Dados do Trabalho
SINUS PERICRANII: AS AN OCCASIONAL FINDING.
Apresentação do caso
Two cases are presented through neuroimaging by different methods performed in healthy patients aged 5 years and 4 months, both with adequate neurodevelopment and asymptomatic. Complementary tests were requested in order to assess the nature of the occasional finding of a palpable lesion on physical examination during a routine pediatric consultation. Cranial ultrasound with Doppler flowmetry demonstrates communication between superficial veins and the sagittal venous sinus (Figura 1). Contrast-enhanced cranial tomography identified a left parietoccipital nodular lesion in the subcutaneous tissue, vascularized and communicating with diploic vessels to the sagittal sinus (Figure 2).
Pericranial sinus (sinus pericranii) is a rare low-flow vascular malformation related to the development of the cranial vault and the brain venous system. It is characterized by anomalous communication between intracranial dural sinuses and epicranial venous structures. Are closely associated with the periosteum and vary in size according to changes in intracranial pressure. It often involves the superior sagittal sinus. Most of them are congenital and are associated with other anomalies venous, such as aneurysmal malformation of the vein of Galen. From a clinical point, it is usually asymptomatic in childhood. When in adulthood, it can be related to headache, nausea and vertigo. On clinical examination, a tumor with a soft consistency is usually palpable and increases in size with crying/Valsalva maneuver. In addition to the methods of cranial ultrasound and cranial tomography, magnetic resonance imaging confirms a transosseous connection with blood flow from the sagittal sinus to the overlying pericranial varicosity and from the varicosity to an adjacent intracranial vein (Figure 3). Differential diagnoses should be considered, the main ones being dermoid and epidermoid cysts, infantile hemangioma and meningoceles. Treatment, is usually surgical by excision, although endovascular therapy (embolization) may be considered. The intervention aims to prevent complications, such as hemorrhage, infection or embolism.
Although it is a rare entity, sinus pericranii should be considered as a cause of chronic headache in adolescentes/young adults. Therefore, in patients with cranial bulging present since birth, diagnostic hypotheses should extend beyond epidermoid cysts and include consideration of the pericranial sinus, especially when located in the midline.
Referências (se houver)
Neuroimaging; Cranial vascular malformation; Pericranial sinus.
Fonte de Fomento (se houver)
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Sem conflito de interesse.
Hospital Moinhos de Vento - Rio Grande do Sul - Brasil
Nicole Zanardo Tagliari, Mariane Cibelle Barros, Marco Aurélio Castellano Almeida, Barbara Limberger Nedel, Rodrigo Dalcanalle Garcia, Letícia Antoniuk Seus, Gabriela Maycá Sanfelice, Gabrielle Canto Petter, Emanuele Smaniotto Frederich