An in-depth examination of variations in cerebral venous sinuses and the occurrence of sinovenous thrombosis

Background: Pediatric cerebral sinovenous thrombosis (CSVT) is an uncommon yet serious cause of stroke in children. Although cerebral venous anatomical variations (AVs) are frequently encountered on MR venography (MRV), their potential contribution to CSVT remains unclear. Only one prior study has explored the relationship between AVs and CSVT, highlighting the need for larger population-based investigations. This study aimed to examine the prevalence of AVs in pediatric CSVT and non-CSVT populations and to assess their potential association with thrombosis and CSVT-related complications. Methods: This retrospective study included 124 children who underwent MRV between January 2020 and November 2025. Sixty-two patients diagnosed with CSVT were age- and sex-matched with 62 controls. MRV examinations were evaluated for the presence and subtype of AVs. Clinical presentation, complications, and demographic characteristics were recorded. Results: AV prevalence did not differ significantly between CSVT and control groups (46.7% vs. 50%, p = 0.67). The most common variation in both groups was left hypoplastic transverse sinus. AV rates were also similar between complicated and uncomplicated CSVT cases (44.4% vs. 47.1%, p = 0.92). Headache was the predominant presenting symptom (70.1%). Complications—including papilledema, elevated intracranial pressure, and venous infarction—were more common in younger patients (p = 0.01). Conclusions: AVs are common findings on pediatric MRV; however, their presence does not appear to influence CSVT development or complication risk. This study represents the largest cohort evaluating AVs in pediatric CSVT and contributes valuable evidence suggesting that AVs are incidental rather than pathogenic in this context. © The Author(s) 2026.