Detailed anatomy of intracranial venous anomalies associated with atretic parietal cephaloceles revealed by high-resolution 3D-CISS and high-field T2-weighted reversed MR images

Purpose: The advancement of magnetic resonance (MR) imaging technology has revealed that intracranial venous anomalies, such as vertical embryonic positioning of the straight sinus (VEP of SS), are associated with atretic parietal cephaloceles. However, the precise anatomical relationships among the venous anomalies, superior sagittal sinus (SSS), cistern, and cephalocele have not been demonstrated. We compared the imaging features of conventional MR images and high-resolution 3-dimensional (3-D) MR images, such as Fourier-transformation-constructive interference in steady-state (CISS) images and T2-weighted reversed (T2R) images obtained on a 3-T MR machine. Methods: Three patients ranging in age from 1 to 18 years, with midline subscalp lesions, participated in this study. In two cases, the lesions were surgically excised and subjected to pathological examination. Results: In two children, 3-D MR images more clearly demonstrated anomalous veins, including bilateral internal cerebral veins, the great vein of Galen and the vertical position of the straight sinus in the falx, extending superiorly within the CSF tract in the posterior interhemispheric fissure. While the vertical straight sinus drained into the SSS, the CSF tract maintained a position posterior to the anomalous veins, ran through the SSS and extended to the skull defect. In one patient, ascending positioning of the anomalous vein from the inferior sagittal sinus to the SSS in the CSF space was observed; this could not be depicted on conventional MR images. Conclusion: Detailed findings of the venous anomalies on 3-D MR images provide clues to the diagnosis of atretic cephalocele.