Antonetta Margaretha Gezina Sas, MD and
Fop van Kooten, PhD
From the Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Address correspondence and reprint requests to Dr. F. van Kooten, Department of Neurology, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
An 18-year-old woman was referred for a slowly growing tumoron her scalp, which had been present since her birth. Examinationrevealed a soft-tissue non-pulsating mass on her scalp (figure 1)which became larger in recumbent position and with Valsalvamaneuver. CT showed that almost the entire venous system drainedthrough enlarged parietal foramina with dilated emissary veinsconnected to multiple subcutaneous veins, which is called sinuspericranii (SP) (figure 2). Generally, SP is located frontallyin the midline and connected with the superior sagittal sinus.SP is commonly asymptomatic, and classified as dominant if themajor venous flow is through the SP and accessory if it concernsa minor part of the venous flow. The prognosis is nearly alwaysgood with a low risk of bleeding. Only accessory SPs can betreated safely by surgical intervention or endovascular embolization.1,2Treatment is not recommended for dominant SP and we did notrecommend treatment in this case.
Figure 2 CT scan without (A and B) and with contrast (C and D) just beneath (A and C) and just above (B and D) the skull
CT scan without (A and B) and with contrast (C and D) with axial slices intracranially just under (A and C) and extracranially just above (B and D) the skull through the tumor, showing bilateral enlarged parietal foramina (F) with dilated emissary veins and the varicosity of the tumor. Not shown here, but visible on CT, were hypoplasia of the falx, bilateral small transverse and sigmoid sinuses, and small jugular foramina with minimally developed jugular veins.
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