Sinus Pericranii: Unraveling the Pathophysiological Mechanisms and Neurological Implications

Sinus pericranii (SP) is a rare venous anomaly characterized by abnormal communication between intracranial dural sinuses and extracranial veins. Beyond its structural features, SP may function as an auxiliary venous outflow pathway and a buffer for transient intracranial pressure changes, albeit with limited capacity compared to major dural sinuses. To synthesize current knowledge on the embryology and pathophysiological mechanisms of SP, and to discuss diagnostic and management strategies. This narrative review integrates evidence from published literature on SP's anatomical features, hemodynamic role, associated conditions, and imaging characteristics, with emphasis on its physiological and pathological significance. SP development is associated with factors such as elevated intracranial pressure, congenital cranial anomalies, trauma, and vascular malformations. Pathophysiological changes can predispose to cerebral venous sinus thrombosis and intracranial hypertension. Advances in magnetic resonance (MR) venography and 3D-CT have improved diagnostic accuracy and anatomical mapping, supporting decisions between conservative observation and surgical or endovascular intervention. Understanding both the physiological and pathological roles of SP enhances diagnostic precision and guides multidisciplinary treatment planning. Integrating anatomical and pathophysiological perspectives offers a comprehensive framework for clinical decision-making.