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Dural Sinus and Aberrant Arachnoid Granulations
Surjith Vattoth, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Arachnoid granulation (AG)
                • Aberrant arachnoid granulation (AbAG)
              • Synonyms

                • Pacchionian depressions, granulations, or bodies
                • When large → "giant" AG
                • When in sphenoid bone and T-bone → AbAG (arachnoid pit)
              • Definitions

                • Arachnoid villi: Term used to describe smaller AG
                • AG: Enlarged arachnoid villi projecting from subarachnoid space (SAS) into major dural venous sinus (DVS) lumen
                • AbAG: AG that penetrates dura but fails to reach DVS, typically in sphenoid or temporal bone
                  • Rarely other bones like parietal, occipital bone
                  • Also referred to as arachnoid pits or osteodural defects

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Freeman CW et al: Variations of the CNS venous system mimicking pathology: spectrum of imaging findings. J Neuroimaging. ePub, 2019
                                          2. Sade R et al: Brain herniation into the transverse sinuses' arachnoid granulations in the pediatric population investigated with 3 T MRI. Acta Neurol Belg. 119(2):225-31, 2019
                                          3. Taieb G et al: Reversible giant arachnoid granulations. Neurology. 91(24):1107-8, 2018
                                          4. Battal B et al: Brain herniations into the dural venous sinuses or calvarium: MRI of a recently recognized entity. Neuroradiol J. 27(1):55-62, 2014
                                          5. De Keyzer B et al: Giant arachnoid granulations mimicking pathology. A report of three cases. Neuroradiol J. 27(3):316-21, 2014
                                          6. Settecase F et al: Spontaneous lateral sphenoid cephaloceles: anatomic factors contributing to pathogenesis and proposed classification. AJNR Am J Neuroradiol. 35(4):784-9, 2014
                                          7. Alonso RC et al: Spontaneous skull base meningoencephaloceles and cerebrospinal fluid fistulas. Radiographics. 33(2):553-70, 2013
                                          8. Barañano CF et al: Sternberg's canal: fact or fiction? Am J Rhinol Allergy. 23(2):167-71, 2009
                                          9. La Fata V et al: CSF leaks: correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings. AJNR Am J Neuroradiol. 29(3):536-41, 2008
                                          10. Lloyd KM et al: Imaging of skull base cerebrospinal fluid leaks in adults. Radiology. 248(3):725-36, 2008
                                          11. Schuknecht B et al: Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: imaging findings and correlation with endoscopic sinus surgery in 27 patients. AJNR Am J Neuroradiol. 29(3):542-9, 2008
                                          12. Haroun AA et al: Arachnoid granulations in the cerebral dural sinuses as demonstrated by contrast-enhanced 3D magnetic resonance venography. Surg Radiol Anat. 29(4):323-8, 2007
                                          13. Amlashi SF et al: Intracranial hypertension and giant arachnoid granulations. J Neurol Neurosurg Psychiatry. 75(1):172, 2004
                                          14. Liang L et al: Normal structures in the intracranial dural sinuses: delineation with 3D contrast-enhanced magnetization prepared rapid acquisition gradient-echo imaging sequence. AJNR Am J Neuroradiol. 23(10):1739-46, 2002
                                          15. Casey SO et al: Prevalence of arachnoid granulations as detected with CT venography of the dural sinuses. AJNR Am J Neuroradiol. 18(5):993-4, 1997
                                          16. Leach JL et al: Normal appearance of arachnoid granulations on contrast-enhanced CT and MR of the brain: differentiation from dural sinus disease. AJNR Am J Neuroradiol. 17(8):1523-32, 1996
                                          17. Roche J et al: Arachnoid granulations in the transverse and sigmoid sinuses: CT, MR, and MR angiographic appearance of a normal anatomic variation. AJNR Am J Neuroradiol. 17(4):677-83, 1996
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Arachnoid granulation (AG)
                                                        • Aberrant arachnoid granulation (AbAG)
                                                      • Synonyms

