Contribution to direct sinugraphy in children injecting opaque medium into the superior sagital sinus

Assuming that some clinical disturbances are produced by the occlusion of dural sinuses, the author made a X-ray study of these venous channels after injecting opaque medium directly into the superior sagittal sinus. Since there is a great number of normal anatomical varieties of dural sinuses, the main part of the paper concerns the study of 50 cases, all in children whose disturbances could not be attributed to any sinus lesion. For better illustration of the concept of normality, five supplementary pathological cases are presented. Considering that the direct sinugraphy permits radiographic examinations only down-tream the site of the injection, the method is naturally limited in its indications. Accordingly with his findings, the author concludes: 1. Direct sinugraphy by introduction of the opaque medium into the superior sagittal sinus is indicated for the examination of the confluent sinuses, except the straight one. 2. Its execution is technically easy and may be repeated at once if necessary. 3. It is well tolerated, for no inconvenient consequences were observed in any of the studied cases. 4. From the several variations of sinusal confluence reported by the anatomists, only three may be radiographically identified: common reservoir type, plexiform type (with a bifurcated superior sagittal sinus) and occipital type. The ipsilateral type (with a crossed circulation) and the plexiform type (with a bifurcated straight sinus) variations cannot be radiographically detected by the method. 5. Under X-ray examination, the common reservoir and plexiform (with a superior sagittal bifurcated sinus) types are more frequent and the occipital type is less found. In spite of the anatomical data, the greater frequency of the common reservoir type of sinusal confluence is only illusory, for in that group are included the ipsilateral (with a crossed circulation) and plexiform (with a bifurcated straight sinus) types. 6. Cases of intracranial venous circulation with unilateral derivation through the sinusal confluence are seldom observed. 7. Predominance of intracranial venous drainage through one of the transverse sinuses was not noticed. 8. The direct sinugraphy through the superior sagittal sinus, because of the venous blood flow, allows the diagnosis of organic occlusions placed: (a) in the superior sagittal sinus down-stream the site of the injection; (b) in the origin of one of the transverse sinuses near the confluence, but only when there is a bifurcated superior sagittal sinus or a crossed circulation channel; (c) in the transverse sinuses. 9. The method is not fitted for diagnosing: (a) incomplete occlusions of the dural venous channels; (b) occlusion of either transverse sinuses in their origin when there is no bifurcated superior sagittal sinus or crossed circulation channel, since it could not be discriminated from the variations of the unilateral or ipsilateral type without a crosses circulation. 10. The occlusion of the internal jugular veins produced by digital compression is a very useful procedure when one of the transverse sinuses cannot be visualized; it permits the differentiation between an organic occlusion and a false one produced by occasional circumstances.