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Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance

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Abstract

Objectives

To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI.

Methods

A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients’ symptoms and clinical findings were recorded.

Results

Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients.

Conclusion

Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours.

Key points

• Brain herniations into the DVS are more common than previously assumed.

• The most frequent locations are the transverse sinus.

• These herniations are incidental findings.

• The relationship between brain herniation into DVS and headache is uncertain.

• High-resolution MR sequences are most useful in detection of brain herniations.

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Abbreviations

B-FFE:

balanced fast field echo

CFS:

cerebrospinal fluid

CISS:

constructive interference in steady state

DVS:

dural venous sinus

DVA:

developmental venous anomaly

DWI:

diffusion weighted imaging

FLAIR:

fluid-attenuated inversion recovery

GRE:

gradient recalled echo

MPR:

multi-planar reformatted

MRI:

magnetic resonance imaging

SE:

spin-echo

SS:

sigmoid sinus

TS:

transverse sinus

TSE:

turbo spin-echo

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Acknowledgments

The scientific guarantor of this publication is Bilal Battal. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was not required for this study because of its retrospective design. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Gulhane Military Medical School, 06018, Ankara, Turkey

    Bilal Battal, Salih Hamcan, Veysel Akgun, Sebahattin Sari & Mustafa Tasar

  2. Department of Neurology, Gulhane Military Medical School, Ankara, Turkey

    Oguzhan Oz

  3. Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Mauricio Castillo

Authors
  1. Bilal Battal
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  2. Salih Hamcan
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  3. Veysel Akgun
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  4. Sebahattin Sari
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  5. Oguzhan Oz
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  6. Mustafa Tasar
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  7. Mauricio Castillo
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Correspondence to Bilal Battal.

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Battal, B., Hamcan, S., Akgun, V. et al. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance. Eur Radiol 26, 1723–1731 (2016). https://doi.org/10.1007/s00330-015-3959-x

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  • DOI: https://doi.org/10.1007/s00330-015-3959-x

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