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Arachnoid granulations, also known as Pacchionian granulations, are projections of the arachnoid membrane (villi) into the dural sinuses that allow CSF to pass from the subarachnoid space into the venous system.
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They increase in size and number with age and are seen in approximately two-thirds of patients.
They most frequently occur in a parasagittal location with the transverse and superior sagittal sinuses being the most common locations. The granulations typically occur next to the entrance of a superficial draining cortical vein into a sinus (similar to colonic diverticula occurring next to penetrating vessels).
They are most commonly encountered in radiological practice as incidental osteolytic, sharply circumscribed indolent-appearing lucencies on skull CT or x-rays, or a filling defect in dural venous sinuses, which can be mistaken for dural venous thrombosis.
The granulations are typically of CSF density and protrude into the calvaria or a dural venous sinus causing a filling defect. They may simulate a dural venous sinus thrombosis but are usually easy differentiated given their round well-defined shape and classic location.
Signal characteristics are generally those of CSF 2:
- T1: low signal intensity
- T2: high signal intensity; iso- or even slightly hyperintense to CSF
- FLAIR: should attenuate
- T1 C+ (Gd): no enhancement
Giant granulations (>10 mm) may show atypical MRI signal characteristics, with higher T1 and T2 signal than CSF and incomplete FLAIR signal suppression 5. Rarely these may cause sinus obstruction 6.
History and etymology
Arachnoid granulations are named after Antonio Pacchioni (1665-1726), an Italian physician, who wrote extensively on the anatomy of the dura mater, and provided the first written description of his eponymous granulations in 1705 in the Dissertatio Epistolaris de Glandulis Conglobatis Durae Meningis Humanae, one of his monographs 1.
On CT if there is lytic erosion of the bone also consider
- small calvarial metastases/myeloma/plasmacytoma etc.
- intradiploic epidermoid - often centered towards the mid to outer margins of the skull
- 1. Brunori A, Vagnozzi R, Giuffrè R. Antonio Pacchioni (1665-1726): early studies of the dura mater. (1993) Journal of neurosurgery. 78 (3): 515-8. doi:10.3171/jns.1993.78.3.0515 - Pubmed
- 2. Ikushima I, Korogi Y, Makita O et-al. MRI of arachnoid granulations within the dural sinuses using a FLAIR pulse sequence. Br J Radiol. 1999;72 (863): 1046-51. Br J Radiol (abstract) - Pubmed citation
- 3. Lu CX, Du Y, Xu XX et-al. Multiple occipital defects caused by arachnoid granulations: Emphasis on T2 mapping. World J Radiol. 2012;4 (7): 341-4. doi:10.4329/wjr.v4.i7.341 - Free text at pubmed - Pubmed citation
- 4. Rodallec MH, Krainik A, Feydy A et-al. Cerebral venous thrombosis and multidetector CT angiography: tips and tricks. Radiographics. 2006;26 Suppl 1 : S5-18. doi:10.1148/rg.26si065505 - Pubmed citation
- 5. Trimble CR, Harnsberger HR, Castillo M et-al. "Giant" arachnoid granulations just like CSF?: NOT!!. AJNR Am J Neuroradiol. 2010;31 (9): 1724-8. doi:10.3174/ajnr.A2157 - Pubmed citation
- 6. Kan P, Stevens EA, Couldwell WT. Incidental giant arachnoid granulation. AJNR Am J Neuroradiol. 2006;27 (7): 1491-2. Pubmed citation