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[Traumatic sinus pericranii. Case report]
Insights
A rare case of sinus pericranii, an extracranial vascular malformation, developed in a child following head trauma. Surgical resection successfully removed the mass and closed the connection to the superior sagittal sinus.
Area of Science:
- Vascular Surgery
- Pediatric Neurosurgery
- Medical Imaging
Background:
- Sinus pericranii is a rare congenital or acquired vascular malformation involving abnormal communication between intracranial venous sinuses and extracranial veins.
- Traumatic head injuries, particularly those involving scalp contusions and fractures, are implicated in the development of acquired sinus pericranii.
Observation:
- A patient with a history of head trauma at age 1 presented at age 5 with a palpable extracranial scalp mass.
- Diagnostic angiography revealed the mass connected to the superior sagittal sinus via emissary veins.
- Histological examination showed a vascular malformation without neoplastic features.
Findings:
- The scalp mass was diagnosed as secondary sinus pericranii, directly linked to the prior head trauma.
- Complete surgical resection of the mass and closure of the sinus connection were successfully performed.
- The case highlights the potential for delayed development of sinus pericranii after significant head injury.
Implications:
- This case underscores the importance of considering sinus pericranii in the differential diagnosis of pediatric scalp masses, especially with a history of trauma.
- Prompt diagnosis and surgical management are crucial for preventing complications such as hemorrhage or infection.
- Further research into the pathogenesis and long-term outcomes of traumatic sinus pericranii is warranted.
Abstract:
The patient was involved in a traffic accident at the age of 1 and the left parieto-occipital scalp was contused without skull fracture. At the age of 5, an extracranial scalp mass was first noticed just beneath the multiple scalp scars. Angiography through the mass revealed that the extracranial mass cavity was connected to the superior sagittal sinus through the emissary veins. The mass located in the subgaleal, epiperiosteal space was totally resected and the connection with the intracranial sinus was closed with bone wax. Histologically, there were many capillaries and some large blood cavities with only one layered endothelium and connective tissue. Therefore, the mass was diagnosed as sinus pericranii and considered to be secondary to previous head trauma because: 1) The patient had a history of head trauma with considerably severe scalp injuries. 2) The extracranial blood sinus was located exactly beneath the traumatic scar. 3) There was no neoplastic tissue histologically. 4) No scalp mass was noticed before the traffic accident. 5) There was an elapsed time between the trauma and the growth of the mass. 6) No scalp nevus such as port-wine stain existed.