Sinus Pericranii (SP)

Sinus pericranii is a rare vascular birthmark condition. Normally, there is no obvious communication between the intracranial and extracranial venous drainages in the head. In patients with sinus pericranii, there is an abnormal communication, either from the extracranial system to the intracranial venous sinuses or from the intracranial venous system to the extracranial draining veins.  

 

1st image is a photo showing a small venous malformation in the forehead in a patient with proven sinus pericranii vascular anomaly. 2st image is an arteriogram showing intracranial vascular anomalies and opacification of the extracranial venous malformation in the forehead region.

Although a classic presentation of this condition is bluish skin discoloration or vascular birthmark on the midline forehead region, this condition is usually associated with large extensive vascular anomalies of the head and neck.    

The Importance of this condition is unclear; however, it is speculated that it may cause significant problems related to abnormal drainage pattern and/or weakness of the bony skull in the diseased area.  

Treatment of this condition is also unclear at this point. The general approach to these patients is to treat the extracranial vascular anomaly which is usually a venous malformation (commonly referred to as “cavernous hemangioma”) and to increase the stability of the bony skull surgically if needed. The venous drainage pattern of the intracranial circulation should be studied carfully before any attempts are made to treat the extracranial vascular lesion.

 

       
1st image is a subtraction radiograph during iodinated contrast injection into the scalp venous malformation anomaly clearly demonstrating an abnormal connection with the intracranial venous system or sinuses. 2nd image is a 3D CT reconstruction image showing a bony defect in the SP (temporal area). 

 

 

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