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 »  Abstract
 »  Introduction
 »  Case report
 »  Discussion
 »  References

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Year : 2001  |  Volume : 49  |  Issue : 3  |  Page : 305-7

Sinus pericranii in the frontal region : a case report.


Department of Neurosurgery, Seth G.S. Medical College and King Edward Memorial Hospital, Parel, Mumbai-400012, India.

Correspondence Address:
Department of Neurosurgery, Seth G.S. Medical College and King Edward Memorial Hospital, Parel, Mumbai-400012, India.
deketandesai@hotmail.com

  »  Abstract

Sinus pericranii is a rare vascular anomaly. A case of sinus pericranii at the nasion with an orbital extension is presented. The drainage was into the superior sagittal sinus. The pathogenesis is discussed and the literature is reviewed.

How to cite this article:
Desai K, Bhayani R, Goel A, Muzumdar D. Sinus pericranii in the frontal region : a case report. Neurol India 2001;49:305


How to cite this URL:
Desai K, Bhayani R, Goel A, Muzumdar D. Sinus pericranii in the frontal region : a case report. Neurol India [serial online] 2001 [cited 2019 Dec 7];49:305. Available from: http://www.neurologyindia.com/text.asp?2001/49/3/305/1251




   »   Introduction Top

Sinus pericranii is a rare vascular anomaly. It is an abnormal venous communication between the extracranial and intracranial circulation, which usually involves the superior sagittal sinus and some times the transverse sinus.[1] Sinus pericranii usually presents in the paediatric age group as a smallcircumscribed swelling of the scalp. In general, sinus pericranii is considered to be a congenital anomaly. Some cases have been attributed to trauma or to an unusual stress or strain.[2] Various synonyms for this anomaly have been described such as osteovascular fistula, venous tumour of the cranial bones and subperiosteal venous tumour,[3] but the term sinus pericranii has been well accepted. A rare case of sinus pericranii at the root of the nose with an orbital extension is presented. Sinus pericranii with an orbital component is not reported earlier.


   »   Case report Top

A 16 year old female presented with a soft swelling at the nasion for 5 years. The swelling did not increase significantly over this period. On examination the swelling was 1.5 x 1.5 cm in size, soft, globular, fluctuant and reducible on pressure. The swelling was non-pulsatile but had a positive impulse on coughing. It became tense on valsalva maneuver. The skin over the swelling was normal and there was no transillumination. The plain X- ray of the skull demonstrated an irregular erosion of the root of the nasal bone. The computerised tomography (CT) scan showed an isodense lesion at the nasion with an extension into the supero-medial aspect of the left orbit. There was homogenous enhancement following contrast administration [Figure - 1]. Digital substraction angiography (DSA) showed a normal arterial phase. The venous phase showed a large irregular venous lake just behind the nasion. A thin vein was seen communicating the venous lake with the superior sagittal sinus. The rest of the cortical veins showed no abnormality [Figure - 2] and [Figure - 3]. As the patient was asymptomatic and the swelling was non progressive in size, she has been under observation for the last 4 years.


