Combined treatment of surgery and sclerotherapy for sinus pericranii

Rapidly growing sinus pericranii within a short period: a case report

INTRODUCTION

Sinus pericranii (SP) is a rare vascular malformation characterized by abnormal communication between the intracranial and extracranial venous systems [1]. Sinus pericranii is most commonly seen in the distribution areas of the superior sagittal and transverse sinuses [2]. There are no uniform criteria for the etiology, pathogenesis, diagnostic criteria, treatment options, or prognosis of sinus pericranii [3].

CASE DESCRIPTION

In this paper, we present the diagnosis and treatment of a child admitted to our neurosurgery department in 2019 with rapidly growing frontal sinus pericranii, as well as the 3-year postoperative follow-up.

DISCUSSION

The authors summarize the clinical presentation characteristics, diagnosis and treatment methods, and prognosis of this disease using relevant domestic and international literature to improve clinicians' understanding of this disease.

CONCLUSION

It is rare to see a significant growing of the sinus pericranii within a short period, and the mechanism of their occurrence needs to be further explored.

Clinical assessment and management of auricular arteriovenous malformation: retrospective study

BACKGROUND

Arteriovenous malformation (AVM) which is a high-blood-flow lesion with connections between arteries and veins without an intervening capillary bed, is difficult to manage. The ear is the second most common site of extracranial AVM. However, studies regarding the management of this condition remain lacking. The purpose of this study was to share managing experiences in our center and to investigate the treatment effect through a retrospective analysis of cases.

METHODS

Among 265 patients with AVM treated in our vascular anomalies center between January 2008 and January 2021, 10 patients with auricular AVM were included in the study to investigate the lesion distribution, clinical stage, and treatment methods by performing a retrospective evaluation.

RESULTS

Among 10 patients, five patients had AVMs distributed in the upper half of the ear, one patient in the lower half of the ear, and four patients in whole ear, respectively. Seven patients had Schobinger stage II, and three had stage III. One patient received surgical treatment only, four patients received sclerotherapy only, and five patients received both surgical treatment and sclerotherapy. The posttreatment status was checked as controlled in two patients, improved in seven patients, persistent in one patient. There were no worsening patients.

CONCLUSION

Auricular AVM is a disease that is difficult to manage by one specific department, thus requiring a collaborative management effort from multidisciplinary team.

Delayed rupture of a posttraumatic retromaxillary pseudoaneurysm causing massive bleeding: a case report

Posttraumatic pseudoaneurysm of the face is caused by blunt, penetrating, or surgical trauma. Although its incidence is low, pseudoaneurysm rupture can cause a life-threatening, massive hemorrhage. A 48-year-old man visited our emergency center due to a fall-down accident. Three-dimensional computed tomography (CT) showed a comminuted zygomaticomaxillary complex fracture of the left face. After open reduction and internal fixation, the surgical wound healed without any complications. However, the patient was readmitted 10 days after surgery due to pus-like discharge from the wound. Contrast-enhanced CT to find the abscess unexpectedly revealed a pseudoaneurysm in the left retromaxillary area. Massive oral bleeding occurred on the night of re-hospitalization and emergency surgery was done. The bleeding site was identified as a pseudo-aneurysmal rupture of the posterior superior alveolar artery in the retromaxillary area. Hemostasis was achieved by packing Vaseline gauze in the maxillary sinus using an endoscope. Delayed rupture and massive bleeding of posttraumatic retromaxillary pseudoaneurysm after a zygomaticomaxillary fracture is a low-probability, but high-impact event. Therefore, additional contrast-enhanced CT should be considered to evaluate the possibility of a posttraumatic pseudoaneurysm in cases of severe comminuted zygomaticomaxillary fracture.

A Simple Surgical Technique for Pediatric Sinus Pericranii: Intraoperative Manual Compression of a Major Shunting Point

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.