Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Giant Arachnoid Granulation Misdiagnosed as Transverse Sinus Thrombosis

  • Choi, Hyuk-Jin (Department of Neurosurgery Maryknoll Medical Center Busan Catholic Health System) ;
  • Cho, Chang-Won (Department of Neurosurgery Maryknoll Medical Center Busan Catholic Health System) ;
  • Kim, Yoon-Suk (Department of Neurosurgery Maryknoll Medical Center Busan Catholic Health System) ;
  • Cha, Jae-Hun (Department of Neurosurgery Maryknoll Medical Center Busan Catholic Health System)
  • Published : 2008.01.28
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Abstract

We experienced a case of giant arachnoid granulation misdiagnosed as dural sinus thrombosis. A 66-year-old woman presented with a one month history of progressive occipital headache. Computed tomography angiography and cerebral angiography showed a round filling defect at the transverse sinus which was speculated as a transverse sinus thrombosis. Anticoagulation therapy was performed to prevent worsening of thrombosis for 2 weeks and then a Gadolinium-enhanced magnetic resonance imaging scan was performed. The filling defect lesion at the transverse sinus revealed a non-enhancing granule with central linear enhancement, which was compatible with giant arachnoid granulation. We checked the intrasinus pressure difference across the lesion the through the dural sinus in order to exclude the lesion as the cause of headache. Normal venous pressure with no significant differential pressure across the lesion was noted. Headache was treated with medical therapy.

Keywords

References

  1. Arjona A, Delgado F, Fernandez-Remero E : Intracranial hypertension secondary to giant arachoind granulations. J Neurol Neurosurg Pschiatry 74 : 418, 2003 https://doi.org/10.1136/jnnp.74.4.418
  2. Brunori A, Vagnozzi R, Giuffre R : Antonio Pacchioni (1665-1726) : early studies of the dura mater. J Neurosurg 78 : 515-518, 1993 https://doi.org/10.3171/jns.1993.78.3.0515
  3. Chin SC, Chen CY, Lee CC, Chen FH, Lee KW, Hsiao HS, et al : Giant arachnoid granulation mimicking dural sinus thrombosis in a boy with headache : MRI. Neuroradiology 40 : 181-183, 1998 https://doi.org/10.1007/s002340050564
  4. Dormont D, Sag K, Biondi A, Wechsler B, Marsault C : Gadoliniumenhanced MR of chronic dural sinus thrombosis. AJNR 16 : 1347-1352, 1995
  5. Grossman CB, Potts DG : Arachnoid granulations : radiology and anatomy. Radiology 113 : 95-100, 1974 https://doi.org/10.1148/113.1.95
  6. Hsu FP, Nesbit GM, Barnwell SL : Cerebral venous and sinus thrombosis in Winn HR (ed) : Youmans Neurosurgical Surgery, ed 5. Philadelphia : Saunders, 2003, Vol 2, pp1723-1731
  7. Kan P, Stevens EA, Couldwell WT : Incidental giant arachnoid granulation. AJNR 27 : 1491-1492, 2006
  8. Leach JL, Jones BV, Tomsick TA, Stewart CA, Balko MG : Normal appearance of arachnoid granulations on contrast-enhanced CT and MR of the brain : differentiation from dural sinus disease. AJNR 17 : 1523-1532, 1996
  9. LeGros Clark WE : On the pacchionian bodies. J Anat 55 : 40-48, 1920
  10. Mamourian AC, Towfighi J : MR of giant arachnoid granulation, a normal variant presenting as a mass within the dural venosus sinus. AJNR 16 : 901-904, 1995
  11. Potts DG, Reilley KF, Deonarine V : Morphology of arachnoid villi and granulations. Radiology 105 : 333-341, 1972 https://doi.org/10.1148/105.2.333
  12. Tokiguchi S, Hayashi S, Takahashi H, Okamoto K, Ito J : CT of the pacchionian body. Neuroradiology 35 : 347-348, 1993 https://doi.org/10.1007/BF00588366
  13. Wolpow ER, Schaumburg HH : Structure of the human arachnoid granulation. J Neurosurg 37 : 724-727, 1972 https://doi.org/10.3171/jns.1972.37.6.0724
  14. [No authors listed] : Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 42-1984. A 29-year-old woman with a lytic lesion of a parietal bone. N Engl J Med 311 : 1036-1043, 1984 https://doi.org/10.1056/NEJM198410183111608

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