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PubMed This is a summary of 14 peer-reviewed journal articles Updated
Radiology

Diagnosis, Imaging, and What the Results Mean

At a Glance

Imaging for Enlarged Parietal Foramina (EPF) looks for symmetric skull holes with smooth, corticated margins to confirm they are benign. MRIs are used to rule out serious conditions like encephaloceles and check for harmless venous anomalies like a persistent falcine sinus.

When a doctor looks at imaging of a child’s skull, they aren’t just looking for holes—they are looking at the shape, the edges, and what is happening inside those holes. Understanding the specific language used in radiology reports can help demystify the diagnosis of Enlarged Parietal Foramina (EPF).

What the Radiologist Sees: The “Benign” Look

EPF has a very characteristic appearance on a CT scan (which looks at bone) or an MRI (which looks at soft tissue). Radiologists look for several reassuring features:

  • Symmetry: EPF is usually “bilateral and symmetric,” meaning there is a hole on both the left and right sides of the skull in roughly the same spot [1][2].
  • Location: The holes are found in the parietal bones (the top-back of the head) near the midline [1].
  • Smooth, Corticated Margins: This is one of the most important terms in a report. Corticated means the edge of the hole is lined with a thin layer of hard, mature bone [3][4]. It tells the doctor that the hole isn’t “active” or being eaten away by disease; rather, it is a stable, developmental feature [3].

Ruling Out Other Conditions

The primary reason doctors use high-resolution imaging is to distinguish EPF from more serious conditions, most notably a parietal encephalocele.

  • Parietal Encephalocele: This is a condition where the protective membranes or even a small portion of brain tissue “herniates” (pokes through) a defect in the skull [5][6].
  • The Difference: While the word “encephalocele” can sound incredibly frightening, doctors can easily and definitively rule it out with an MRI, providing immediate peace of mind. In isolated EPF, the brain stays exactly where it belongs. Imaging allows the doctor to confirm that the dura mater (the brain’s tough outer lining) and the brain tissue itself are healthy and haven’t moved into the openings [7][8].

Understanding “Persistent” Veins

Sometimes, the report will mention an “intracranial venous anomaly.” The most common one seen with EPF is a persistent falcine sinus [9][10].

  • What is it? During fetal development, babies have a specific vein (the falcine sinus) that helps drain blood from the brain. Normally, this vein disappears before birth as other, more permanent veins take over. If it doesn’t disappear, it is called “persistent” [10][11].
  • Why is it there? In children with EPF, the usual “drainage pipes” (like the straight sinus) might be smaller than usual. The persistent falcine sinus stays open as a “backup route” to ensure blood continues to drain properly [12][10].
  • Is it dangerous? In most cases, a persistent falcine sinus doesn’t cause any symptoms. It is simply a different way the brain’s plumbing is organized. However, it is a critical piece of information for doctors to know if they ever need to plan a surgery near that area [13][14].

By combining CT scans to look at the “borders” and MRI/MRV scans to look at the “plumbing,” your medical team can ensure that the EPF is isolated and not affecting your child’s brain health.

(Return to the Home Page.)

Common questions in this guide

What does it mean if my child's skull holes have corticated margins?
Corticated margins mean the edges of the holes are lined with a thin layer of hard, mature bone. This reassures doctors that the openings are a stable, developmental feature and not caused by an active disease eroding the bone.
How do doctors confirm my child has EPF and not a parietal encephalocele?
Doctors use high-resolution MRIs to get a clear view of the soft tissue inside the skull. This imaging allows them to confirm that the brain and its tough outer lining remain safely inside the skull and have not pushed through the openings.
What is a persistent falcine sinus on an EPF MRI report?
A persistent falcine sinus is a fetal vein that normally disappears before birth. In children with EPF, it often remains open to act as a backup drainage route, ensuring blood continues to flow properly from the brain.
Is a persistent falcine sinus dangerous for my child?
In most cases, this venous anomaly does not cause any symptoms and is simply a variation in how the brain's blood vessels are organized. However, it is an important detail for medical teams to be aware of if your child ever requires head surgery.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does the imaging show 'corticated margins,' and what does that tell us about the nature of these holes?
  2. 2.Did the radiologist confirm that there is no brain tissue herniating (leaking) through the openings?
  3. 3.Is there a persistent falcine sinus or any other unusual vein patterns mentioned in the report?
  4. 4.Do we need an MRV or CTV (venous imaging) to get a better look at how blood is draining from the brain?
  5. 5.How do these findings compare to my child's previous scans, or are these common findings for EPF?

