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Mehta RI, Mehta RI. Giant Arachnoid Granulations: A Systematic Literature Review. Int J Mol Sci 2023; 24:13014. [PMID: 37629195 PMCID: PMC10455743 DOI: 10.3390/ijms241613014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
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.
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Affiliation(s)
- Rupal I. Mehta
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Rashi I. Mehta
- Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA;
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
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Mehta RI, Mangla R, Mehta RI. Giant Arachnoid Granulations: Diagnostic Workup and Characterization in Three Symptomatic Adults. Int J Mol Sci 2023; 24:11410. [PMID: 37511166 PMCID: PMC10379399 DOI: 10.3390/ijms241411410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Giant arachnoid granulations (GAGs) are poorly investigated. Here, we document clinical findings associated with five new GAGs and illustrate the anatomical composition of these structures as well as diagnostic considerations in three symptomatic adults. The GAGs ranged from 1.1 to 3.6 cm (mean, 2.2 cm) in maximum dimension and manifested in middle-aged individuals who presented with long-standing brain mass and/or chronic headache. On imaging examinations, the tissues appeared as irregular parasagittal and/or perisinus structures that demonstrated heterogeneous internal elements. The GAGs abutted dura, extended through calvarial marrow spaces, and impinged on dural venous sinuses, causing their stenosis. The histologic workup of two GAG specimens resected from separate individuals revealed central collagen with pronounced internal vascular proliferation. One specimen additionally exhibited reactive changes within the lesion, including venous thrombosis, hemorrhage, and conspicuous inflammation. The salient immune component consisted of a foam cell-rich infiltrate that obstructed subcapsular and internal sinusoidal GAG spaces. Within this specimen, meningothelial hyperplasia was also appreciated. Notably, proliferated lymphatic vascular elements were additionally observed within the structure, extending into deep central collagen regions and engulfing many extravasated erythrocytes in the subcapsular space. In both surgically treated patients, symptoms resolved completely following resection. This report is the first to definitively depict reactive vascular and immunological changes within GAGs that were clinically associated with headache. The frequency of reactive changes within these meningeal structures is unclear in the literature, as GAGs are rarely sampled and investigated. Further systematic analyses are warranted to elucidate the causes and consequences of GAG genesis and their roles in physiology and disease states.
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Affiliation(s)
- Rupal I. Mehta
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Rajiv Mangla
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Rashi I. Mehta
- Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA
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Liu L, Wu Y, Zhang K, Meng R, Duan J, Zhou C, Ji X. Anatomy imaging and hemodynamics research on the cerebral vein and venous sinus among individuals without cranial sinus and jugular vein diseases. Front Neurosci 2022; 16:999134. [PMID: 36238084 PMCID: PMC9551167 DOI: 10.3389/fnins.2022.999134] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022] Open
Abstract
In recent years, imaging technology has allowed the visualization of intracranial and extracranial vascular systems. However, compared with the cerebral arterial system, the relative lack of image information, individual differences in the anatomy of the cerebral veins and venous sinuses, and several unique structures often cause neurologists and radiologists to miss or over-diagnose. This increases the difficulty of the clinical diagnosis and treatment of cerebral venous system diseases. This review focuses on applying different imaging methods to the normal anatomical morphology of the cerebral venous system and special structural and physiological parameters, such as hemodynamics, in people without cranial sinus and jugular vein diseases and explores its clinical significance. We hope this study will reinforce the importance of studying the cerebral venous system anatomy and imaging data and will help diagnose and treat systemic diseases.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Yan Wu
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Kaiyuan Zhang
- Department of Radiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jiangang Duan
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Chen Zhou
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- *Correspondence: Chen Zhou,
| | - Xunming Ji
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, China
- Xunming Ji,
