirmed by surgery, and describe the radiological findings ofDoppler ultrasonography, CT and MR imaging.

Proptose intermitente associada a sinus pericranii: diagnóstico diferencial de varizes orbitrárias / Intermitent proptosis associated with sinus pericranii: diferential diagnosis of orbital varices

Um caso de Sinus Pericranii associado a uma malformação do seio sagital superior, na qual o lobo frontal apresenta sua drenagem venosa para o exterior do crânio através do próprio Sinus Pericranii, originando varizes orbitárias. O diagnóstico preciso foi obtido pelo estudo angiográfico e o tratamento foi conservador devido ao risco cirúrgico. Foi feita uma breve revisão da literatura sobre Sinus Pericranii.

A Case of Parital Sinus Pericranii

Sinus pericranii is a rare vascular anomaly which is defined as a group of abnormal communications between the extracranial and intracranial venous systems, usually involving the superior sagittal sinus. A case of parietal sinus pericranii is presented which 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, bone scan, computed tomography and angiography are presened. The presence of vascular endothelium in the pathologic examination suggested a congenital origin. The lesion, pericranial blood sinus was removed completely and then mutiple, small vascular connections through the underlying skull were obliterated by air-powered drilling.

Two Cases of Sinus Pericranii

The "sinus pericranii" is a rare vascular anomaly involving an abnormal communication between extracranial and intracranial venous system, which usually involves the superior sagittal sinus, sometimes the transverse sinus. It is found beneath or in the periosteum of the cranial vault and is connected with an intracranial sinus through anomalous diploic veins of congenital or acquired origin. It is benign scalp mass, and should be differentiated from vascular anomalies of the scalp and cystic masses of the scalp communication with the cerebrospinal space. The authors present 2 cases of sinus pericranii which was spontaneously developed without any history if head injury. The lesion was found to be changed in it's volume according to patient's head position. Clinical characteristics of sinus pericranii is discussed.