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Sinus pericranii (SP) is a rare vascular condition that results when abnormal communication between the intracranial and extracranial venous systems is present. Here we report a rare case of hydrocephalus revealed through a SP scalp mass with a review of literature. A 13-year-old girl presented with a history of bulging left eye, bilateral gradual deterioration of vision, nausea, and progressive headaches. The family reported the sudden appearance of a scalp mass prior to these symptoms. Brain imaging showed supra- and infratentorial communicating hydrocephalus and subcutaneous vascular collaterals from the midportion of the superior sagittal sinus. After ventriculoperitoneal shunt insertion, interval reduction of the ventricular size and disappearance of extracranial veins without associated intra- or extracranial vascular anomalies was observed. SP is divided into two main types: (1) Spontaneous type, in which lesions are formed due to acquired causes without a syndromic association or other vascular anomalies or stenosis. The most commonly reported cause is trauma in which SP may develop at the trauma site rather than the midline. (2) Congenital type, in which case the most commonly reported association is craniosynostosis. It can also be seen with vein of Galen hypoplasia, vein of Galen malformations, dural sinus malformations, solitary developmental venous anomalies, and intraosseous arteriovenous malformations. We are reporting the first case of idiopathic SP with hydrocephalus without a congenital association or acquired cause, including trauma. The sudden change in SP size can indicate a change in intracranial pressure and the development of hydrocephalus. [ABSTRACT FROM AUTHOR]

Management of meningiomas with major dural venous sinus involvement is challenging. We present our case series and perspective on reconstruction of the sinuses. Fifty-five patients underwent operations between 2005 and 2016 and the retrospective data were collected and analyzed. The cohort was younger with a mean of 51.3 years (range, 19–72 years) predominantly involving the superior sagittal sinus (44 patients). Sinus involvement was classified into group 1 (<50% of sinus, n = 28), group 2 (50%–99%, n = 8), and group 3 (total occlusion, n = 19). Venous collateralization was present in 100% of group 2 and 3 and in 36% of group 1 occlusions. Sinus pericranii was seen in 22 patients. Gross total resection was achieved in 87.2%, and sinus reconstruction followed in 38 patients (24 by direct suture and 14 by a patch graft). Pathology showed 36 (65%) World Health Organization grade I, 18 (33%) grade II, and 1 (2%) grade III tumors. During the mean follow-up of 60 months (range, 1–132 months), sinus was patent (74%) or narrowed but patent (24%) in 98%; 2 recurrences (3.6%) were observed (at 24 and 120 months). The mean preoperative/postoperative Karnofsky Performance Status and Kaplan-Meier cumulative overall/recurrence-free survival were 84.2%/88.1% and 90.9%/80.1%, respectively. These meningiomas present in a younger population, are more likely to be World Health Organization grade II or III, necessitating a more aggressive tumor resection strategy. Aggressive resection coupled with sinus reconstruction results in good long-term surgical outcome and low recurrence rates. [ABSTRACT FROM AUTHOR]

Background Sinus pericranii (SP) is a rare abnormal connection between the intracranial and extracranial venous drainage pathways through the osseous channels. Herein we present the case of a patient with growing SP, which was successfully treated using endovascular transvenous embolization through external compression with a plastic cup for preventing glue migration into subcutaneous veins. Case Description A 9-month-old boy presented with a gradually growing mass on the midline cranial vertex after his birth, for which transvenous embolization was performed. A microcatheter was successfully navigated into the SP from the superior sagittal sinus. Because the subcutaneous drainages were confirmed to be multidirectional, we compressed the drainages through the skin using a plastic cup during the glue injection step for preventing glue migration. Subsequently, the SP was completely obliterated. The postoperative course was uneventful. Conclusions Manual compression using a plastic cup was useful not only for embolization but also for reducing the physician's exposure to radiation as compared with that in the finger compression method. When a direct puncture is required, a plastic cylinder can also be used. [ABSTRACT FROM AUTHOR]

Résumé Le sinus pericranii désigne un ensemble de présentations cliniques qui ont en commun une connexion pathologique entre les veines du scalp et le sinus veineux intracrânien sous-jacent. La nature de cette communication va de la simple dilatation des veines émissaires du crâne, à des connexions larges à travers un os calvarial défectueux laissant quasiment le sinus veineux intracrânien en contact direct avec les structures sous-cutanées. Les auteurs présentent le cas d'un sinus pericranii occipital de découverte peropératoire. Congénitale, post-traumatique ou spontanée, l'anomalie concerne le plus souvent le scalp frontal, et siège sur ou près de la ligne médiane. La présentation clinique habituelle est celle d'une masse souple qui se vide à la pression en position debout, tandis qu'elle se remplit dans toutes les situations qui augmentent la pression intracrânienne (manœuvre de Valsalva ...). Le diagnostic de certitude n'est pas toujours facile à établir, et repose sur un faisceau d'arguments cliniques et radiologiques. À travers une revue de la littérature nous proposons de mettre le point sur les particularités cliniques, moyens diagnostiques et options thérapeutiques de cette entité rare. Summary The sinus pericranii refers to a set of clinical presentations that share a pathological communication between the scalp veins and the underlying cranial venous sinus. The nature of this connection ranges from the simple dilatation of the emissary veins, to wide connections through a calvarial bone loss leaving almost the cranial venous sinus in direct contact with the subcutaneous tissue. The authors present the case of an occipital pericranii sinus of intraoperative discovery. Congenital, post-traumatic or spontaneous, this anomaly is most often frontal and located on or close to the midline. The usual clinical presentation is that of a soft mass that empties to the pressure while standing, while it fills in all situations that increase the intracranial pressure (Valsalva maneuver ...). The diagnosis is not always easy to establish, and relies on a bundle of clinical and radiological arguments. Through a review of the literature we propose to focus on the clinical features, diagnostic means and therapeutic options of this rare entity. [ABSTRACT FROM AUTHOR]

