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Research ArticleHead and Neck Imaging

Prevalence of Sigmoid Sinus Dehiscence and Diverticulum among Adults with Skull Base Cephaloceles

H. Sotoudeh, G. Elsayed, S. Ghandili, O. Shafaat, J.D. Bernstock, G. Chagoya, T. Atchley, P. Talati, D. Segar, S. Gupta and A. Singhal
American Journal of Neuroradiology June 2020, DOI: https://doi.org/10.3174/ajnr.A6602
H. Sotoudeh
aFrom the Division of Neuroradiology, Departments of Radiology (H.S., A.S.)
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  • ORCID record for H. Sotoudeh
G. Elsayed
bNeurosurgery (G.E., G.C., T.A.), University of Alabama at Birmingham, Birmingham, Alabama
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S. Ghandili
cDepartment of Radiology (S. Ghandili), Aventura Hospital, Miami, Florida
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O. Shafaat
dDepartment of Radiology and Interventional Neuroradiology (O.S.), Isfahan University of Medical Sciences, Isfahan, Iran
eRussell H. Morgan Department of Radiology and Radiological Science (O.S.), Johns Hopkins University School of Medicine, Baltimore, Maryland
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J.D. Bernstock
fDepartment of Neurological Surgery (J.D.B., D.S., S. Gupta), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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G. Chagoya
bNeurosurgery (G.E., G.C., T.A.), University of Alabama at Birmingham, Birmingham, Alabama
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T. Atchley
bNeurosurgery (G.E., G.C., T.A.), University of Alabama at Birmingham, Birmingham, Alabama
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P. Talati
gDepartment of Neurological Surgery (P.T.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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D. Segar
fDepartment of Neurological Surgery (J.D.B., D.S., S. Gupta), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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S. Gupta
fDepartment of Neurological Surgery (J.D.B., D.S., S. Gupta), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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A. Singhal
aFrom the Division of Neuroradiology, Departments of Radiology (H.S., A.S.)
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  • FIG 1.
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    FIG 1.

    Dehiscence of the right sigmoid sinus (arrow). Lack of osseous coverage of the sigmoid sinus with the air-on-sinus sign.

  • FIG 2.
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    FIG 2.

    Diverticulum of the left sigmoid sinus (arrow) with focal protrusion of the sigmoid sinus toward the mastoid air cells. The left sigmoid sinus was normal in shape above and below this section (A, Bone window CT; B, Postcontrast T1 MR imaging).

Tables

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    Table 1:

    Univariable analysis of cephaloceles and SSDD

    Cephalocele Only (n = 35)Cephalocele and SSDD (n = 21)Total (n = 56)P Value
    Age (yr).71
     Mean (SD)51.5 (13.6)49.7 (11.9)50.8 (12.9)
     Range27–7927–6727–79
    Sex.019
     Female24 (68.6%)20 (95.2%)44 (78.6%)
     Male11 (31.4%)1 (4.8%)12 (21.4%)
    Symptoms.235
     Bilateral hearing loss0 (0.0%)1 (4.8%)1 (1.8%)
     CSF leak15 (42.9%)9 (42.9%)24 (42.9%)
     Incidental17 (48.6%)5 (23.8%)22 (39.3%)
     Headache secondary to IIH1 (2.9%)1 (4.8%)2 (3.6%)
     Meningitis1 (2.9%)3 (14.3%)4 (7.1%)
     Meningitis with CSF leak1 (2.9%)1 (4.8%)2 (3.6%)
     Otorrhea0 (0.0%)1 (4.8%)1 (1.8%)
    Content of cephalocele.672
     Brain and meninges13 (37.1%)9 (42.9%)22 (39.3%)
     Meninges22 (62.9%)12 (57.1%)34 (60.7%)
    Location.866
     Anterior skull base21 (60.0%)12 (57.1%)33 (58.9%)
     Skull base foramina2 (5.7%)2 (9.5%)4 (7.1%)
     Temporal bone12 (34.3%)7 (33.3%)19 (33.9%)
    Volume of cephalocele (mm³).015
     Mean (SD)3828 (3559)1562 (1511)2979 (3144)
     Median (minimum-maximum)40–12,61730–487230–12,617
    Cephalocele repaired?.141
     No17 (48.6%)6 (28.6%)23 (41.1%)
     Yes18 (51.4%)15 (71.4%)33 (58.9%)
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    Table 2:

    Logistic regression for volume less than average (3086 mm³) versus SSDD association with cephalocele

    Presence of SSDD
    Volume below average 3086 mm³OR = 3.58
    95% CI, 2.30–4.86P = .05
    Constant0.25
    (−0.85–1.35)
    Observations56
    Log likelihood–34.91
    Akaike information criterion73.81
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H. Sotoudeh, G. Elsayed, S. Ghandili, O. Shafaat, J.D. Bernstock, G. Chagoya, T. Atchley, P. Talati, D. Segar, S. Gupta, A. Singhal
Prevalence of Sigmoid Sinus Dehiscence and Diverticulum among Adults with Skull Base Cephaloceles
American Journal of Neuroradiology Jun 2020, DOI: 10.3174/ajnr.A6602

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Prevalence of Sigmoid Sinus Dehiscence and Diverticulum among Adults with Skull Base Cephaloceles
H. Sotoudeh, G. Elsayed, S. Ghandili, O. Shafaat, J.D. Bernstock, G. Chagoya, T. Atchley, P. Talati, D. Segar, S. Gupta, A. Singhal
American Journal of Neuroradiology Jun 2020, DOI: 10.3174/ajnr.A6602
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