                                                        • Pacchionian depressions, granulations, or bodies
                                                        • When large → "giant" AG
                                                        • When in sphenoid bone and T-bone → AbAG (arachnoid pit)
                                                      • Definitions

                                                        • Arachnoid villi: Term used to describe smaller AG
                                                        • AG: Enlarged arachnoid villi projecting from subarachnoid space (SAS) into major dural venous sinus (DVS) lumen
                                                        • AbAG: AG that penetrates dura but fails to reach DVS, typically in sphenoid or temporal bone
                                                          • Rarely other bones like parietal, occipital bone
                                                          • Also referred to as arachnoid pits or osteodural defects

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Freeman CW et al: Variations of the CNS venous system mimicking pathology: spectrum of imaging findings. J Neuroimaging. ePub, 2019
                                                                                  2. Sade R et al: Brain herniation into the transverse sinuses' arachnoid granulations in the pediatric population investigated with 3 T MRI. Acta Neurol Belg. 119(2):225-31, 2019
                                                                                  3. Taieb G et al: Reversible giant arachnoid granulations. Neurology. 91(24):1107-8, 2018
                                                                                  4. Battal B et al: Brain herniations into the dural venous sinuses or calvarium: MRI of a recently recognized entity. Neuroradiol J. 27(1):55-62, 2014
                                                                                  5. De Keyzer B et al: Giant arachnoid granulations mimicking pathology. A report of three cases. Neuroradiol J. 27(3):316-21, 2014
                                                                                  6. Settecase F et al: Spontaneous lateral sphenoid cephaloceles: anatomic factors contributing to pathogenesis and proposed classification. AJNR Am J Neuroradiol. 35(4):784-9, 2014
                                                                                  7. Alonso RC et al: Spontaneous skull base meningoencephaloceles and cerebrospinal fluid fistulas. Radiographics. 33(2):553-70, 2013
                                                                                  8. Barañano CF et al: Sternberg's canal: fact or fiction? Am J Rhinol Allergy. 23(2):167-71, 2009
                                                                                  9. La Fata V et al: CSF leaks: correlation of high-resolution CT and multiplanar reformations with intraoperative endoscopic findings. AJNR Am J Neuroradiol. 29(3):536-41, 2008
                                                                                  10. Lloyd KM et al: Imaging of skull base cerebrospinal fluid leaks in adults. Radiology. 248(3):725-36, 2008
                                                                                  11. Schuknecht B et al: Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: imaging findings and correlation with endoscopic sinus surgery in 27 patients. AJNR Am J Neuroradiol. 29(3):542-9, 2008
                                                                                  12. Haroun AA et al: Arachnoid granulations in the cerebral dural sinuses as demonstrated by contrast-enhanced 3D magnetic resonance venography. Surg Radiol Anat. 29(4):323-8, 2007
                                                                                  13. Amlashi SF et al: Intracranial hypertension and giant arachnoid granulations. J Neurol Neurosurg Psychiatry. 75(1):172, 2004
                                                                                  14. Liang L et al: Normal structures in the intracranial dural sinuses: delineation with 3D contrast-enhanced magnetization prepared rapid acquisition gradient-echo imaging sequence. AJNR Am J Neuroradiol. 23(10):1739-46, 2002
                                                                                  15. Casey SO et al: Prevalence of arachnoid granulations as detected with CT venography of the dural sinuses. AJNR Am J Neuroradiol. 18(5):993-4, 1997
                                                                                  16. Leach JL et al: Normal appearance of arachnoid granulations on contrast-enhanced CT and MR of the brain: differentiation from dural sinus disease. AJNR Am J Neuroradiol. 17(8):1523-32, 1996
                                                                                  17. Roche J et al: Arachnoid granulations in the transverse and sigmoid sinuses: CT, MR, and MR angiographic appearance of a normal anatomic variation. AJNR Am J Neuroradiol. 17(4):677-83, 1996