3-25. CEREBRAL VENOGRAPHY AND SINUS VENOGRAPHY
a. General. Cerebral venograms may be produced incidental to cerebral
arteriography when exposures are made during the venous phase of circulation.
Certain diagnostic situations, however, demand a more detailed demonstration of
specific venous channels than is afforded by this type of venogram (which is actually the
result of indirect venography); for example, when it is desirable to obtain a more
selective filling of specific venous channels with accompanying lack of dilution of the
contrast substance. The preparation of the patient, preliminary procedure, positioning
technique, and radiography are, for the most part, the same as for cerebral
arteriography. The principal difference lies in the methods of introducing contrast
b. Injection Method for Superior Sagittal Sinus Venogram. With the patient
in the supine position on the table, the examiner makes an incision at the hairline in the
mid-forehead area after having induced local anesthesia. A burr hole is made, then a
ureteral-type catheter is inserted. The exposed end of the inserted catheter is
connected to the stopcock complex and the usual infusion apparatus. Approximately 15
cc of the contrast solution (sterile aqueous type containing 35 percent iodine compound)
is injected at a rate of approximately 5 cc per second. The first exposure is made at the
completion of injection. Subsequent injections and views are made in accordance with
c. Injection Method for Retrograde Jugular Venogram. The patient is placed
in the supine position on the x-ray table. After aseptic preparation and administration of
local anesthesia, an antecubital vein is surgically exposed. A cardiac catheter is
inserted into the selected vein and then advanced to the desired level in the jugular vein
under fluoroscopic control. The patient's head is positioned for the lateral view.
Approximately 25 cc of contrast medium is injected through the catheter at a rate of 10
to 15 cc per second. The first exposure is made just as the last of the contrast medium
leaves the syringe. In some instances, the examiner may have an assistant exert
manual pressure on both jugular veins during injection. Subsequent injections and/or
exposure are made in accordance with clinical dictates.
3-26. INTRA-OSSEOUS VENOGRAPHY
In this method of venography, the contrast medium is introduced into selected
venous pathways via the intramedullary or intraspongious route. In some situations,
this technique may offer certain advantages over those previously described. The
specialist should consult standard textbooks on this subject.