Abstract
Introduction
Brain herniations (BH) into arachnoid granulations (AG) in dural venous sinuses and calvarium have rarely been reported in the literature.
Methods
MRIs of 38 patients with BH into AG (BHAG) were retrospectively analyzed. Locations of BHAG, gyrus/lobe of the herniated brain, parenchymal abnormalities of the BH, and clinical and radiological conditions with raised intracranial pressure were recorded.
Results
Sixty-eight BHAG were found, by order of frequency, in the occipital squama (OS), transverse sinus (TS), lateral lacuna of the superior sagittal sinus (LLSSS), and straight sinus (SS), with cerebellar tissue being the most frequently involved in BHAG (94.5 % of OS, 55 % of TS, 100 % SS BHAG). Multiple BHAG were found in 58 % of the patients (up to five per patient). Parenchymal signal and structural changes (SSCG) were observed in 46 % of BHAG (100 % were cerebellar). Three patients had pseudotumor cerebri (PTCS); one patient had only MRI signs of PTCS. Twenty-one percent of patients had intracranial conditions susceptible of increasing cerebrospinal fluid (CSF) pressure other than PTCS.
Conclusions
BHAG occurred in the OS, TS, LLSSS, and the SS. SSCG of the herniated cerebellum were frequent and possibly result from tethering/strangulation in the AG. No symptoms could be clearly attributed to BHAG, though in three cases of PTCS, TS BHAG could have contributed to sustaining the raised CSF pressure. Various factors are probably involved in the development of BHAG including normal pia-arachnoid bridges between the brain surface and the AG, hydrodynamic constrains on the brain and AG, and, in some cases, increased intracranial pressure.
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Abbreviations
- AG:
-
Arachnoid granulation
- BH:
-
Brain herniation
- BHAG:
-
Brain herniation into an AG
- ITG:
-
Inferior temporal gyrus
- ISL:
-
Inferior semilunar lobule
- L:
-
Left
- LLSSS:
-
Lateral lacunae of the SSS
- LOTG:
-
Lateral occipito-temporal gyrus
- NC-CT:
-
Non-contrast CT
- OS:
-
Occipital squama
- PC-CT:
-
Post-contrast CT
- PTCS:
-
Pseudotumor cerebri syndrome
- R:
-
Right
- SiS:
-
Sigmoid sinus
- SS:
-
Straight sinus
- SSCG:
-
Signal and structural changes
- SSL:
-
Superior semilunar lobule
- SSS:
-
Superior sagittal sinus
- TS:
-
Transverse sinus
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We declare that while all patients gave informed consent for imaging studies, due to the retrospective nature of this work, Institutional Review Board approval was not required.
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Malekzadehlashkariani, S., Wanke, I., Rüfenacht, D.A. et al. Brain herniations into arachnoid granulations: about 68 cases in 38 patients and review of the literature. Neuroradiology 58, 443–457 (2016). https://doi.org/10.1007/s00234-016-1662-5
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DOI: https://doi.org/10.1007/s00234-016-1662-5