Sinus Pericranii

Case contributed by Dr Gilcrease-Garcia

Presentation

Swelling over mid parietal region, aggravated by crying or dependent positioning.

Patient Data

Age: 6 mo
Modality: X-ray

Focal irregular cranial defect along sagittal suture.

Modality: Ultrasound

Hypoechoic lesion superficial to the right parietal bone near midline.  This lesion communicates with the superior sagittal sinus via a 1 mm defect in the parietal bone.  Doppler images show flow from the superior sagittal sinus, through the osseous defect, and into the extracranial lesion.  Spectral analysis  of flow within the lesion has a venous characterization.

Modality: MRI

There is a dilated right superficial temporal vein, which communicates with a cluster of dilated superficial veins near the posterior parietal vertex and proximally drains into the right retromandibular vein. 

The cluster of superficial vessels crosses midline before looping back to give rise to a single large venous channel that penetrates the diploic space before terminating in the superior sagittal sinus.

Normal flow signal within the venous structures including the superior sagittal sinus, interior cerebral veins, sigmoid sinuses, straight sinus, and transverse sinuses.

Case Discussion

6 month old female born with a skull defect in mid parietal region, with classic symptoms of engorgement and swelling aggravated by crying or dependent positioning. Clinical diagnosis of sinus pericranii (SP) was confirmed with imaging.

The patient was taken to surgery at approximately 1 year of age. During the procdure, a venous varix was identified in the subgaleal space and the auxiliary retromandibular draining venous limb was ligated and excised.  A small midline craniectomy was curetting out circumferentially around the base of the stalk of the SP. The stalk and pedicle were coagulated with bipolar cautery. There were no complications.

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Case Information

rID: 45061
Case created: 12th May 2016
Last edited: 3rd Jun 2016
Inclusion in quiz mode: Included

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