Sinus pericranii is a cranial venous anomaly in which there is an abnormal communication between intracranial dural sinuses and extracranial venous structures, usually via an emissary transosseous vein.
It is considered a type of low flow vascular malformation. It occurs in close communication with the cranial vault and most frequently involves the superior sagittal sinus.
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Clinical presentation
A simple clinical test can be performed when suspected on a radiological basis. Unless thrombosed, the sinus pericranii will appear more prominent in supine position than when sitting because of variable venous pressure with gravity. The lesions are not classically associated with discolouration of the overlying skin.
Pathology
They comprise non-muscular venous blood vessels that tightly adhere to the outer calvaria and directly communicate with an intracranial venous sinus through diploic veins 1,4.
Associations
Radiographic features
Ultrasound
Color Doppler may show communication with superficial veins and dural venous sinuses 2.
CT
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non contrast
slightly increased attenuation compared with brain parenchyma
may show an associated cranial vault defect
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post contrast
unless thrombosed, the abnormal communication between dural sinuses and the cranial vault will tend to enhance to the same degree as cerebral venous structures
MRI
The signal may vary due to slow flow 2. An abnormal communication between dural sinuses and the cranial vault is usually seen.
Differential diagnosis
Consider:
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