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Tsutsumi S, Ono H, Ishii H. Arachnoid granulations bulging into the transverse sinus, sigmoid sinus, straight sinus, and confluens sinuum: a magnetic resonance imaging study. Surg Radiol Anat 2021; 43:1311-1318. [PMID: 33635406 DOI: 10.1007/s00276-021-02719-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Few studies have explored arachnoid granulations (AGs) bulging into the cranial dural sinuses using contrast-enhanced magnetic resonance imaging (MRI). This study aimed to explore such AGs in the transverse (TS), sigmoid (SigS), and straight (StS) sinuses, and confluens sinuum (ConfS) using thin-sliced, contrast MRI. METHODS A total of 102 patients with intact dural sinuses underwent thin-sliced, contrast MRI in the axial, coronal, and sagittal planes. RESULTS In 88.2%, more than one AG was identified in the TS and SigS, StS, and ConfS. In the TS, AGs were identified in 40.2% on the right side and 37.3% on the left and were frequently located in the middle and lateral thirds. In the SigS, AGs were identified on the right in 17.6% and on the left in 18.6% in the distal region. In the StS, AGs were identified in 35.3% of cases, most frequently located in the proximal third, followed by the distal third. In the ConfS, AGs were identified in 20.6% of cases. Furthermore, in 23.5%, a collection of multiple AGs of varying sizes was found in the TS. A statistical difference was not shown between the mean age of 90 patients with AGs and that of 12 patients without identifiable AGs. CONCLUSIONS Bulging AGs may more frequently found in the TS. Thin-sliced, contrast MRI is useful for delineating AGs.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Hisato Ishii
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Wang Z, Ding J, Chen J, Ding Y, Ji X, Meng R. Cerebral venous sinus stenosis should not be neglected when cerebral artery stenosis is confirmed: a case report. Int J Neurosci 2020; 131:1237-1242. [PMID: 32532163 DOI: 10.1080/00207454.2020.1782901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Cerebral venous sinus stenosis (CVSS) is easily neglected in clinical setting due to its nonspecific symptoms. In patients with cerebral arterial stenosis (CAS), the symptoms caused by CVSS are often mistakenly thought of being attributed to CAS. In this case, we aimed to highlight the clinical manifestations and treatment strategies of CVSS comorbid with CAS. MATERIALS AND METHODS We present an 83-year-old female who complained a series of nonspecific and non-focal neurological deficits such as tinnitus, head noise, dizziness, etc. She was initially diagnosed as CAS and underwent anti-CAS medication orally for over 2 years, whereas her symptoms were still aggravating. RESULTS Magnetic resonance venography (MRV) and magnetic resonance imaging (MRI) displayed severe stenoses at bilateral sigmoid-transverse sinus conjunctions, and thus, the patient underwent intravenous stenting finally. Her aforementioned symptoms significantly attenuated after venous stenting and even disappeared gradually at 3-month, 6-month and 1-year follow-up. CONCLUSIONS This paper revealed that cerebral venous outflow disturbance should not be overlooked when the nonspecific and non-focal neurological deficits could not be explained by cerebral artery disease. For this arteriovenous condition, intravenous stenting may be a feasible and effective way for symptoms relieving.
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Affiliation(s)
- Zhongao Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiayue Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
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Mamaliga T, Hadi M. An unusual vermiform giant arachnoid granulation. Radiol Case Rep 2019; 14:1525-1528. [PMID: 31709020 PMCID: PMC6831846 DOI: 10.1016/j.radcr.2019.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Tatiana Mamaliga
- Medical student, University of Louisville School of Medicine, 530 S Jackson Street, Louisville, KY, 40205, USA
| | - Mohiuddin Hadi
- Department of Radiology, University of Louisville School of Medicine, 530 S Jackson Street, Louisville, KY, 40205, USA
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Giant arachnoid granulation mimicking dural sinus thrombosis. North Clin Istanb 2017; 4:185-187. [PMID: 28971178 PMCID: PMC5613268 DOI: 10.14744/nci.2017.93063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 02/27/2017] [Indexed: 11/20/2022] Open
Abstract
Arachnoid granulations (AG) are composed of dense, collagenous connective tissue that includes clusters of arachnoid cells. They tend to invaginate into the dural sinuses, through which cerebrospinal fluid enters the venous system. AG are most commonly seen at the junction between the middle and lateral thirds of the transverse sinuses near the entry sites of the superficial veins. Presently described is the case of a 21-year-old female who presented at the clinic with recurrent headaches. Magnetic resonance (MR) imaging revealed a 3.5-cm lesion, which extended from confluens sinuum through the superior sagittal sinus. The lesion had created a scallop-shaped area of erosion in the neighboring occipital bone. To exclude sinus thrombosis, MR venography was performed, which displayed a maintained venous flow around the lesion. Headaches were treated symptomatically with medical therapy. Giant AG can be misdiagnosed as dural sinus thrombosis. MR imaging combined with MR venography is the most useful diagnostic tool to differentiate giant AG from dural sinus thrombosis.
