Letter to the Editor
Sinus pericranii: early infant diagnosis
Sinus pericranii: diagnóstico precoz en el lactante
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Se visualiza variz (flecha blanca, imagen de vacío de señal) con drenaje en seno sagital. B) Corte coronal a nivel de la variz (flecha blanca). Se observa la protrusión en superficie. C) Imagen axial en la que se observa el nivel de la lesión y su localización en línea media. D) Aspecto externo del sinus pericranii. Mácula a nivel de cuero cabelludo, fluctuante en la exploración.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Lubián-Gutiérrez, M.I. Sánchez-Códez, E. Peromingo-Matute, A. Zuazo-Ojeda" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Lubián-Gutiérrez" ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Sánchez-Códez" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Peromingo-Matute" ] 3 => array:2 [ "nombre" => "A." 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Iglesias Espinosa, J. Fernández Pérez, T. Ramírez García, P.J. Serrano Castro" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Iglesias Espinosa" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Fernández Pérez" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Ramírez García" ] 3 => array:2 [ "nombre" => "P.J." "apellidos" => "Serrano Castro" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485317303006" "doi" => "10.1016/j.nrl.2017.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485317303006?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300365?idApp=UINPBA00004N" "url" => "/21735808/0000003500000001/v1_202004040635/S2173580820300365/v1_202004040635/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "<span class="elsevierStyleItalic">Sinus pericranii</span>: early infant diagnosis" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "70" "paginaFinal" => "72" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Lubián-Gutiérrez, M.I. Sánchez-Códez, E. Peromingo-Matute, A. Zuazo-Ojeda" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Lubián-Gutiérrez" "email" => array:1 [ 0 => "manu.lubian@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.I." "apellidos" => "Sánchez-Códez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Peromingo-Matute" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Zuazo-Ojeda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Pediatría y sus áreas específicas, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario Puerta del Mar, Cádiz, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Sinus pericranii</span>: diagnóstico precoz en el lactante" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1702 "Ancho" => 1992 "Tamanyo" => 210057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Sagittal T2-weighted MRI sequence. The white arrow (signal voids) points to the varicose vein draining to the sagittal sinus. (B) Coronal slice at the level of the varicose vein (white arrow). Protrusion is observed at the surface. (C) Axial sequence showing the lesion at the midline. (D) External appearance of the <span class="elsevierStyleItalic">Sinus pericranii</span>. A macule is visible on the scalp; its size fluctuated during examination.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sinus pericranii</span> (SP) is an infrequent vascular malformation consisting of direct venous communication between the intracranial dural sinuses and epicranial veins, causing varicose dilation of these veins.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> The literature reports approximately 200 cases, half of which were diagnosed before the second decade of life.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> Diagnosis in early childhood is infrequent. We present the case of an infant presenting the malformation from birth.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 2-month-old boy with no relevant history and normal psychomotor development for his age. From birth, a soft purplish nodule of 3<span class="elsevierStyleHsp" style=""></span>mm diameter was present on the scalp; its size fluctuated with Valsalva manoeuvres and crying (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A cranial Power Doppler ultrasound showed a vascular lesion that increased in size with crying, draining into the superior sagittal sinus. Given suspicion of SP, we performed a non-contrast-enhanced MRI angiography of the venous sinus, with maximum intensity projection reconstruction. The study confirmed the vascular communication, showing a varicose vein draining into a pericranial vein, both of small size and located on the scalp. The varicose vein was receiving venous blood from the superior sagittal sinus through a transosseous vein. We opted for conservative treatment considering the patient's age and the characteristics of the malformation. The patient is currently asymptomatic and no changes have been observed in the lesion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">SP is the most frequent venous anomaly observed in diploic veins.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> The most frequent location is the midline, especially in the frontal region, although other locations have also been described.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">4,5</span></a> Most cases are congenital, due to probable transient hypertension during the embryonic period.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">3</span></a> However, diagnosis is usually delayed. The most frequent secondary causes include head trauma, which causes avulsion of the emissary veins.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,6</span></a> Our patient presents a congenital SP and is one of the earliest diagnosed cases in the literature.</p><p id="par0025" class="elsevierStylePara elsevierViewall">From a clinical viewpoint, progression is usually asymptomatic; examination typically reveals a bluish tumour of soft consistency that increases in size with Valsalva manoeuvres. Cases related to headache, skin pain, seizures, nausea, vertigo, ataxia, etc. have been described in adults.