Pediatric brain herniation into the dural venous sinuses: a case series and review of the literature.

purposeBrain herniation into the dural venous sinus (BHDVS) is a rare and underrecognized imaging finding. Although often incidental, it may be associated with idiopathic intracranial hypertension (IIH), particularly in adults. Pediatric cases remain uncommon. This study presents three pediatric BHDVS cases and reviews current literature to highlight clinical relevance, imaging features, and management.

methodsPediatric cases of BHDVS were evaluated using magnetic resonance imaging. A comprehensive literature review was conducted to summarize current knowledge on prevalence, imaging characteristics, clinical presentation, and management strategies.

resultsCase 1: A 6-year-old female with daily headaches had right occipital lobe herniation into the right transverse sinus with partial sinus filling defect, but no signs of raised intracranial pressure. Managed conservatively, follow-up imaging showed stability. Case 2: A 3-year-old male evaluated for developmental delay was incidentally found to have cerebellar herniation into the left transverse sinus. He was asymptomatic and no treatment was required. Case 3: A 3-year-old female with epilepsy had an incidental left temporal lobe herniation into the transverse sinus. The lesion was unrelated to seizures and remained stable without intervention. Very few similar cases were found in a literature review; a brief review of existing literature is presented and comparisons made between BHDVS and similar conditions.

conclusionBHDVS may mimic more serious pathology. Accurate recognition of imaging, particularly in pediatric patients, is essential to prevent misdiagnosis and overtreatment. While typically managed conservatively, its association with IIH warrants further investigation. Increased awareness and continued study may refine understanding of its clinical implications.