Amuluru Krishna, Al-Mufti Fawaz, Shah Manan, Prestigiacomo Charles J, Liu James K, Gandhi Chirag D
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA; Department of Interventional Neuroradiology, University of Pittsburgh Medical Center - Hamot, Erie, Pennsylvania, USA.
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, New Jersey, USA.
World Neurosurg. 2017 Feb;98:872.e5-872.e9. doi: 10.1016/j.wneu.2016.11.129. Epub 2016 Dec 3.
Sinus pericranii is a rare vascular anomaly characterized by abnormal connections between the extra- and intracranial venous systems. Although the etiology still remains unclear, sinus pericranii is usually congenital in nature, or less likely may be secondary to spontaneous or traumatic causes.
We present a unique case of spontaneous sinus pericranii secondary to a parasagittal meningioma invading and occluding the superior sagittal sinus, torcula herophilii, and bilateral transverse sinuses. The resultant venous outlet obstruction and venous hypertension may have been the inciting factors for the development of the collateral channel connecting the intra- and extracranial venous systems.
This case highlights the effect of the reversal of normal venous outflow secondary to meningiomatous occlusion of intracranial dural sinuses. Sinus pericranii may, on rare occasions, represent the sole means for intracranial venous drainage in cases of intracranial venous thrombosis or incomplete development of the cerebral venous system. Therefore, this case also highlights the importance of pretreatment evaluation of the venous drainage system in patients with sinus pericranii and those with meningiomas.
颅骨膜窦是一种罕见的血管异常,其特征为颅外和颅内静脉系统之间存在异常连接。尽管病因仍不明确,但颅骨膜窦通常本质上是先天性的,或较少情况下可能继发于自发或创伤性原因。
我们报告了一例独特的自发性颅骨膜窦病例,继发于矢状窦旁脑膜瘤侵犯并阻塞上矢状窦、窦汇及双侧横窦。由此导致的静脉流出道梗阻和静脉高压可能是连接颅内和颅外静脉系统的侧支通道形成的诱发因素。
本病例突出了颅内硬脑膜窦被脑膜瘤阻塞后正常静脉流出方向逆转的影响。在颅内静脉血栓形成或脑静脉系统发育不全的情况下,颅骨膜窦可能在极少数情况下代表颅内静脉引流的唯一途径。因此,本病例还突出了对颅骨膜窦患者和脑膜瘤患者进行静脉引流系统术前评估的重要性。