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,7–9</span></a> Furthermore, SP has been related to some vascular and lymphatic malformations or to syndromic symptoms, which was not the case in our patient.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">3,4,7,10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Diagnosis is clinical, although it is confirmed with radiology. There is no consensus on the test of choice. Computed tomography scans display associated bone defects, and magnetic resonance imaging is useful to rule out accompanying venous malformations (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">11–13</span></a> MR angiography provides the highest sensitivity; in our case, these images were very characteristic and were valuable in selecting the management approach (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Doppler ultrasound is a non-invasive method of visualising blood flow; in our patient, it was essential to orient the diagnosis. More cutting-edge techniques, such as digital subtraction angiography, show high sensitivity and more precise haemodynamic evaluation. Differential diagnosis includes other vascular malformations,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">14</span></a> eosinophilic granulomas, epidermoid tumours, meningoceles, encephaloceles, and traumatic leptomeningeal cysts.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,4</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Most reported cases support conservative treatment, with treatment performed for aesthetic reasons.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> Some studies discuss performing the intervention to prevent complications. These authors advocate the block resection of the cranial mass with ligation of the communicating vessels, although this is contraindicated when SP is part of the main cerebral venous drainage. Haemorrhage is the most frequent complication.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">1,7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">After assessing the risks and benefits of the treatment, we deem it reasonable to maintain a watchful waiting approach in asymptomatic patients. Published cases report good progression and prognosis, with no neurological deficits or reappearances in cases of intervention.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">15</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lubián-Gutiérrez M, Sánchez-Códez MI, Peromingo-Matute E, Zuazo-Ojeda A. <span class="elsevierStyleItalic">Sinus pericranii</span>: diagnóstico precoz en el lactante. Neurología. 2020;35:70–72.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1702 "Ancho" => 1992 "Tamanyo" => 210057 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Sagittal T2-weighted MRI sequence. The white arrow (signal voids) points to the varicose vein draining to the sagittal sinus. (B) Coronal slice at the level of the varicose vein (white arrow). Protrusion is observed at the surface. (C) Axial sequence showing the lesion at the midline. (D) External appearance of the <span class="elsevierStyleItalic">Sinus pericranii</span>. A macule is visible on the scalp; its size fluctuated during examination.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 755 "Ancho" => 900 "Tamanyo" => 54472 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MR angiography (magnetic resonance venography). The white arrows points to a varicose vein with pericranial drainage, communicating with the sagittal sinus through a transosseous vein.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Sinus pericranii</span>. A case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Guillen-Quesada" 1 => "M. Alamar-Abril" 2 => "G. García Fructuoso" 3 => "J.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 0 | 16 |
| 2024 October | 102 | 12 | 114 |
| 2024 September | 116 | 21 | 137 |
| 2024 August | 120 | 18 | 138 |
| 2024 July | 117 | 10 | 127 |
| 2024 June | 154 | 15 | 169 |
| 2024 May | 147 | 5 | 152 |
| 2024 April | 167 | 17 | 184 |
| 2024 March | 137 | 9 | 146 |
| 2024 February | 106 | 10 | 116 |
| 2024 January | 134 | 17 | 151 |
| 2023 December | 122 | 11 | 133 |
| 2023 November | 171 | 16 | 187 |
| 2023 October | 152 | 13 | 165 |
| 2023 September | 126 | 3 | 129 |
| 2023 August | 108 | 7 | 115 |
| 2023 July | 166 | 9 | 175 |
| 2023 June | 156 | 12 | 168 |
| 2023 May | 186 | 13 | 199 |
| 2023 April | 218 | 15 | 233 |
| 2023 March | 201 | 12 | 213 |
| 2023 February | 139 | 4 | 143 |
| 2023 January | 109 | 10 | 119 |
| 2022 December | 120 | 5 | 125 |
| 2022 November | 128 | 17 | 145 |
| 2022 October | 146 | 14 | 160 |
| 2022 September | 142 | 25 | 167 |
| 2022 August | 124 | 31 | 155 |
| 2022 July | 107 | 13 | 120 |
| 2022 June | 125 | 13 | 138 |
| 2022 May | 160 | 23 | 183 |
| 2022 April | 122 | 25 | 147 |
| 2022 March | 113 | 13 | 126 |
| 2022 February | 124 | 11 | 135 |
| 2022 January | 137 | 25 | 162 |
| 2021 December | 98 | 14 | 112 |
| 2021 November | 82 | 10 | 92 |
| 2021 October | 114 | 7 | 121 |
| 2021 September | 69 | 16 | 85 |
| 2021 August | 55 | 17 | 72 |
| 2021 July | 86 | 12 | 98 |
| 2021 June | 42 | 6 | 48 |
| 2021 May | 89 | 14 | 103 |
| 2021 April | 203 | 39 | 242 |
| 2021 March | 126 | 19 | 145 |
| 2021 February | 103 | 19 | 122 |
| 2021 January | 96 | 20 | 116 |
| 2020 December | 92 | 20 | 112 |
| 2020 November | 129 | 33 | 162 |
| 2020 October | 82 | 18 | 100 |
| 2020 September | 71 | 21 | 92 |
| 2020 August | 17 | 15 | 32 |
| 2020 July | 9 | 17 | 26 |
| 2020 June | 36 | 7 | 43 |
| 2020 May | 9 | 16 | 25 |
| 2020 April | 11 | 6 | 17 |
| 2020 March | 0 | 13 | 13 |
| 2020 February | 0 | 13 | 13 |
| 2020 January | 0 | 31 | 31 |
| 2019 December | 0 | 25 | 25 |
| 2019 November | 0 | 14 | 14 |
| 2019 October | 0 | 19 | 19 |
| 2019 September | 0 | 13 | 13 |
| 2019 August | 0 | 7 | 7 |
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