Endovascular transvenous embolization of sinus pericranii

Abstract

<jats:p>Sinus pericranii (SP) is an abnormal communication between the intra- and extracranial venous drainage pathways. Treatment of this condition has mainly been recommended for reasons of cosmesis and prevention of hemorrhage. The authors report a novel endovascular transvenous route for definitive treatment of SP.</jats:p>

Sinus pericranii: diagnosis and management in 21 pediatric patients

“…There are reports in the literature on a few small series of patients treated surgically, 13,36 whereas conservative treatment has been described in some isolated cases. 1,40 Since 2009, a few cases of endovascular treatment have been reported, 7,22,37 but no large series exists yet. In the past 9 years, our management strategy for SP has progressively changed.…”

“…3,12 Moreover, brain MRI may fail to reveal the transcranial vein when the amount of flow is not conspicuous. 4 Cranial unenhanced CT with bone windowing is usually not able to depict transcranial vessels, 14 but it provides complementary information re- garding the location, size, shape, and margins of the bony communication, which enables us to choose the optimal size of the coils that should be used to embolize the vessel 7 and to select which side to navigate the catheter toward to reach the superior sagittal sinus. To minimize the patient's radiation exposure, we usually perform low-dose CT with automatic exposure control centered on the skull defect.…”

Endovascular embolization with Onyx in the management of sinus pericranii: a case report

“…4 Other conservative approaches have been proposed, since the bone channels are often small enough to be occluded with bone wax. 3 In case of an SP in which the cerebral venous pattern is accessory, surgical or endovascular treatment can be an option; as previously described, treatment of a dominant SP is contraindicated because it may lead to venous congestion, venous infarction, or bleeding. In the present case, indications for endovascular treatment were relief of facial pain and the desirability of a minimally invasive intervention for cosmetic reasons.…”

“…Endovascular treatment of SP with N-butyl cyanoacrylate glue has been proposed. 3 Since its approval by the US Food and Drug Administration, the liquid embolic agent Onyx (ethylenevinyl alcohol copolymer) has been used in the endovascular treatment of intracranial arteriovenous malformations, arteriovenous fistulas, and other venous malformations with excellent results. 5,8,16 We decided to combine the use of coils and Onyx to obtain a fast obliteration of the diploic vein, minimizing the number of coils used.…”

“…3 The communication usually occurs via dilated emissary or diploic veins that leave the skull through an aberrant skull defect that is usually lined with connective tissue or endothelial cells. The etiology of SP is unknown, although the condition was described as early as 1760 by Percival Pott.…”