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Brain herniations into arachnoid granulations: about 68 cases in 38 patients and review of the literature

  • Diagnostic Neuroradiology
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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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Authors and Affiliations

  1. Unité de neuroradiologie, Service d’imagerie diagnostique et interventionnelle, Hôpital de Sion, CHVR, Avenue du Grand-Champsec 80, 1950, Sion, Switzerland

    Sonaz Malekzadehlashkariani & Diego San Millán

  2. Zentrum für Neuroradiologie, Klinik Hirslanden, Zurich, Switzerland

    Isabel Wanke, Daniel A Rüfenacht & Diego San Millán

  3. Institutes für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen, Germany

    Isabel Wanke

Authors
  1. Sonaz Malekzadehlashkariani
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  2. Isabel Wanke
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  3. Daniel A Rüfenacht
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  4. Diego San Millán
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Corresponding author

Correspondence to Diego San Millán.

Ethics declarations

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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We declare that we have no conflict of interest.

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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

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