Sinus pericranii: an update illustrated with a large case with long-term follow-up

Sinus pericranii (SP) is a rare venous anomaly consisting of an aberrant communication between the intra- and extra-cranial venous systems forming a venous malformation in the scalp. It is usually defined as midline frontal or parietal fluctuating bluish tumour that increases in size with Valsalva manoeuvre. The gold standard for its diagnosis is digital subtraction angiography, but initial test of choice is magnetic angio-resonance imaging. Although being a benign condition it usually poses aesthetic concerns and fear of complications. This is the reason why, although conservative management is accepted, treatment is usually considered, either endovascular or surgical. We herein review the current management of these rare vascular lesions and illustrate it with a case of a large frontal SP in which surgical excision was decided and performed with an excellent long-term result. We underline the importance of careful haemostasis and multidisciplinary work for the safe management of complex vascular anomalies. Level of evidence: Level V, therapeutic study.