LAUSR

© BMJ Publishing Group Limited 2022. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION A woman in her early 30s presented with swelling over the right supraorbital region and forehead that she had since birth (figure 1A). On examination, the swelling was soft, nontender and increased in size on bending forwards. Doppler ultrasound scan revealed a few prominent venous vascular channels. Contrastenhanced MRI showed a large deep venous anomaly (DVA) in the right frontal lobe. The DVA was seen draining into an ectatic venous pouch in the right basifrontal region. It further showed transosseous drainage into a venous sac in the subcutaneous plane (right supraorbital region) (figure 1B). The patient underwent diagnostic cranial digital subtraction angiography (DSA) in order to plan endovascular management. DSA confirmed MRI findings and also showed nonopacification of the inferior sagittal sinus and anterior portion of the superior sagittal sinus (figure 2). In addition, drainage of the DVA (ie, the dominant drainage of frontal lobes) via transosseous channels into the venous sac and further into the facial vein was seen (figure 2). The constellation of imaging findings on MRI and DSA, along with the clinical history, helped in arriving at a diagnosis of type I cerebrofacial venous metameric syndrome (CVMS). Ethanol/setrol sclerotherapy and/or surgery are the usual treatment options for these malformations. However, in our case, the vascular channels along the forehead and supraorbital region were the sole drainage pathway for the anterior cranial fossa structures, hence they were not embolised and the patient was kept on conservative management. CVMS is a complex craniofacial vascular malformation in which the patient presents with a myriad of venous vascular malformations, which may affect bone, the dura, soft tissues and neural structures including the ocular globe and brain. CVMS can present with a constellation