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Sinus pericranii: an update illustrated with a large case with long-term follow-up. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fujimoto Y, Ishibashi R, Maki Y, Kitagawa M, Kinosada M, Kurosaki Y, Ikeda H, Chin M. A Simple Surgical Technique for Pediatric Sinus Pericranii: Intraoperative Manual Compression of a Major Shunting Point. Pediatr Neurosurg 2021; 56:286-291. [PMID: 33780955 DOI: 10.1159/000514478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sinus pericranii is a vascular anomaly with extra- and intracranial venous connections. Sinus pericranii is categorized into 2 groups according to its contribution to the normal venous circulation. The accessory type sinus pericranii, which does not contribute to the normal major venous circulation, can be managed. Despite several proposed operative maneuvers, a standardized technique is yet to be established to control intraoperative bleeding. CASE PRESENTATION A 2-week-old neonate underwent examination of a subcutaneous mass in the parieto-occipital region. The subcutaneous mass had a major venous connection to the superior sagittal sinus on ultrasonography. The subcutaneous mass was partially thrombolized on magnetic resonance imaging and was minimally enhanced on computed tomography venography. The subcutaneous mass seemed not to contribute to the normal venous circulation. Surgical removal of the subcutaneous mass was performed due to its increased size at the age of 1 year and 3 months. While subcutaneous mass was detached from the scalp, the major venous connection was manually compressed, and minor venous connections were easily detected. The intraoperative bleeding was controllable. The pathological diagnosis was sinus pericranii. The patient is now followed up in the outpatient clinic. No recurrence was seen 18 months after the surgery. DISCUSSION/CONCLUSION Intraoperative hemostasis is essential while sinus pericranii is detached from the cranium. Hemostatic agents such as bone wax or absorbable gelatin and heat coagulation seem to be useful. However, complicative hemorrhage concerning to the preceded technique has been also reported. As seen in our case, to detect minor shunting points between the sinus pericranii and the intracranial veins, the major venous connection was manually compressed. Intraoperative manual compression of a major venous connection of sinus pericranii can be an option to manage intraoperative bleeding.
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Affiliation(s)
- Yuki Fujimoto
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Yoshinori Maki
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masashi Kitagawa
- Department of Neurosurgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masanori Kinosada
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | | | - Hiroyuki Ikeda
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
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Sinus pericranii occipital : à propos d’une situation inhabituelle et revue de la littérature. ANN CHIR PLAST ESTH 2019; 64:106-111. [DOI: 10.1016/j.anplas.2018.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/17/2018] [Indexed: 11/18/2022]
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Sanders FH, Edwards BA, Fusco M, Oskouian RJ, Tubbs RS, Johnston JM. Extremely large sinus pericranii with involvement of the torcular and associated with Crouzon's syndrome. Childs Nerv Syst 2017; 33:1445-1449. [PMID: 28685259 DOI: 10.1007/s00381-017-3507-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Sinus pericranii is a rare vascular malformation that connects the intracranial dural sinuses to the extracranial venous drainage system and is caused by either trauma or congenital defects. Although the majority of these vascular structures are due to trauma, some are congenital. CASE REPORT Herein, we report a 5-month-old patient with a very large and fluctuating subcutaneous mass over the occiput and the diagnosis of Crouzon's syndrome. The child presented with a large midline mass that on imaging, connected to the underlying torcular and was diagnosed as a sinus pericranii. At long-term follow-up and without operative intervention, the sinus pericranii resolved. This uncommon relationship is reviewed. CONCLUSION Premature closure of posterior fossa sutures as part of Crouzon's syndrome can present with large sinus pericranii. Such subcutaneous swellings might resolve spontaneously.
