Sinus pericranii in children: report of 16 patients and preoperative evaluation of surgical risk

Clinical article

Seong-Cheol Park M.D.1,3, Seung-Ki Kim M.D., Ph.D.1,3, Byung-Kyu Cho M.D., Ph.D.1,3, Hyun Jib Kim M.D., Ph.D.1, Jeong Eun Kim M.D., Ph.D.1, Ji Hoon Phi M.D.1,3, In-One Kim M.D., Ph.D.2,3, and Kyu-Chang Wang M.D., Ph.D.1,3
View More View Less
  • 1 Departments of Neurosurgery, and
  • | 2 Radiology, Seoul National University College of Medicine; and
  • | 3 Seoul National University Children's Hospital, Seoul, Republic of Korea
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

Object

Sinus pericranii (SP) is a rare venous varix in an extracranial location connected to the intracranial venous system. The aim of this retrospective study was to report on 16 pediatric cases of SP with consideration of the preoperative evaluation of surgical risk.

Methods

The study population consisted of 10 patients who had undergone surgery for SP and 6 patients with concomitant craniosynostosis and SP. The mean age of the patients at presentation was 3.7 years. To identify characteristics of SP with high operative risk, 8 cases in this report and 11 previously reported cases of SP with sufficient information were categorized on the basis of the number and size of SP, the number and size of transcranial channels, the venous drainage type, and the amount of blood loss. Hemorrhage amounts were classified into 3 grades based on the description of intraoperative blood loss.

Results

Sinus pericranii not associated with craniosynostosis were resected without any postoperative morbidity. Sinus pericranii associated with craniosynostosis were preserved. After craniofacial reconstruction, 2 cases of SP with craniosynostosis regressed, completely in one patient and partially in another. These 2 patients with SP were confirmed to have compromised intracranial sinus before craniofacial reconstruction. Among a total of 19 patients, multiplicity or size (> 6 cm) of SP (p = 0.036) and multiplicity (> 3) or size (> 3 mm) of transcranial channels (p = 0.004) was associated with more severe hemorrhage grade. Sinus pericranii with peripheral venous drainage (drainer type) was not associated with hemorrhage grade after classification into 3 grades (p = 0.192). However, all 3 cases of SP with massive Grade 3 hemorrhage were the drainer type. Hemorrhage grade was correlated with the number of risk factors for SP (r = 0.793, p < 0.001).

Conclusions

Three risk factors of SP and the presence of compromised intracranial sinus are markers for highrisk SP. “Squeezed-out sinus syndrome” is suggested as a concept for SP associated with compromised intracranial sinus, mainly caused by craniosynostosis. Sinus pericranii in squeezed-out sinus syndrome probably serves as a crucial alternative to venous drainage of the brain with intracranial venous compromise. Conservative treatment for such patients with SP is recommended.

Abbreviations used in this paper:

DS = digital subtraction; ICP = intracranial pressure; SP = sinus pericranii; TOF = time-of-flight.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Alperin N, , Lee SH, , Mazda M, , Hushek SG, , Roitberg B, & Goddwin J, et al.: Evidence for the importance of extracranial venous flow in patients with idiopathic intracranial hypertension (IIH). Acta Neurochir Suppl 95:129132, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Azusawa H, , Ozaki Y, , Shindoh N, & Sumi Y: Usefulness of MR venography in diagnosing sinus pericranii: case report. Radiat Med 18:249252, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Bollar A, , Allut AG, , Prieto A, , Gelabert M, & Becerra E: Sinus pericranii: radiological and etiopathological considerations. Case report. J Neurosurg 77:469472, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Brisman JL, , Niimi Y, & Berenstein A: Sinus pericranii involving the torcular sinus in a patient with Hunter's syndrome and trigonocephaly: case report and review of the literature. Neurosurgery 55:433, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Bruhl K, , Stoeter P, , Wietek B, , Schwarz M, , Humpl T, & Schumacher R, et al.: Cerebral spinal fluid flow, venous drainage and spinal cord compression in achondroplastic children: impact of magnetic resonance findings for decompressive surgery at the cranio-cervical junction. Eur J Pediatr 160:1020, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Buxton N, & Vloeberghs M: Sinus pericranii. Report of a case and review of the literature. Pediatr Neurosurg 30:9699, 1999

  • 7

    Chen Z, , Feng H, , Zhu G, , Wu N, & Lin J: Anomalous intracranial venous drainage associated with basal ganglia calcification. AJNR Am J Neuroradiol 28:2224, 2007

    • Search Google Scholar
    • Export Citation
  • 8

    Cinalli G, , Spennato P, , Sainte-Rose C, , Arnaud E, , Aliberti F, & Brunelle F, et al.: Chiari malformation in craniosynostosis. Childs Nerv Syst 21:889901, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Févre M, & Modec L: Sinus pericranii et tumeurs vasculaires extracraniennes communiquant avec la circulation intracranienne. J Chir (Paris) 47:561588, 1936

