Scalp Vein Detected Using Internal Carotid Angiography That Did ...
AJNR Am J Neuroradiol 21:1032–1033, June/July 2000
Case Report
Scalp Vein Detected Using Internal Carotid Angiography
that Did Not Result in Venous Sinus Compromise
Kazuhiro Ohtakara, Tadashi Kojima, and Waro Taki
Summary: We present an unusual case of a scalp vein de-
Discussion
tected by using angiography of the internal carotid artery.
Scalp veins occasionally can be seen in the ve-
The vein arose from the superior sagittal sinus and drained
nous phases on angiograms of external and com-
into the deep posterior cervical vein via the parietal emis-
mon carotid arteries or by direct injection of the
sary vein. This scalp vein may be a collateral pathway for
scalp veins (1). Under normal conditions, however,
venous sinuses; however, the patient had no evidence of
opacification of scalp veins on internal carotid an-
venous sinus occlusive disease or intracranial hypertension.
giograms is extremely rare (1, 2). Heindrich et al
(cited by Yasargil and Damur [3]) reported visu-
alization of frontal emissary veins in only 1% of
Under normal conditions, opacification of scalp
4000 carotid angiograms. The parietal emissary
veins on internal carotid angiograms is very un-
vein is usually not shown by normal internal ca-
usual (1, 2). A scalp vein may be seen as an im-
rotid angiograms (1). According to Waga and Han-
portant collateral pathway in the presence of ve-
da (2), abnormal filling of scalp veins may be seen
nous sinus compromise caused by various disorders
on carotid angiograms under the following condi-
such as parasagittal meningiomas (2) or venous si-
tions: superior sagittal sinus occlusion by parasag-
nus thrombosis (3, 4). We describe an unusual case
ittal meningeal tumors and venous sinus thrombo-
of visualization of a scalp vein by angiography of
sis (3, 4), arteriovenous malformations of the scalp,
the internal carotid artery that did not result in
malignant tumors involving the scalp and skull, si-
compromised flow within the intracranial venous
nus pericranii, and increased intracranial pressure
(5). Scalp veins may act as important collateral ve-
sinuses.
nous pathways in cases of venous sinus occlusion
(2).
In the present case, the scalp vein was detected
Case Report
by using internal carotid angiography, whereas
neuroimaging examinations revealed no abnormal
A 75-year-old woman was referred to our institution with a
conditions compromising the venous sinuses. The
diagnosis of internal carotid artery aneurysm detected using
MR angiography. Her history was unremarkable except for
scalp vein arose from the superior sagittal sinus via
treatment by her local physician for systemic lupus erythe-
the parietal emissary vein and drained into the deep
matosus 10 years earlier. The neurologic examination showed
posterior cervical vein. The posterior condyloid
no abnormalities. Angiography of the internal carotid angiog-
vein connects the deep posterior cervical vein with
raphy showed a saccular aneurysm of the left internal carotid
the jugular bulb (1). Therefore, this scalp vein may
artery bifurcation and a well-defined scalp vein (Fig 1). The
be a possible collateral pathway for venous sinuses
scalp vein originated from the superior sagittal sinus and
in flow-restricting circumstances.
drained into the right, deep, posterior cervical vein via the
parietal emissary vein. The flow within the venous sinuses was
preserved, although the left transverse sinus was hypoplastic.
References
1. Hacker H. Normal supratentorial veins and dural sinuses. In:
Newton TH, Potts DG, eds. Radiology of the Skull and Brain. vol
2, book 3. St Louis: Mosby;1974:1851–1862
Received October 29, 1999; accepted after revision January 3,
2. Waga S, Handa H. Scalp veins as collateral pathway with para-
2000.
sagittal meningiomas occluding the superior sagittal sinus.
From the Department of Neurosurgery, Mie University
Neuroradiology 1976;11:199–204
School of Medicine, Tsu, Mie, Japan.
3. Yasargil MG, Damur M. Thrombosis of the cerebral veins and
Address reprint requests to Kazuhiro Ohtakara, MD, De-
dural sinuses. In: Newton TH, Potts DG, eds. Radiology of the
Skull and Brain, vol 2, book 3. St Louis: Mosby;1976:2375–2400
partment of Neurosurgery, Mie University School of Medicine,
4. Kinal ME. Traumatic thrombosis of dural venous sinuses in
2-174 Edobashi, Tsu, Mie 514-8507, Japan.
closed head injury. J Neurosurg 1967;27:142–145
5. Osterholm JL. Reaction of the cerebral venous sinus system to
American Society of Neuroradiology
acute intracranial hypertension. J Neurosurg 1970;32:654–659
1032
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AJNR: 21, June/July 2000
SCALP VEIN VISUALIZATION
1033
FIG 1.
Serial venous-phase angiograms of the right internal carotid artery shows a scalp vein arising from the superior sagittal sinus
via the parietal emissary vein and draining into the deep posterior cervical vein. The left transverse sinus is hypoplastic. A, C, and E,
Towne projections; B, D, and F, lateral projections.
