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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(04): 769-772
DOI: 10.1055/s-0043-1776301
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Circular Configuration of Torcular Herophili Presenting as Childhood Headache: 2D Computational Fluid Dynamic Analysis with a Proposed Mechanism

Debajyoti Datta
1   Department of Neurosurgery, All India Institute of Medical Sciences,, Bhubaneswar, Odisha, India
,
Arunkumar Sekar 
1   Department of Neurosurgery, All India Institute of Medical Sciences,, Bhubaneswar, Odisha, India
,
Ashis Patnaik
1   Department of Neurosurgery, All India Institute of Medical Sciences,, Bhubaneswar, Odisha, India
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Abstract

This case report presents a rare anatomical variant of the torcular Herophili, characterized by a circular configuration and the absence of the left transverse sinus. A 12-year-old child presented with intermittent holocranial headaches, and imaging revealed the circular torcular Herophili along with mild ventricular enlargement. The straight sinus drained into the left side of the circular torcular Herophili. Following lumbar puncture and cerebrospinal fluid (CSF) drainage, the child experienced symptom improvement. During a 6-month follow-up, the patient remained asymptomatic, without further headaches or academic disruptions. Similar to a previously reported case, the circular torcular Herophili with unilateral absent transverse sinus may be associated with impaired CSF absorption due to altered blood flow through abnormal venous anatomy. We performed two-dimensional computational fluid dynamic analysis of simulated flow through a synthetic model and showed that this circular configuration is associated with venous stasis. The venous stasis in the sinus may impair CSF absorption through the arachnoid granulations causing hydrocephalus and explaining the headache. Close monitoring and follow-up are recommended for patients with this variant. Further investigation is needed to better understand the clinical implications and underlying mechanisms of such torcular Herophili variations.

Keywords

childhood headache - confluence of sinuses - neuroanatomy - torcula - venous sinus anomaly

Authors' Contributions

A.S. was involved in patient care and review of the article. D.D helped in manuscript preparation.




Publication History

Article published online:
29 December 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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