Scalp cavernous angioma presenting as sinus pericranii: diagnostic value of cerebral angiography and magnetic resonance imaging

Objects: Sinus pericranii is only a symptom complex, and it can have a vari ety of etiologies. Therefore, it is important to differentiate these etiolo gies preoperatively by means of radiological examinations. A 5-year-old boy was admitted with a soft and fluctuant tumor in the right parietal region near the midline. The tumor appeared when the child was in a recumbent posi tion, distending noticeably with the Valsalva maneuver and disappearing com pletely when the patient was in the sitting position, Methods: Magnetic res onance imaging showed the lesion with honeycomb-like heterogeneous iso- and low-intensity signals on the T1-weighted image and with heterogeneous high - and isointensity signal on the T2-weighted image. Dynamic study with an i njection of gadolinium diethylene-triaminopentaacetic acid demonstrated and nodular peripheral enhancement at early phase and subsequent progressive e nhancement towards the center of tumor. The internal carotid angio-gram was normal. The external carotid angiogram, however, showed a tumor stain fed by the superficial temporal arteries. The stain was retained until the late phase and drained into the scalp veins and into the superior sagittal sinu s. Following direct injection of contrast medium into the tumor there was p rolonged retention of the medium in the tumor and leakage into scalp veins and the superior sagittal sinus. The mass under the periosteum was totally removed and proved to be a cavernous angioma. Conclusions: Scalp cavernous angioma is one of the etiologies of sinus pericranii and may be diagnosed p reoperatively by cerebral angiography or magnetic resonance imaging. Serial dynamic magnetic resonance imaging will be particularly helpful for this d iagnosis.