Surgical Treatment of Scaphocephaly With Sinus Pericranii

Abstract

A 1-year-old female was admitted with a subcutaneous, pulsatile soft mass in the midline parietal region, and abnormal head shape. Fundus examination showed papilledema, suggesting elevated intracranial pressure. Radiological findings showed sagittal suture craniosynostosis with sinus pericranii. Magnetic resonance venography showed that the drainage through the sinus pericranii was not essential for the venous outflow from the brain. The patient underwent surgical resection of the sinus pericranii and total cranial remodeling. Ligation of the stalk-like orifice attached to the superior sagittal sinus with resection of the sinus pericranii and total cranial reconstruction were performed concurrently. The postoperative course was uneventful, and her papilledema resolved. No recurrence of the sinus pericranii has occurred for 3 years. This case describes a unique one-staged operation to treat sinus pericranii with sagittal suture craniosynostosis.

36‐Year‐Old Man with Parietal Scalp Mass

“…MRI with contrast is the best tool to diagnose sinus pericranii , showing the connection of the vascular mass to an intracranial dural venous sinus . CT scan shows associated bone defect and the enhancement of the mass with intravenous contrast . Differential diagnoses are clinical and radiological.…”

“…It is a pulsatile mass with thrill. Cavernous hemangiomas may clinically look like sinus pericranii but they are localized in the subcutaneous tissue and do not adhere to the skull and they do not communicate with intracranial veins . In children, clinical differential diagnoses include meningoceles and meningoencephaloceles but radiologically they do not contain vascular structures .…”

“…Other lesions and malformations have been reported associated with sinus pericranii such as scaphocephaly, systemic angiomas, mutlisutural synostosis, Crouzon and oxycephaly …”

Single, small, spontaneous, accessory, closed type, frontal sinus pericranii in a child: Favorable outcome with surgical excision

“…[9,10] Raised intracranial pressure especially chronic venous hypertension has been considered as one of the possible risk factor for congenital variant and this hypothesis is supported by its association with craniosynostosis and spontaneous regression of sinus pericranii after bony correction to alleviate intracranial hypertension. [10][11][12][13][14] Mechanical theory with traumatic avulsion of emissary veins is the most accepted hypothesis for traumatic cases. [4,5,15] Various classification patterns based on the size of venous communication, nature of circulation and compressibility status have been described.…”

“…[10] Traditionally surgical intervention in the form of sac excision, trans-cranial venous anastomotic channel blockage and reinforcement/ replacement of the underlying bone or minimally invasive endovascular neuro-intervention has been advocated for usually asymptomatic patients with cosmetic disfigurement. [13,14,19,20] More recently, there has been a paradigm shift in the management of sinus pericranii patients conservatively, considering sinus pericranii as normal and often necessary venous shunting whose disconnection from the brain could have grave consequence. [10][11][12] Angiographic evidence of dependence of venous outflow of brain on dominant sinus pericranii or developmental venous anomaly draining into accessory sinus pericranii is important contraindication for surgical removal.…”