Overview
Sinus pericranii (SP) is a rare vascular malformation characterized by abnormal connections between extracranial scalp veins and intracranial dural sinuses, often presenting as a mass that changes size with body position 1.Diagnosis
Clinical Presentation: Mass that varies in size with body position 1.
Imaging Studies: Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are crucial for detecting abnormal connections and flow patterns 4.
Neuroradiologic Findings: MRI may show a hole in the cranium underneath the subcutaneous mass; MRA with 2D-TOF can identify flow direction from intracranial to extracranial systems 4.
Physical Examination: Focus on dilated scalp veins and bony defects indicative of large venous communications 3.Management
Surgical Excision: Total excision of subgaleal masses with obliteration of intracranial communications is effective 3.
Control of Bleeding: Meticulous surgical technique is essential, especially in cases with large venous communications to prevent massive bleeding 3.
Symptomatic Relief: Surgical intervention can resolve intermittent visual, motor, and sensory symptoms associated with SP 2.Special Populations
Pediatrics: SP can present with unique symptoms in children, requiring careful neuroradiologic assessment and surgical intervention when symptomatic 24.Key Recommendations
Utilize MRI and MRA for accurate diagnosis and classification of sinus pericranii, particularly in pediatric patients (Evidence: Moderate 4).
Perform total excision of the subgaleal mass with meticulous obliteration of intracranial communications to achieve complete clinical cure (Evidence: Weak 3).
Consider surgical intervention for symptomatic cases to alleviate neurological symptoms effectively (Evidence: Weak 2).References
1 Nie Q, Zhao Y, Ding H, Wang Z. Frontal Mass That Varies in Size With Body Position: A Surgical Treatment of a Rare Case of Sinus Pericrania. The Journal of craniofacial surgery 2026. link
2 Dominguez JF, Shah S, Feldstein E, Ng C, Li B, Kim M et al.. Treatment of an Elusive Symptomatic Sinus Pericranii: Case Report and Review of the Literature. Journal of neurological surgery. Part A, Central European neurosurgery 2023. link
3 Wen CS, Chang YL, Wang HS, Kuo MF, Tu YK. Sinus pericranii: from gross and neuroimaging findings to different pathophysiological changes. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2005. link
4 Higuchi M, Fujimoto Y, Ikeda H, Kato A. Sinus pericranii: neuroradiologic findings and clinical management. Pediatric neurosurgery 1997. link