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| LETTER TO EDITOR |
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| Year : 2012 | Volume
: 60
| Issue : 2 | Page : 249-250 |
Fusiform aneurysm of transverse sinus associated with growth retardation
Yin Dong, Qingwei Liu
Department of Radiology, Provincial Hospital, Shandong University, Jinan, China
| Date of Submission | 22-Nov-2011 |
| Date of Decision | 16-Jan-2012 |
| Date of Acceptance | 22-Jan-2012 |
| Date of Web Publication | 19-May-2012 |
Correspondence Address:
Yin Dong
Department of Radiology, Provincial Hospital, Shandong University, Jinan
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.96430
How to cite this article:
Dong Y, Liu Q. Fusiform aneurysm of transverse sinus associated with growth retardation. Neurol India 2012;60:249-50 |
Sir,
Aneurysm of transverse sinus is a rare anomaly of the venous system. No more than ten cases of this anomaly have been found in the literature. Aneurysm of transverse sinus is saccular or fusiform dilatation of the transverse sinus. It manifested by pulsatile tinnitus or associated with other venous anomaly. [1],[2],[3] We report an infant with fusiform aneurysm of transverse sinus associated with growth retardation.
An eight-month-old male infant presented with growth retardation of about three months. Mother had normal pregnancy with no abnormal maternal and prenatal screens. He was 6.7 kg and 64 cm at admission indicating growth retardation, while head circumference was 47.5 cm which was larger than it should be. Otherwise the examination was normal. There was no history of previous trauma. Computed tomography (CT) scan revealed obstructive hydrocephalus caused by an isodense extra-axial lesion with a hyperdense capsule compressing the left cerebellar hemisphere. Left squamous part of the occipital bone had bulged and was thinner than the other side [Figure 1]. Magnetic resonance imaging (MRI) scan revealed a cystic lesion with flow artifacts in T2-weighted images (T2WI). The lesion enhanced homogeneously in T1-weighted images (T1WI) after contrast injection and continued to the left sigmoid sinus [Figure 2]. MR angiography showed aneurysmal dilatation of the left transverse sinus which connects the right transverse sinus and the superior sagittal sinus to the left sigmoid sinus, no abnormal arteries or veins were found in the vicinity [Figure 3]. Whole-spine MRI images were obtained after the brain examination to exclude any other anomaly, and no other abnormality such as dural dysplasia was found. Since the infant was so young and it was almost impossible to treat such an aneurysm by either endovascular treatment or surgery, he was given endoscopic third ventriculostomy for release of obstructive hydrocephalus and is being followed up. He gained weight and height rapidly a couple of weeks after surgery. | Figure 1: CT scan demonstrating obstructive hydrocephalus caused by mass effect of an isodense lesion in the left posterior cranial fossa
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 | Figure 2: MRI scan demonstrating flow artifacts in the cystic lesion (a,b) and homogeneous enhancement of the cystic lesion which shared same signal intensity with venous sinus and continued to left sigmoid sinus (c,d)
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 | Figure 3: MRI angiography demonstrating the continuity of transverse sinus aneurysm and right transverse sinus, left sigmoid sinus and superior sagittal sinus
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The case reported by Yilmazer et al.,[1] demonstrated a fusiform aneurysm of the left transverse sinus with bony erosion accompanied by internal jugular vein aneurysm. The patient was not treated and was followed up. Marco et al., [2] described a case with a wide-necked venous aneurysm of the left transverse sigmoid sinus, and they treated it by endovascularly stent placement across the aneurysm neck and embolization of the aneurysm with Guglielmi detachable coils. Gologorsky et al., [3] reported a wide-necked venous aneurysm of the right transverse sigmoid sinus, and they treated it by surgically coagulation of aneurysmal neck and reconstruction of transverse sigmoid junction with a series of U-clips. In our patient both surgical and endovascular treatments were rather contraindicated, so palliative third ventriculostomy was done for obstructive hydrocephalus. This procedure helped the patient in attaining weight and growth. Perhaps use of flow diverters would also be useful in such cases. However, because we had little experience with the use of flow diverters in infants and as we also felt that the infant might grow out of it, we did not use this method.
| » References | |  |
| 1. | Yilmazer R, Ulusan M, Kumral TL, Suoglu Y. Aneurysm of the Internal Jugular Vein and Transverse Sinus Associated with Occipital Bone Erosion. Internet J Head Neck Surg 2009;3:1-3. 
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| 2. | Zenteno M, Murillo-Bonilla L, Martínez S, Arauz A, Pane C, Lee A, et al. Endovascular treatment of a transverse-sigmoid sinus aneurysm presenting as pulsatile tinnitus. Case report. J Neurosurg 2004;100:120-2.
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| 3. | Gologorsky Y, Meyer SA, Post AF, Winn HR, Patel AB, Bederson JB. Novel Surgical Treatment of A Transverse-Sigmoid Sinus Aneurysm Presenting As Pulsatile Tinnitus: Technical Case Report. Neurosurgery 2009;64:393-4.
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[Figure 1], [Figure 2], [Figure 3]
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