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Affiliation(s)
- Felipe H Sanders
- Seattle Science Foundation, Seattle, WA, USA.,Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - Bryan A Edwards
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada. .,, 11545 95A Ave, Delta, BC, V4C 3V4, Canada.
| | - Matthew Fusco
- Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA.,Department of Neurosurgery, Vanderbilt University, Nashville, TN, USA
| | | | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, USA.,Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
| | - James M Johnston
- Seattle Science Foundation, Seattle, WA, USA.,Pediatric Neurosurgery, Children's of Alabama, Birmingham, AL, USA
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Ellis JA, Mejia Munne JC, Feldstein NA, Meyers PM. Determination of sinus pericranii resectability by external compression during angiography: technical note. J Neurosurg Pediatr 2016; 17:129-133. [PMID: 26474103 DOI: 10.3171/2015.6.peds15183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sinus pericranii is an uncommon congenital cranial venous malformation that may become symptomatic in the pediatric population. Both dominant and accessory sinus pericranii, as determined by the intracranial venous drainage pattern, have been described. The dominant variety drain a significant proportion of the intracranial venous outflow while the accessory variety have minimal or no role in this. Classic teachings hold that dominant sinus pericranii should never be treated while accessory sinus pericranii may be safely obliterated. This determination of dominance is solely based on a qualitative assessment of standard venous phase catheter cerebral angiography, leaving some doubt regarding the actual safety of obliteration. In this paper the authors describe a simple and unique method for determining whether intracranial venous outflow may be compromised by sinus pericranii treatment. This involves performing catheter angiography while the lesion is temporarily obliterated by external compression. Analysis of intracranial venous outflow in this setting allows visualization of angiographic changes that will occur once the sinus pericranii is permanently obliterated. Thus, the safety of surgical intervention can be more fully appraised using this technique.
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Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York
| | - Juan C Mejia Munne
- Department of Neurological Surgery, Columbia University Medical Center, New York
| | - Neil A Feldstein
- Department of Neurological Surgery, Columbia University Medical Center, New York
| | - Philip M Meyers
- Department of Neurological Surgery, Columbia University Medical Center, New York
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Bouali S, Maamri K, Abderrahmen K, Asma B, Boubaker A, Hafedh J. Clinical and imaging findings in a rare case of sinus pericranii. Childs Nerv Syst 2015; 31:1429-32. [PMID: 26174617 DOI: 10.1007/s00381-015-2813-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/03/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sinus pericranii is a rare, usually asymptomatic condition that is characterized by an abnormal communication between the intra- and extracranial venous drainage pathways. The etiology is unknown but both congenital and post-traumatic etiologies have been proposed. Treatment is primarily surgical but newer minimally invasive endovascular approaches have been reported and is indicated due to cosmesis, hemorrhage, and air embolism. ILLUSTRATIVE CASE We present a case of an 11-month-old boy having sinus pericranii, who was referred for a slowly growing tumor located frontally in the midline on his scalp since 6 months of age. CT-scan with three-dimensional CT (3D-CT) reconstruction and magnetic resonance imaging along with venography was performed which confirmed the diagnosis. Simple surveillance was decided because of a limited esthetic prejudice and the absence of any functional disorder. CONCLUSION The prognosis is nearly always good with a low risk of bleeding. A simple follow-up is often proposed because of the usual absence of complications.
