title: Sinus pericranii: diagnosis and management in 21 pediatric patients.
abstract: OBJECTIVE
  Sinus pericranii (SP) is a rare venous anomaly abnormally connecting the intracranial dural sinuses with the epicranial veins. In the present study the authors aimed to clarify this clinicoradiological entity, define the role of angiography in its preoperative assessment, and suggest a diagnostic-therapeutic flow chart for management purposes.
  
  
  METHODS
  The authors retrospectively reviewed the clinical charts and neuroimages of 21 patients with SP. All patients underwent brain MRI, MR venography, and craniocerebral CT. Diagnostic digital subtraction angiography was performed in 19 of 21 patients, and the SPs were categorized as dominant (draining the majority of the intracranial venous outflow) or accessory (draining only a minority of the intracranial venous outflow).
  
  
  RESULTS
  SP was median or paramedian in 20 patients and lateral in 1 patient. There were 5 dominant and 14 accessory SPs. The dominant SPs were not treated. Among the patients with accessory SP, 4 were not treated, 2 underwent surgical ligature, and 8 were treated endovascularly (with either transvenous or percutaneous embolization). No complications were observed, and symptoms disappeared after treatment in all cases.
  
  
  CONCLUSIONS
  Accepted guidelines or recommendations concerning the management, diagnosis, and treatment of SP are still lacking. The authors define here a diagnostic-therapeutic flow chart, in which angiography plays a crucial role in the classification of SP and choice of the optimal treatment. Only accessory SP is amenable to treatment, whereas dominant SP must be preserved. The endovascular approach is becoming increasingly relevant and has proven to be safe and effective.
authors.affiliation: Departments of 1 Pediatric Neurosurgery and.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavanello
authors.forename: Ilaria
authors.initials: I
authors.lastname: Melloni
authors.forename: Eleonora
authors.initials: E
authors.lastname: Antichi
authors.forename: Mariasavina
authors.initials: M
authors.lastname: Severino
authors.forename: Marcello
authors.initials: M
authors.lastname: Ravegnani
authors.forename: Gianluca
authors.initials: G
authors.lastname: Piatelli
authors.forename: Armando
authors.initials: A
authors.lastname: Cama
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Carlo
authors.initials: C
authors.lastname: Gandolfo
mesh_terms: D015901:Angiography, Digital Subtraction; D002648:Child; D002675:Child, Preschool; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000601:surgery; D003663:Decision Trees; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D010690:Phlebography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020779:Sinus Pericranii / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: CDUS = color Doppler ultrasound; DSA = digital subtraction angiography; DVA = developmental venous anomaly; GDC = Guglielmi detachable coil; MRV = MR venography; SP = sinus pericranii; endovascular treatment; scalp vein; sinus pericranii; vascular anomaly; vascular disorders