    • Search Google Scholar
    • Export Citation
  • 10

    Gandolfo C, , Krings T, , Alvarez H, , Ozanne A, , Schaaf M, & Baccin CE, et al.: Sinus pericranii: diagnostic and therapeutic considerations in 15 patients. Neuroradiology 49:505514, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Jung S, , Lee JK, , Kim SH, , Kim JH, , Kang SS, & Lee JH: Parietal sinus pericranii: case report and technical note. Surg Neurol 54:270273, 2000

  • 12

    Kaido T, , Kim YK, & Ueda K: Diagnostic and therapeutic considerations for sinus pericranii. J Clin Neurosci 13:788792, 2006

  • 13

    Kurosu A, , Wachi A, , Bando K, , Kumami K, , Naito S, & Sato K: Craniosynostosis in the presence of a sinus pericranii: case report. Neurosurgery 34:10901093, 1994

    • Search Google Scholar
    • Export Citation
  • 14

    Linderkamp O, , Versmold HT, , Riegel KP, & Betke K: Estimation and prediction of blood volume in infants and children. Eur J Pediatr 125:227234, 1977

  • 15

    Marras C, , McEvoy AW, , Grieve JP, , Jager HR, , Kitchen ND, & Villani RM: Giant temporo-occipital sinus pericranii. A case report. J Neurosurg Sci 45:103109, 2001

    • Search Google Scholar
    • Export Citation
  • 16

    Moritani T, , Aihara T, , Oguma E, , Makiyama Y, , Nishimoto H, & Smoker WR, et al.: Magnetic resonance venography of achondroplasia: correlation of venous narrowing at the jugular foramen with hydrocephalus. Clin Imaging 30:195200, 2006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Nakayama T, & Matsukado Y: Sinus pericranii with aneurysmal malformation of the internal cerebral vein. Surg Neurol 3:133137, 1975

  • 18

    Nemoto EM: Dynamics of cerebral venous and intracranial pressures. Acta Neurochir Suppl 96:435437, 2006

  • 19

    Osborn AG, , Blaser S, & Salzman K: Diagnostic Imaging: Brain Salt Lake City, Amirsys, 2004

  • 20

    Poole MD: Surgical caution with Carpenter's syndrome. J Craniomaxillofac Surg 21:9395, 1993

  • 21

    Robson CD, , Mulliken JB, , Robertson RL, , Proctor MR, , Steinberger D, & Barnes PD, et al.: Prominent basal emissary foramina in syndromic craniosynostosis: correlation with phenotypic and molecular diagnoses. AJNR Am J Neuroradiol 21:17071717, 2000

    • Search Google Scholar
    • Export Citation
  • 22

    Sakai K, , Namba K, , Meguro T, , Mandai S, , Gohda Y, & Sakurai M, et al.: Sinus pericranii associated with a cerebellar venous angioma—case report. Neurol Med Chir (Tokyo) 37:464467, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Sandberg DI, , Navarro R, , Blanch J, & Ragheb J: Anomalous venous drainage preventing safe posterior fossa decompression in patients with Chiari malformation Type I and multisutural craniosynostosis. Report of two cases and review of the literature. J Neurosurg 106:6 Suppl 490494, 2007

    • Search Google Scholar
    • Export Citation
  • 24

    Sawamura Y, , Abe H, , Sugimoto S, , Tashiro K, , Nakamura N, & Gotoh S, et al.: [Histological classification and therapeutic problems of sinus pericranii.]. Neurol Med Chir (Tokyo) 27:762768, 1987. (Jpn)

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Spektor S, , Weinberger G, , Constantini S, , Gomori JM, & Beni-Adani L: Giant lateral sinus pericranii. Case report. J Neurosurg 88:145147, 1998

  • 26

    Taylor WJ, , Hayward RD, , Lasjaunias P, , Britto JA, , Thompson DN, & Jones BM, et al.: Enigma of raised intracranial pressure in patients with complex craniosynostosis: the role of abnormal intracranial venous drainage. J Neurosurg 94:377385, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Thompson DN, , Hayward RD, , Harkness WJ, , Bingham RM, & Jones BM: Lessons from a case of kleeblattschadel. Case report. J Neurosurg 82:10711074, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Tuite GF, , Evanson J, , Chong WK, , Thompson DN, , Harkness WF, & Jones BM, et al.: The beaten copper cranium: a correlation between intracranial pressure, cranial radiographs, and computed tomographic scans in children with craniosynostosis. Neurosurgery 39:691699, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Waga S, & Handa H: Scalp veins as collateral pathway with parasagittal meningiomas occluding the superior sagittal sinus. Neuroradiology 11:199204, 1976

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Wakisaka S, , Okuda S, , Soejima T, & Tsukamoto Y: Sinus pericranii. Surg Neurol 19:291298, 1983

  • 31

    Wen CS, , Chang YL, , Wang HS, , Kuo MF, & Tu YK: Sinus pericranii: from gross and neuroimaging findings to different pathophysiological changes. Childs Nerv Syst 21:482488, 2005

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 779 219 6
Full Text Views 185 14 1
PDF Downloads 186 18 1
EPUB Downloads 0 0 0