Like all organs, the brain contains a complex but usually predictable network of blood vessels (arteries, veins and capillaries) to carry blood to and from other parts of the body. Some people, however, are either born with or develop abnormal vessels.
People with a disorder called sinus pericranii have a collection of abnormal veins just outside the skull. These veins can show up as a swelling in the scalp.
Sinus pericranii often causes no symptoms at all, but it can be a cosmetic problem for some, since it is so close to the scalp. Some doctors, however, recommend treating the disorder with surgery to guard against bleeding, clots and infection.
Surgery can be risky, though, as described by Columbia neurosurgeons Dr. Neil Feldstein and Dr. Philip Meyers, along with neurosurgery resident Dr. Jason Ellis, in a recent article in the Journal of Neurosurgery: Pediatrics.
It’s the job of veins to carry blood from organs and return it to the heart. In some cases, the veins involved in sinus pericranii perform an essential part of this job in the brain and need to stay put. At other times, the abnormal veins involved are not needed and can be safely removed.
How does one tell the difference?
Historically, doctors injected a dye into the abnormal veins in order to get an idea of whether or not they were essential for the brain. However, since all veins take up the dye to some extent, they could not be 100% certain of which veins were not needed.
In the article, the doctors describe a different method of differentiating between the two different types of veins potentially affected by sinus pericranii: the “dominant”, which contains veins needed to drain blood from the brain, and the “accessory”, which contains veins that have no useful role. After using a dye to see the area, they apply pressure near it. This has the effect of stopping blood flow temporarily.
The surgeons are then able to see if the blood drains properly from the brain without traveling through the sinus pericranii. If it does, the area can be safely removed.
In their article, Drs. Feldstein, Meyers and Ellis reported on their experience using this technique on a 7-month-old girl. The infant had a mass on her scalp; tests showed a diagnosis of sinus pericranii.
After first injecting a dye to view blood flow through all the vessels, the surgeons applied pressure just above the sinus pericranii and injected the dye again. Blood flowed normally through the brain, so the sinus pericranii vessels were not needed. The surgeons were able to take the girl right to the operating room to tie off the vessels and reduce the size of the abnormal area. She did well and left the hospital the following day.
The doctors concluded that the vessel compression method described in the article is a safe and effective option for treating the condition.
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