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Torcular dural sinus malformation
  1. Fergus Robertson
  1. Correspondence to Dr Fergus Robertson, Great Ormond Street Hospital, London WC1N 3JH, UK; fergusrobertson{at}nhs.net

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Dural sinus malformation (DSM) is a rare pediatric cerebrovascular malformation, presenting in antenatal or early postnatal life with massive dilation of the dural sinuses. Barbosa’s 2003 seminal paper describes two forms of the disease: a midline subtype spanning the confluence of the sinuses with giant dural sinus lakes (so-called ‘torcular DSM’ (tDSM), the focus of Yang’s two JNIS papers and a lateral subtype involving the jugular bulb with otherwise normal sinuses and associated high flow sigmoid sinus arteriovenous fistula.1

The cause of DSM is unknown. As with all rare pediatric conditions, literature is sparse, based on single cases and small case series, many historical and numbering less than 100 in total. As part of normal venous development there is ‘ballooning’ of the transverse sinuses toward the end of the second trimester, reflecting increased venous flow from the rapidly growing cerebral hemispheres. Normally, remodeling to a more normal ‘adult’ pattern occurs around birth, with formation of the jugular bulbs.2 However, …

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