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[A case of sinus pericranii manifesting as a parietal midline mass]
1Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa-city, Chiba 277-8567, Japan.
Abstract:
A case of sinus pericranii was reported. A 5-year-old boy was admitted to our hospital, complaining of scalp mass located at the midparietal region. He was noticed to have had it since 3 years before. The mass decreased in size under mild compression, and during standing position, but increased in size due to lying down. Magnetic resonance imaging (MRI) demonstrated a mass with mixed signal intensity on the T1 weighted image and high signal intensity on the T2 weighted image. Gd-DTPA study showed irregular enhancement. Cerebral angiogram showed no communication between the mass and the superior sagittal sinus. Neither did direct injection of contrast medium into the mass revealed any communication. 3D-CT demonstrated three tiny bone defects beneath the mass. Open surgery revealed that the mass existed between the galea aponeurotica and the periosteum, which had a small communication with the emissary vein. Pathological examination showed a multiple lobular cyst with endothelial wall lining. This case report highlighted the fact that sinus pericranii with minimal communication with the dural sinus can be treated by removal of the mass and closure of the cranial bone abnormalities with bone wax without craniotomy.
Insights
This case report details a sinus pericranii in a child, a rare scalp mass. Successful treatment involved mass removal and bone defect closure without craniotomy.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Vascular Malformations
Background:
- Sinus pericranii is a rare congenital vascular malformation characterized by a venous communication between the intracranial dural sinuses and the pericranial veins.
- These lesions typically present as a soft, compressible scalp mass that enlarges when the patient is in a dependent position.
Observation:
- A 5-year-old boy presented with a midparietal scalp mass present for 3 years, which varied in size with posture.
- Magnetic resonance imaging (MRI) revealed a mass with mixed T1 and high T2 signal intensity, and irregular enhancement after Gd-DTPA administration.
- Cerebral angiography and direct mass injection failed to demonstrate communication with the superior sagittal sinus, while 3D-CT identified small underlying bone defects.
Findings:
- Surgical exploration confirmed the mass was located between the galea aponeurotica and periosteum, with a minor communication to an emissary vein.
- Pathological examination identified the mass as a lobular cyst with an endothelial lining.
- The absence of significant dural sinus communication was noted.
Implications:
- This case highlights a minimally communicating sinus pericranii successfully treated via surgical excision and closure of cranial bone defects with bone wax.
- The findings suggest that craniotomy may not be necessary for treating certain sinus pericranii cases, offering a less invasive surgical approach.
- This approach potentially reduces surgical morbidity in pediatric patients with this rare vascular anomaly.