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Magnetic resonance imaging (MRI) findings of giant arachnoid granulation. Axial T1-weighted imaging (T1WI) (a) and coronal T2-weighted imaging (T2WI) (b) of the brain revealed a protruding nodular lesion causing compression within the anterior superior sagittal sinus in the midline, showing high signal intensity on T2WI and low intensity on T1WI, similar to that of the cerebrospinal fluid (CSF) signal. Coronal T2WI (b) and enhanced sagittal T1WI (c) showed narrowing with compression of the dural sinus and right-sided displacement of the cortical vein adjacent to the lesion. Enhanced axial T1WI (d) revealed that the cortical vein drained to the frontal pole AG lesion and into the superior sagittal sinus.
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Case presentation:
A 6-year-old girl complained of diplopia and headache over a 2-week period after sustaining a minor head injury. Her neurological examinations were normal, but visual examination identified bilateral papilledema. Magnetic resonance imaging of the brain revealed a protruding nodular lesion causing compression within the anterior...
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Background and PurposeThe aim of this study was to assess the safety and effectiveness of lateral sinus stenosis (LSS) stenting in patients with idiopathic intracranial hypertension (IIH) who are refractory to medical treatment, particularly focusing on visual outcomes including papilledema.Material and Methods
Retrospective study of consecutive pa...
Citations
... [1][2][3][4][5] Arachnoid granulations and herniation of cerebral tissue into the venous sinuses have also been reported as rare and benign phenomena, with most patients being asymptomatic. [6][7][8][9][10][11][12][13] We describe the case of a pediatric patient with symptomatic intracranial hypertension from the herniation of ectopic cerebellar tissue into the dural venous sinuses. This resulted in stenosis of the torcula and bilateral transverse sinuses. ...
BACKGROUND
Venous sinus stenosis has been implicated in intracranial hypertension and can lead to papilledema and blindness. The authors report the unique case of a cerebellar transtentorial lesion resulting in venous sinus stenosis in the torcula and bilateral transverse sinuses that underwent resection.
OBSERVATIONS
A 5-year-old male presented with subacute vision loss and bilateral papilledema. Imaging demonstrated a lesion causing mass effect on the torcula/transverse sinuses and findings of increased intracranial pressure (ICP). A lumbar puncture confirmed elevated pressure, and the patient underwent bilateral optic nerve sheath fenestration. Cerebral angiography and venous manometry showed elevated venous sinus pressures suggestive of venous hypertension. The patient underwent a craniotomy and supracerebellar/infratentorial approach. A stalk emanating from the cerebellum through the tentorium was identified and divided. Postoperative magnetic resonance imaging showed decreased lesion size and improved sinus patency. Papilledema resolved and other findings of elevated ICP improved. Pathology was consistent with atrophic cerebellar cortex. Serial imaging over 6 months demonstrated progressive decrease in the lesion with concurrent improvements in sinus patency.
LESSONS
Although uncommon, symptoms of intracranial hypertension in patients with venous sinus lesions should prompt additional workup ranging from dedicated venous imaging to assessments of ICP and venous manometry.
... Of the 147 persons with documented gender, GAGs involved 80 (54%) females and 67 (46%) males and were similarly distributed across sex (1.2:1 female-to-male ratio) ( Table 2). The afflicted persons included infants [15], children [10,[16][17][18][19][20], adolescents [17,[21][22][23][24], and adults across a wide age spectrum [10,15,45] (range, 0.33 to 91 years; mean, 43 ± 20 years). Interestingly, one pediatric case was reported by parents since birth [16]. ...
... Diagnosis of GAG on imaging workup (Table S1) was accomplished by visualization of round-to-ovoid, irregular or oblong, unilocular or multilocular cystic-appearing structures with or without internal septations, and with internal CSF-like density or signal intensity and communication with the subarachnoid space on MRI with and/or without contrast [8,13,15,17,19,20,[22][23][24][25][26]28,30,31,[36][37][38][39] (Figure 4A), MR angiogram/venogram [10,23,25,[34][35][36][39][40][41][42], CT with and/or without contrast, or CT angiogram [8,21,25,27,28,31,34,35] ( Figure 4B). GAGs were also identified as well-delineated focal calvarial defects on plain X-ray [13,15] or as focal filling defects within the DVS on conventional angiography and/or on cross-sectional studies [11]. ...
