title: MRI findings of intracranial anomalies associated with cephalocele--a case series.
abstract: BACKGROUND
  Cephalocele is a relatively rare cranial dysraphism characterised by herniation of intracranial structures through the skull. Surgical management is primarily necessary where a risk of infection through communication of the lesion with the intracranial space exists, a risk of rupture, or for cosmetic purposes. Cephalocele is often associated with venous anomalies such as vertical embryonic positioning of the straight sinus, splitting of the superior sagittal sinus, vein of Galen elongation, along with tenting of the tentorium [Morioka et al. Childs Nerv Syst 25:309-315, 2009]
  
  
  METHODS
  Here, we report four cases of cephalocele with pre-operative MRI imaging retrospectively studied, demonstrating associated venous anomalies. Three of these patients went on to have uncomplicated, corrective surgery, while one was managed conservatively.
  
  
  RESULTS
  All four cases demonstrated the main venous drainage going through a persistent falcine sinus to drain into the superior sagittal sinus. Upward tenting of the tentorium was observed in three cases (cases 1, 3 and 4). Two of our cases demonstrated other venous anomalies frequently reported in the literature, namely splitting of the superior sagittal sinus and absence of the transverse sinus (case 1) and communication of the cephalocele with the superior sagittal sinus and absence of the straight sinus (case 2).
  
  
  CONCLUSIONS
  The association between cephalocele and venous anomalies suggests that pre-operative MRI should be mandatory for a full evaluation of a suspicious midline cranial lesion in order to evaluate the safety of corrective surgery.
authors.affiliation: Alder Hey Children's NHS Foundation Trust, Eaton Road, West Derby, Liverpool, L12 2AP, UK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Perez da Rosa
authors.forename: Christopher Paul
authors.initials: CP
authors.lastname: Millward
authors.forename: Muhammad Imran
authors.initials: MI
authors.lastname: Bhatti
authors.forename: Andrew
authors.initials: A
authors.lastname: Healey
authors.forename: Sasha Clare
authors.initials: SC
authors.lastname: Burn
authors.forename: Ajay
authors.initials: A
authors.lastname: Sinha
mesh_terms: D001164:Arteriovenous Fistula / Q000601:surgery; D004677:Encephalocele / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies