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

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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 (&gt; 6 cm) of SP (p = 0.036) and multiplicity (&gt; 3) or size (&gt; 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 &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

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.…”

Sinus pericranii: long-term outcome in a 10-year-old boy with a review of literature

“…Surgical management has been demonstrated in a retrospective study conducted by Park et al where 10 patients underwent operations for SP 10. All patients with SP associated with craniosynostosis were managed conservatively.…”

Sinus Pericranii: A Scalp Mass in a 6-Month-Old Boy

“…Patients with SP present with a soft, nonpulsatile mass adherent to the scalp and situated near an intracranial sinus increasing in size with intracranial pressure (crying or Valsalva maneuvers) and disappearing on compression [1,2,5,7]. The lesion is usually located in the frontal region (40%), followed by parietal (34%), occipital (23%) and temporal (4%) locations [8].…”

“…In some cases it may be associated with craniosynostosis and developmental venous anomalies [2,4,5]. …”