Hypoplastic rostral superior sagittal sinus

Case contributed by Dr Dalia Ibrahim

Presentation

Headache. Suspected dural venous sinus thrombosis.

Patient Data

Age: 6-year-old
Gender: Female

Complete hypoplasia of the rostral one third of the superior sagittal sinus with compensatory drainage through bilateral large frontal cortical veins.

Normal MRI and MRV of the brain.

Right otomastoiditis.

Bilateral ethmoid and to less extent maxillary sinusitis.

Annotated image

Complete hypoplasia of the rostral one third of the superior sagittal sinus (sagittal image) with compensatory drainage through bilateral large frontal cortical veins (arrows in coronal image).

Case Discussion

Anatomic variations of the superior sagittal sinus are frequent.

Variations of SSS include:

  • variations in the anterior (rostral) SSS (most frequent)
  • hypoplasia of the middle part of SSS

Four types of variations of the anterior (rorstral) superior sagittal sinus may be identified:1

  • classic anatomy with a fully developed rostral SSS
  • duplication of the rostral SSS
  • unilateral hypoplastic rostral SSS
  • complete or bilateral hypoplastic rostral SSS,  in those cases of complete hypoplastic rostral SSS, the absent portion of the superior sagittal sinus is replaced by a pair of large parasagittal superior frontal cortical veins that run dorsally to join the origin of the SSS close to the coronal suture

Knowledge of this anatomic variation is extremely important to avoid wrong diagnosis with sinus thrombosis.

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