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Tsutsumi S, Ogino I, Miyajima M, Ito M, Arai H, Yasumoto Y. Cerebrospinal fluid drainage through the diploic and spinal epidural veins. J Anat 2015; 227:297-301. [PMID: 26184099 DOI: 10.1111/joa.12349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to quantitatively evaluate the function of the cranial diploic and spinal epidural veins as cerebrospinal fluid (CSF) drainage pathways by measuring lipocalin-type prostaglandin D synthase (PGDS) and cystatin C (CysC) dissolved in the blood of these veins. This was a prospective study involving 51 consecutive patients, 31 males and 20 females, who underwent 41 cranial and 10 spinal surgeries. Intraoperatively, peripheral venous blood and diploic venous blood, or peripheral venous blood and spinal epidural venous blood samples were simultaneously collected and immediately centrifuged. For all samples, dissolved albumin (for reference), PGDS and CysC were measured using an enzyme-linked immunosorbent assay. The diploic vein/peripheral vein ratios in five cranial locations and epidural vein/peripheral vein ratios were calculated and statistically evaluated for the three biomarkers. For PGDS, the diploic vein/peripheral vein ratio was significantly increased in the frontal (P = 0.011), temporal (P = 0.028), parietal (P = 0.046) and skull base (P = 0.039), while it did not reach statistical significance for CysC. For patients older than 45 years, the diploic vein/peripheral vein ratio for PGDS was significantly decreased in the frontal region (P = 0.028), and the epidural vein/peripheral vein ratio for CysC was significantly decreased (P = 0.014). These results show that the diploic veins constitute CSF drainage pathways with heterogeneous functional intensity at different cranial locations. Compared with the diploic veins, spinal epidural veins seem to drain less CSF. The cranial diploic and spinal epidural veins may jointly function as an alternative, age-related trans-dural CSF drainage system.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Ikuko Ogino
- Department of Neurological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Miyajima
- Department of Neurological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Masanori Ito
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hajime Arai
- Department of Neurological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
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Tsutsumi S, Ogino I, Miyajima M, Nakamura M, Yasumoto Y, Arai H, Ito M. Cranial arachnoid protrusions and contiguous diploic veins in CSF drainage. AJNR Am J Neuroradiol 2014; 35:1735-9. [PMID: 24948506 DOI: 10.3174/ajnr.a4007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Studies have suggested that arachnoid villi or granulations found in the walls of the cranial dural sinuses, olfactory mucosa, and cranial nerve sheaths function as outlets for intracranial CSF. However, their role as CSF outlets has not yet been verified. Here we show that arachnoid protrusions and contiguous diploic veins provide an alternative drainage route for intracranial CSF. MATERIALS AND METHODS Four hundred patients with intact skull, dura mater, and dural sinuses underwent MR imaging to explore arachnoids protruding into the skull and diploic veins. Patients with symptoms of increased intracranial pressure or intracranial hypotension were excluded. For 15 patients undergoing craniotomy, both peripheral and diploic venous blood was collected. Albumin and the CSF-specific biomarkers were measured by enzyme-linked immunosorbent assay. RESULTS With MR imaging, arachnoid protrusions into the skull and contiguous diploic veins were consistently identified throughout the cranium with their characteristic appearance depending on the cranial region. In addition, elevated amounts of prostaglandin D synthase and cystatin C were confirmed in diploic veins compared with peripheral venous blood. CONCLUSIONS Diploic veins are distributed ubiquitously throughout the cranium. A portion of the intracranial CSF may be drained through arachnoid protrusions and contiguous diploic veins.
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Affiliation(s)
- S Tsutsumi
- From the Department of Neurological Surgery (S.T., Y.Y., M.I.), Juntendo University Urayasu Hospital, Chiba, Japan
| | - I Ogino
- Department of Neurological Surgery (I.O., M.M., H.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Miyajima
- Department of Neurological Surgery (I.O., M.M., H.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Nakamura
- Division of Radiological Technology (M.N.), Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Y Yasumoto
- From the Department of Neurological Surgery (S.T., Y.Y., M.I.), Juntendo University Urayasu Hospital, Chiba, Japan
| | - H Arai
- Department of Neurological Surgery (I.O., M.M., H.A.), Juntendo University School of Medicine, Tokyo, Japan
| | - M Ito
- From the Department of Neurological Surgery (S.T., Y.Y., M.I.), Juntendo University Urayasu Hospital, Chiba, Japan
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Abstract
Arachnoid granulation is often found incidentally in the dural sinuses and skull. It may also enlarge the dural sinus or inner table of the skull. We report a 46-year-old woman who presented with occipital headaches and arachnoid granulations in both transverse sinuses and torcular herophili. Neurological examination was normal. Fundoscopic examination, visual fields and acuity were normal. The headache resolved with medical treatment. No intervention for these lesions was planned. The patient was followed up with magnetic resonance imaging studies.