   »   Discussion Top

Hecker first described this vascular anomaly in 1845 as 'varix spurious circumscriptus venae diploicae frontalis'.[1] In 1850, Stromeyer referred this anomaly as a 'subperiosteal blood-filled cyst of the skull communicating with an intracranial sinus' and proposed the term 'sinus pericranii'.[4] Ohta et al described this condition as a collection of venous blood vessels without tunica muscularis or 'venous haemangioma' adhering tightly to the outer surface of the skull bone and directly communicating with an intracranial venous sinus by way of many diploic veins of several sizes. [5] Sinus pericranii has been defined as a varix and classified into three types according to the size of the venous communication between the extracranial blood sac and intracranial venous sinus.[1] Newton and Troost described it as a communication between the extracranial and intracranial venous circulation via large, tortuous, thin walled vascular channels.[6] Volkmann described two types of sinus pericranii : 'true sinus' which fills with increased intracranial pressure and disappears completely with compression and 'pseudo sinus', which fails to disappear completely with compression. They considered the latter to be angioma or cavernoma of mainly venous component. Three possible theories have been postulated regarding the pathogenesis of this anomaly i.e. congenital, spontaneous and traumatic. The congenital theory is widely accepted.[3] Heinke stated that vomiting, forceful coughing, respiratory disturbances and other such forces might cause tearing of emissary veins at the bone surface eventually resulting into a communicating blood cyst on the skull surface.[7] Cohn stated that the endothelial lining of the wall of the sinus pericranii differentiates the congenital type from the acquired type.[8] Most cases of sinus pericranii are located near the midline. The frontal region is most frequently involved followed by the parietal region.[1] A lateral location is unusual.[9] Frontal sinus pericranii with an orbital extension has not been reported in the literature. Usually the patients are not symptomatic and the problems are cosmetic. Rarely there may be headache, giddiness and vertigo. The diagnosis of sinus pericranii can be made by the appearance of soft, fluctuant mass located near the intracranial sinus, which usually vary in size with change in the intracranial pressure. DSA is diagnostic, as it demonstrates the sinus pericranii in the venous phase. Magnetic resonance imaging shows a signal void.[1] The differential diagnosis includes arteriovenous malformation, epicranial varix, cavernoma, growing skull fracture, eosinophilic granuloma, epidermoid tumour, dermoid, meningocele and encephalocele. The sinus pericranii are reported to be associated with vascular malformation, haemangioma of the cerebellum or retina as a part of the von Hippel-Lindau syndrome, blue naevus syndrome, venous cavernoma of the scalp and haemangioma of the tongue.[10]
Although spontaneous regression of sinus pericranii has been reported,[11] most patients require removal of the sinus and blocking the communicating veins. The occlusion of this abnormal pathway has not been reported to result in intracranial venous hypertension.[10] The possible complications during surgery are haemorrhage and air embolism.[1] In our case the patient was asymptomatic, hence was kept under observation.

 

  »   References Top

1.Bollar A, Allut AG, Prieto A et al : Sinus pericranii: radiological and etiolopathological considerations. J Neurosurg1992; 77: 469-472.   Back to cited text no. 1    
2.Mori K, Yoneda S, Handa H : Posttraumatic subepicranial varix. Surg Neurol1976; 5 : 337-339.   Back to cited text no. 2    
3.Mastin WM : Venous-blood tumours of the vault of the cranium communicating with the intracranial venous circulation, especially through the medium of the superior longitudinal sinus. Ann Surg 1885; 1 : 324-340.   Back to cited text no. 3    
4.Stromeyer L : Ueber sinus pericranii. Dtsch Klin 1850; 2 : 160-161.   Back to cited text no. 4    
5.Ohta T, Waga S, Handa H et al : Sinus pericranii. J Neurosurg1975; 42 : 704-712.   Back to cited text no. 5    
6.Newton TH, Troost BT : Arteriovenous malformations and fistulae, In : Radiology of the skull and brain, Newton TH, Potts DG (eds): Vol II. Specific disease processes. CV Mosby St Louis. 1974; 2490-2565.   Back to cited text no. 6    
7.Heinke W : Die chirurgischen Krankheiten des Kopfes. Dtsch Chir1882; 31 : 56-66.   Back to cited text no. 7    
8.Cohn I : Sinus pericranii. Report of a case, review of literature. Surg Gynecol Obstet 1926; 42 : 614-624.   Back to cited text no. 8    
9.Vaquero J, de Sola RG, Martinez R : Lateral sinus pericranii. Case report. J Neurosurg1983; 58 : 139-140.   Back to cited text no. 9    
10.Buxton N, Vloeberghs M : Sinus pericranii. Report of a case and review of the literature. Pediatr Neurosurg1999; 30 : 96-99.   Back to cited text no. 10    
11.Hayakawa I, Fujiwara K, Sasaki A et al : Spontaneous regression of sinus pericranii, report of a case. No Shinkei Geka 1978; 6 : 91-95.   Back to cited text no. 11    

 

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