Background: Hair collar sign (HCS) and hair tuft of the scalp (HTS) are cutaneous signs of an underlying neuroectodermal defect, but most available data are based on case reports.Objective: We sought to define the clinical spectrum of HCS and HTS, clarify the risk for underlying neurovascular anomalies, and provide imaging recommendations.Methods: A 10-year multicenter retrospective and prospective analysis of clinical, radiologic, and histopathologic features of HCS and HTS in pediatric patients was performed.Results: Of the 78 patients included in the study, 56 underwent cranial and brain imaging. Twenty-three of the 56 patients (41%) had abnormal findings, including the following: (1) cranial/bone defect (30.4%), with direct communication with the central nervous system in 28.6%; (2) venous malformations (25%); or (3) central nervous system abnormalities (12.5%). Meningeal heterotopia in 34.6% (9/26) was the most common neuroectodermal association. Sinus pericranii, paraganglioma, and combined nevus were also identified.Limitations: The partial retrospective design and predominant recruitment from the dermatology department are limitations of this study.Conclusions: Infants with HCS or HTS are at high risk for underlying neurovascular anomalies. Magnetic resonance imaging scans should be performed in order to refer the infant to the appropriate specialist for management. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of atretic parietal cephalocele with a persistent parietal falcine sinus and partial absence of the straight sinus. The direct puncture angiographic study demonstrated that there was a major venous channel through the parietal skull defect. From the embryological point of view, this association may provide us with possible pathoetiologic evidence of congenital sinus pericranii is one of the alternative venous drainage pathways to compensate venous outflow in the cases of intracranial developmental anomalies. [Copyright &y& Elsevier]

Abstract: Sinus pericranii is one of the differential diagnoses which should be considered when a physician encounters a patient with a subcutaneous soft scalp mass. Sinus pericranii is a rare vascular anomaly of the venous drainage between the intracranial and extracranial systems via the diploe of the skull. We describe here a 16-year-old female with sinus pericranii following minor head trauma four years prior. CT and MRI scans revealed heterogeneous enhancement of the lesion and three-dimensional CT showed a crater-like depression and multiple honeycomb diploic holes in the skull. Angiography was normal, whereas percutaneous sinusography revealed a connection between the lesion and the superior sagittal sinus. The patient underwent surgery to disconnect her diploic veins from the lesion under general anaesthesia, and her postoperative course was uneventful after six months follow-up. To avoid profuse bleeding and air emboli and to ameliorate cosmetic problems, a specific diagnosis should be made to plan appropriate treatment. [Copyright &y& Elsevier]

Background Sinus pericranii is a rare vascular anomaly characterized by abnormal connections between the extra- and intracranial venous systems. Although the etiology still remains unclear, sinus pericranii is usually congenital in nature, or less likely may be secondary to spontaneous or traumatic causes. Case Description We present a unique case of spontaneous sinus pericranii secondary to a parasagittal meningioma invading and occluding the superior sagittal sinus, torcula herophilii, and bilateral transverse sinuses. The resultant venous outlet obstruction and venous hypertension may have been the inciting factors for the development of the collateral channel connecting the intra- and extracranial venous systems. Conclusions This case highlights the effect of the reversal of normal venous outflow secondary to meningiomatous occlusion of intracranial dural sinuses. Sinus pericranii may, on rare occasions, represent the sole means for intracranial venous drainage in cases of intracranial venous thrombosis or incomplete development of the cerebral venous system. Therefore, this case also highlights the importance of pretreatment evaluation of the venous drainage system in patients with sinus pericranii and those with meningiomas. [ABSTRACT FROM AUTHOR]

Abstract: We present a 3.5-year-old male infant who had been treated at 3 weeks of age with a ventriculoperitoneal (VP) shunt for intraventricular haemorrhage with resultant hydrocephalus. Since his initial treatment he had normal developmental milestones. On this occasion he presented with difficulty in walking, vomiting and irritability. His mother was concerned this was due to his shunt malfunctioning. It had not required revision since insertion as a neonate. He was initially managed at a peripheral hospital without neurosurgical services for 4 weeks as an outpatient. The major clinical concern was a gradually enlarging lesion confined to the top of his head consistent with a vascular malformation. Investigations were focused towards this, with an initial diagnosis made of a cerebral arteriovenous malformation (AVM) with involvement of scalp vessels. His initial head CT scan did not show enlarged ventricles and the shunt was clinically assessed as functioning satisfactorily. The patient’s condition worsened and he was referred with a diagnosis of scalp AVM for neurosurgical attention. After neurosurgical review a clinical diagnosis of raised intracranial pressure (ICP) due to shunt malfunction was made. This was supported by a CT scan that showed an enlarging ventricular system. After revision of the shunt there was complete resolution of the pulsatile scalp swelling with clinical recovery of the child. To our knowledge this is the first reported incidence of a blocked VP shunt causing raised ICP presenting with a localised extracranial pulsatile venous dilation consistent with a “true” sinus pericranii. [Copyright &y& Elsevier]