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The intracranial arachnoid mater : a comprehensive review of its history, anatomy, imaging, and pathology. Childs Nerv Syst 2013; 29:17-33. [PMID: 22961357 DOI: 10.1007/s00381-012-1910-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The arachnoid mater is a delicate and avascular layer that lies in direct contact with the dura and is separated from the pia mater by the cerebrospinal fluid-filled subarachnoid space. The subarachnoid space is divided into cisterns named according to surrounding brain structures. METHODS The medical literature on this meningeal layer was reviewed in regard to historical aspects, etymology, embryology, histology, and anatomy with special emphasis on the arachnoid cisterns. Cerebrospinal fluid dynamics are discussed along with a section devoted to arachnoid cysts. CONCLUSION Knowledge on the arachnoid mater and cerebrospinal fluid dynamics has evolved over time and is of great significance to the neurosurgeon in clinical practice.
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Lu CX, Du Y, Xu XX, Li Y, Yang HF, Deng SQ, Xiao DM, Li B, Tian YH. Multiple occipital defects caused by arachnoid granulations: Emphasis on T2 mapping. World J Radiol 2012; 4:341-4. [PMID: 22900137 PMCID: PMC3419866 DOI: 10.4329/wjr.v4.i7.341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 06/23/2012] [Accepted: 06/30/2012] [Indexed: 02/06/2023] Open
Abstract
A 56-year-old man presented with a 6-mo history of headache. Although neurological and laboratory examinations were normal, computed tomography (CT) scan was performed which revealed multiple occipital osteolytic lesions, which were suspected to be multiple myeloma. Subsequently nuclear magnetic resonance imaging (MRI) showed that these lesions presented with a cerebrospinal fluid (CSF)-like signal intensity, no diffusional restriction and intrinsic mass-like enhancement on conventional sequences were seen. T2 relaxation time was similar to that of CSF in the ventricles and adjacent subarachnoid space on T2-mapping. Single photon emission CT with 99mTc-Methyl diphosphonate was performed which revealed no increased radiotracing accumulation. Finally, these lesions were diagnosed as mutiple arachnoid granulations (AGs). The headache was treated symptomatically with medical therapy. On follow up examination after 6 mo no evidence of tumor was detected. This report aimed to illustrate the appearance and differentiation of occipital defects caused by multiple AGs on CT and MRI, with emphasis on the findings from T2 mapping.
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Mühlstädt M, Thomé C, Kunte C. Rapid wound healing of scalp wounds devoid of periosteum with milling of the outer table and split-thickness skin grafting. Br J Dermatol 2012; 167:343-7. [PMID: 22512740 DOI: 10.1111/j.1365-2133.2012.10999.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Excision of large scalp tumours may result in exposed bone devoid of periosteum. The resultant surgical defects may be too large to close by either primary closure or local cutaneous flap. The denuded bone usually precludes the immediate placement of a skin graft. OBJECTIVES To describe our experience with milling the outer cortical table of the skull in order to promote granulation and hasten wound healing. METHODS In 11 patients, we expanded existing techniques of exposing diploic veins in the cancellous bone by completely milling the exposed outer table of the scalp bone with a rose head burr driven by a pneumatic power drill. After induction of punctate bleeding a split-skin graft was placed in the same session and secured with a tie-over foam dressing. Dressing was removed 7 days after surgery. All patients received perioperative antibiotics. Informed consent was obtained prior to the procedure. RESULTS In all 11 patients a healing of the split-thickness skin graft was observed within 1 week. CONCLUSIONS The combination of extensive exposure of cancellous bone and an immediate split-thickness skin graft reduces convalescence time from multiple weeks to 7 days. This is beneficial in older patients sparing them from frequent visits to the doctor. Furthermore, early closure may reduce the risk of infection.
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Affiliation(s)
- M Mühlstädt
- Department of Dermatology and Allergology, Ludwig-Maximilian University Munich, Frauenlobstr. 9-11, D-80337 Munich, Germany
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