A review of extraaxial developmental venous anomalies of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, venous varices or aneurysmal malformations, and enlarged emissary veins

Abstract

<jats:p>This paper is a narrative review of extraaxial developmental venous anomalies (eDVAs) of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, enlarged emissary veins, and venous varices or aneurysmal malformations. The article highlights the natural history, anatomy, embryology, imaging, clinical implications, and neurosurgical significance of these lesions, which the authors believe represent a continuum, with different entities characterized by distinct embryopathologic features. The indications and surgical management options are discussed for these individual intracranial pathologies with relevant illustrations, and a novel classification is proposed for persistent falcine sinus (PFS). The role of neurointervention and/or microsurgery in specific cases such as sinus pericranii and enlarged emissary veins of the skull is highlighted.</jats:p><jats:p>A better understanding of the pathophysiology and developmental anatomy of these lesions can reduce treatment morbidity and mortality. Some patients, including those with vein of Galen malformations (VOGMs), can present with the added systemic morbidity of a high-output cardiac failure. Although VOGM is the most studied and classified of the above-mentioned eDVAs, the authors believe that grouping the former with the other venous anomalies/abnormalities listed above would enable the clinician to convey the exact morphophysiological configuration of these lesions, predict their natural history with respect to evolving venous hypertension or stroke, and extrapolate invaluable insights from VOGM treatment to the treatment of other eDVAs. In recent years, many of these symptomatic venous malformations have been treated with endovascular interventions, although these techniques are still being refined. The authors highlight the broad concept of eDVAs and hope that this work will serve as a basis for future studies investigating the role of evolving focal venous hypertension/global intracranial hypertension and possibilities of fetal surgical intervention in these cases.</jats:p>

Intracranial venous malformations: Incidence and characterization in a large pediatric cohort

“…alternative, intracranial venous drainage is available for the brain region in question, such SP can be therapeutically occluded safely. Most sinus pericranii are asymptomatic, 12 and in our population most often were found incidentally or on workup for associated venous malformation of the head or face. Classification schemes have been proposed on the basis of various hypothetical types and etiologies of SP, 13 only some of which contain vascular endothelium on histology.…”

The evaluation of cerebral venous normal anatomy and variations by phase-contrast cranial magnetic resonance venography

“…Earlier joins coinciding with the regression process on the left, possibly lead to recessive left vessel chain. ACV regression on the left side influences not only JV but also TS and SS [4,13]. This study revealed that if the TS was dominant, the SS and JV were also dominant on the same side [2].…”

“…Transverse sinus (TS) and sigmoid sinus (SS) originate from the posterior plexus, jugular vein (JV) originates from the anterior cardinal vein (ACV). The correlation between these embryological structures can be determined by comparison of dominance [4]. Can the embryological mechanisms be explained by evaluating the correlation of vascular structures originating from different embryological bud's?…”

A Simple Surgical Technique for Pediatric Sinus Pericranii: Intraoperative Manual Compression of a Major Shunting Point

“…The management indications of SP are prevention of fatal thrombosis, traumatic air embolism, and spontaneous hemorrhage, in addition to a negative cosmetic appearance [10]. Direct surgery, endovascular surgery, and sclerotherapy have been used for the treatment of SP [3, 8, 15].…”

“…Due to the possible risk of postoperative brain swelling, interventional treatment for dominant SP remains contraindicated [9]. As for direct surgery for accessory SP, several surgical techniques to control intraoperative bleeding have been proposed, but are yet to be standardized [10]. Here, we report a pediatric case of SP through which we propose a simple intraoperative technique to facilitate the control of bleeding.…”