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Massive arachnoid granulation in the transverse sinuses on CT myelogram
Beatriz A de Macedo1, Dong Kun Kim2, Brian J Burkett2
1São Camilo Hospital, Fortaleza, Ceará, Brazil.
Radiology Case Reports
|March 28, 2025
Summary
A massive arachnoid granulation was found incidentally in a patient with persistent headaches. This rare finding, occupying both transverse sinuses, did not cause the patient's symptoms.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Giant arachnoid granulations are rare, typically associated with symptoms.
- The largest previously reported giant arachnoid granulation measured 6 cm.
Observation:
- A patient presented with persistent headaches after treatment for a CSF-venous fistula.
- Imaging revealed a massive, irregular arachnoid granulation distinct from the transverse sinuses.
Findings:
- Digital subtraction myelography was negative for residual or recurrent CSF-venous fistula.
- Contrast-enhanced MRI identified a large, nonenhancing lesion.
- Headaches resolved with indomethacin, indicating hemicrania continua and an incidental granulation.
Implications:
- This case highlights an unusually large arachnoid granulation without associated symptoms.
- It underscores the importance of differentiating incidental findings from causative pathologies.
- The presentation suggests that arachnoid granulations can be asymptomatic despite significant size.
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