... Several individuals experienced misdiagnosis or delayed diagnosis of GAG [7,22,43,45]. Since symptoms were sometimes initially interpreted as subacute or chronic DVS thrombosis, hypercoagulability workup and medical treatment were initiated to manage symptoms of presumed coagulopathy, infection, or related processes [12,14,19,22,23,25,26,33,35,36,39,41,43]. Patients were treated with acetazolamide [19,32,41,43], NSAID, anticephalgic medication, or other analgesia [12,23,33,34,43], other anticoagulants [22,35,36], antiepileptics [39], furosemide [41], mannitol [41], prednisolone [25], decongestants [14], and/or antibiotics [14,44] (each in 1 to 4 of 169 patients, or <3%). ...
Giant arachnoid granulations (GAGs) are minimally investigated. Here, we systematically review the available data in published reports to better understand their etiologies, nomenclature, and clinical significance. In the literature, 195 GAGs have been documented in 169 persons of varied ages (range, 0.33 to 91 years; mean, 43 ± 20 years; 54% female). Prior reports depict intrasinus (i.e., dural venous sinus, DVS) (84%), extrasinus (i.e., diploic or calvarial) (15%), and mixed (1%) GAG types that exhibit pedunculated, sessile, or vermiform morphologies. GAG size ranged from 0.4 to 6 cm in maximum dimension (mean, 1.9 ± 1.1 cm) and encompassed symptomatic or non-symptomatic enlarged arachnoid granulations (≥1 cm) as well as symptomatic subcentimeter arachnoid granulations. A significant difference was identified in mean GAG size between sex (females, 1.78 cm; males, 3.39 cm; p < 0.05). The signs and symptoms associated with GAGs varied and include headache (19%), sensory change(s) (11%), and intracranial hypertension (2%), among diverse and potentially serious sequelae. Notably, brain herniation was present within 38 GAGs (22%). Among treated individuals, subsets were managed medically (19 persons, 11%), surgically (15 persons, 9%), and/or by endovascular DVS stenting (7 persons, 4%). Histologic workup of 53 (27%) GAG cases depicted internal inflammation (3%), cystic change consistent with fluid accumulation (2%), venous thrombosis (1%), hemorrhage (1%), meningothelial hyperplasia (1%), lymphatic vascular proliferation (1%), and lymphatic vessel obliteration (1%). This review emphasizes heterogeneity in GAG subtypes, morphology, composite, location, symptomatology, and imaging presentations. Additional systematic investigations are needed to better elucidate the pathobiology, clinical effects, and optimal diagnostic and management strategies for enlarged and symptomatic arachnoid granulation subtypes, as different strategies and size thresholds are likely applicable for medical, interventional, and/or surgical treatment of these structures in distinct brain locations.
... Although the association of arachnoid granulations with patient symptoms remains unclear [13,14] , the importance of distinguishing arachnoid granulations from dural sinus pathology is essential in making the right diagnoses and preventing inappropriate therapy. Arachnoid granulations are considered incidental findings that represent a normal anatomic entity commonly found in the adult population [15] . ...
Arachnoid granulations are outpouchings of arachnoid membrane which extend into the dural sinuses or calvarium, surrounded by a capsule of dense connective tissue. Within dural sinuses, these appear as well-defined, nodular, rounded, or ovoid structures of focal localization. However, it is important to be aware of their variability in presentation in order to correctly identify them and distinguish them from other dural sinus pathology, especially a misdiagnosis of venous sinus thrombosis with risks of unnecessary anticoagulation, intravascular thrombolysis/thrombectomy, or invasive intracranial pressure monitoring. Here we demonstrate a case of a previously unreported giant intrasinus arachnoid granulation of an unusual vermiform morphology, unduly elongated up to 6 cm in length, involving a significant segment of the superior sagittal sinus. The proof of this diagnosis was the radiologic appearance on multiple modalities and an unchanged appearance over the long-term.
