Sinus pericranii, a rare venous anomaly in the superior eyelid

Introduction Sinus pericranii (SP) is a rare venous malformation, by which there is an aberrant transosseous connection between the intracranial venous sinuses and the epicranial veins. Within the aberrant vein, the blood flow could be bidirectional. If the major venous drainage occurs through the SP, it is classified as dominant. And it"s considered an accessory, if the SP marginally contributes to the venous drainage of the brain.

Case description We present a case involving a 47-year-old patient with a slowly progressive, painless, fluctuating, bluish mass in the upper eyelid, persisting for approximately 30 years. A cranial MR-Angiographie in revealed an ectatic venous structure located at the medial supraorbital margin and adjacent nasal bone. This structure traverses the frontal sinus and is intricately linked to the sagittal sinus. The presence of an accessory SP was confirmed radiologically. Due to the endovascular haemodynamics, an interventional radiological intervention was cautiously viewed. A bitemporal skin flap procedure was chosen to expose the anterior cranial vault and forehead while avoiding a visible scar on the face. The vein was not freely exposed in the frontal sinus and was enclosed within the bone. At the level of the supraorbital rim, a venous lesion was identifiable. The extracranial portion of the anomaly was coagulated with a bipolar cautery. The lesion was completely regressed after intervention, and no postoperative complications were observed.

Discussion The case illustrates both clinical and radiological findings essential for identifying the condition and for the perioperative planning. The therapeutic approach involves radiological intervention, specifically embolisation, or surgery.

Publication History

Article published online:
19 April 2024