Type 4A torcular herophili anatomic variant detected by cerebral digital subtraction angiography: case report

Casaperalta G.L.; Medina C.A.L. · Surgical and Radiologic Anatomy (2026) · DOI: 10.1007/s00276-026-03877-z

Resumen

The torcular Herophili (TH) presents numerous anatomical variants. Kobayashi proposed a classification of sinus confluence patterns; the case we present is compatible with type 4A, a very rare presentation. In this case, we present the case of a young male patient who came to the clinic with moderate holocranial headache. A brain magnetic resonance imaging (MRI) with contrast was performed, revealing an image suggestive of a developmental venous anomaly in the left parietal region, that’s why we decide to perform a digital subtraction angiography (DSA). Although no vascular lesion was found, a torcular anatomical variant was evident. The circumstances and logistics allowed for a detailed description of the lesion, and knowledge of the different variants is essential for accurate radiological interpretation and safe surgical planning in the posterior fossa. © The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2026.