Questions For You

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References

References (14)
  1. 1

    Teaching NeuroImages: Enlarged parietal foramina inadvertently labeled as burr holes.

    Fernandez J, Woodson S, Cannard K

    Neurology 2019; (93(8)):e827-e828 doi:10.1212/WNL.0000000000007978.

    PMID: 31427498
  2. 2

    Bilateral Foramina Parietalia Permagna - A Calvarial Defect Caused by Haploinsufficiency of the Msh Homeobox 2 Gene: A Case Report and Current Literature Review.

    Kahl N, Lüsebrink N, Schubert-Bast S, et al.

    Neuropediatrics 2024; (55(3)):205-208 doi:10.1055/s-0044-1781465.

    PMID: 38447947
  3. 3

    New insights into enlarged parietal foramina: an anatomical, radiological, and histological study.

    Seltzer LA, Hines BL, Weisberg ZS, et al.

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2026; (42(1)).

    PMID: 41832921
  4. 4

    Imaging Spectrum of Calvarial Abnormalities.

    Khodarahmi I, Alizai H, Chalian M, et al.

    Radiographics : a review publication of the Radiological Society of North America, Inc 2021; (41(4)):1144-1163 doi:10.1148/rg.2021200198.

    PMID: 34197249
  5. 5

    Congenital interparietal encephalocele with porencephlacic cyst: A case report.

    Tadishu B, Kahsay SH, Yibalih S, Teklebirhan Y

    Radiology case reports 2025; (20(8)):3986-3989 doi:10.1016/j.radcr.2025.04.133.

    PMID: 40496086
  6. 6

    A topographical analysis of encephalocele locations: generation of a standardised atlas and cluster analysis.

    Vakharia VN, Toescu S, Copp AJ, Thompson DNP

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2023; (39(7)):1911-1920 doi:10.1007/s00381-023-05883-7.

    PMID: 36897404
  7. 7

    Parietal Encephalocele With Fenestrated Superior Sagittal Sinus and Persistent Falcine Sinus.

    Kokidko Y, Ranalli N, Shah C

    Cureus 2021; (13(6)):e16019 doi:10.7759/cureus.16019.

    PMID: 34336509
  8. 8

    Congenital interparietal encephalocele: a case report.

    Nayak A, Sharma S, Vadher RK, et al.

    Journal of clinical and diagnostic research : JCDR 2015; (9(4)):PD09-10 doi:10.7860/JCDR/2015/11944.5812.

    PMID: 26023594
  9. 9

    Enlarged parietal foramina presenting as scalp swelling in an infant.

    Chidambaram VA, Hamouda ES

    The Medical journal of Malaysia 2015; (70(4)):263-4.

    PMID: 26358027
  10. 10

    A persistent falcine sinus in a child with venous sinus thrombosis.

    Guarnizo A, Morillo AJ, Bermúdez S

    Acta neurologica Belgica 2023; (123(3)):1123-1124 doi:10.1007/s13760-022-01912-5.

    PMID: 35267182
  11. 11

    A review of extraaxial developmental venous anomalies of the brain involving dural venous flow or sinuses: persistent embryonic sinuses, sinus pericranii, venous varices or aneurysmal malformations, and enlarged emissary veins.

    Manjila S, Bazil T, Thomas M, et al.

    Neurosurgical focus 2018; (45(1)):E9.

    PMID: 29961384
  12. 12

    Persistent falcine sinus in the newborn: 3 case reports of associated anomalies.

    Rousslang LK, Coleman TJ, Meldrum JT, et al.

    Radiology case reports 2023; (18(3)):886-894 doi:10.1016/j.radcr.2022.11.019.

    PMID: 36589489
  13. 13

    Chiari I malformation with craniosynostosis and persistent falcine sinus draining into the straight sinus.

    Newton E, Iwanaga J, Dumont AS, Tubbs RS

    Morphologie : bulletin de l'Association des anatomistes 2021; (105(351)):323-326 doi:10.1016/j.morpho.2020.11.009.

    PMID: 33288422
  14. 14

    Falcine Sinus and Parafalcine Collateral Veins in Meningiomas Invading the Superior Sagittal Sinus.

    Yin T, Zhang H, Wang W, et al.

    World neurosurgery 2019; (132()):e434-e442 doi:10.1016/j.wneu.2019.08.120.

    PMID: 31470161

This page explains EPF imaging terminology for educational purposes. Your child's radiologist and neurologist are the best sources for interpreting their specific scan results.

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