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Affiliation(s)
- Sofiene Bouali
- Department of Neurosurgery, National Institute of Neurology "Mongi Ben Hmida", Tunis, Tunisia, Faculty of Medicine, University of Tunis el MANAR, el Manar, Tunisia,
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Park SC, Kim SK, Cho BK, Kim HJ, Kim JE, Phi JH, Kim IO, Wang KC. Sinus pericranii in children: report of 16 patients and preoperative evaluation of surgical risk. J Neurosurg Pediatr 2009; 4:536-42. [PMID: 19951040 DOI: 10.3171/2009.7.peds0994] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Sinus pericranii (SP) is a rare venous varix in an extracranial location connected to the intracranial venous system. The aim of this retrospective study was to report on 16 pediatric cases of SP with consideration of the preoperative evaluation of surgical risk. METHODS The study population consisted of 10 patients who had undergone surgery for SP and 6 patients with concomitant craniosynostosis and SP. The mean age of the patients at presentation was 3.7 years. To identify characteristics of SP with high operative risk, 8 cases in this report and 11 previously reported cases of SP with sufficient information were categorized on the basis of the number and size of SP, the number and size of transcranial channels, the venous drainage type, and the amount of blood loss. Hemorrhage amounts were classified into 3 grades based on the description of intraoperative blood loss. RESULTS Sinus pericranii not associated with craniosynostosis were resected without any postoperative morbidity. Sinus pericranii associated with craniosynostosis were preserved. After craniofacial reconstruction, 2 cases of SP with craniosynostosis regressed, completely in one patient and partially in another. These 2 patients with SP were confirmed to have compromised intracranial sinus before craniofacial reconstruction. Among a total of 19 patients, multiplicity or size (> 6 cm) of SP (p = 0.036) and multiplicity (> 3) or size (> 3 mm) of transcranial channels (p = 0.004) was associated with more severe hemorrhage grade. Sinus pericranii with peripheral venous drainage (drainer type) was not associated with hemorrhage grade after classification into 3 grades (p = 0.192). However, all 3 cases of SP with massive Grade 3 hemorrhage were the drainer type. Hemorrhage grade was correlated with the number of risk factors for SP (r = 0.793, p < 0.001). CONCLUSIONS Three risk factors of SP and the presence of compromised intracranial sinus are markers for highrisk SP. "Squeezed-out sinus syndrome" is suggested as a concept for SP associated with compromised intracranial sinus, mainly caused by craniosynostosis. Sinus pericranii in squeezed-out sinus syndrome probably serves as a crucial alternative to venous drainage of the brain with intracranial venous compromise. Conservative treatment for such patients with SP is recommended.
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Affiliation(s)
- Seong-Cheol Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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Wang HC, Ma YB, Duan ZX, Zhang H, Li ZX. Sinus pericranii in the right frontal region and thrombosis. Int J Neurosci 2009; 119:2262-73. [PMID: 19916855 DOI: 10.3109/00207450903165569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sinus pericranii is a rare vascular anomaly in which an abnormal communication exists between the extracranial venous system and the underlying dural venous sinus via the diploe of the skull. We describe a case of a spontaneous thrombosis of the sinus pericranii which was located in the right frontal region and presented as a focal, leathery, and noncompressible mass distinguished in character from the typical manifestation of sinus pericranii. In this case, CT, DSA, MRI, MR venography (MRV), and pathologic examination were performed. The CT showed the bone depression in the skull and the MRI demonstrated the mass, but they were not sufficiently sensitive to detect the thrombus. Pathologic examination and MRV were helpful in depicting the thrombus. She underwent a surgical resection, and at the 5-month follow-up there was no evidence of recurrence.
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Affiliation(s)
- Hong-Cai Wang
- Department of Neurosurgery, No. 3 People's Hospital Affiliated to Shanghai Jiao Tong, University School of Medicine, Baoshan District, Shanghai, China
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Brook AL, Gold MM, Farinhas JM, Goodrich JT, Bello JA. Endovascular transvenous embolization of sinus pericranii. Case report. J Neurosurg Pediatr 2009; 3:220-4. [PMID: 19338469 DOI: 10.3171/2008.10.peds08267] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sinus pericranii (SP) is an abnormal communication between the intra- and extracranial venous drainage pathways. Treatment of this condition has mainly been recommended for reasons of cosmesis and prevention of hemorrhage. The authors report a novel endovascular transvenous route for definitive treatment of SP.
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Affiliation(s)
- Allan L Brook
- Departments of Radiology Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA
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Kaido T, Kim YK, Ueda K. Diagnostic and therapeutic considerations for sinus pericranii. J Clin Neurosci 2006; 13:788-92. [PMID: 16815024 DOI: 10.1016/j.jocn.2005.07.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Accepted: 07/06/2005] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Takanobu Kaido
- Department of Neurosurgery, Oyodo Town General Hospital, Oyodo, Nara, Japan.
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Wen CS, Chang YL, Wang HS, Kuo MF, Tu YK. Sinus pericranii: from gross and neuroimaging findings to different pathophysiological changes. Childs Nerv Syst 2005; 21:482-8. [PMID: 15490192 DOI: 10.1007/s00381-004-1035-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2003] [Revised: 04/30/2004] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- Chung-Shi Wen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei 100, Taiwan, Republic of China.
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