Isotope sinograms Technical note JOHN P. KAPP, M.D., PH.D., HAI~RYC. ALFRED, M.D., AND TERRI JONES, R.T.
Panama City, Florida
A technique is described for examination of the dural venous sinuses using isotope angiography. KEy WoRDs
9 dural sinuses
bolus of isotope injected intravenously may be traced by means of a large radio-sensitive scanning crystal placed over the cranium. The passage of the isotope may be followed through the cerebral arteries, capillaries, veins, and finally through the dural venous sinuses. This isotope angiogram may be recorded on magnetic tape to facilitate review of the dynamic study. An appropriate segment of the tape, which shows the isotope concentrated in the dural venous sinuses, may be summated on a single photograph to outline the venous sinuses with a high degree of resolution. This noninvasive technique for examining the dural venous sinuses is reported here in the hope that interest will be stimulated in other hospitals to correlate isotope sinograms with the findings on contrast angiography.
The patient is positioned in front of the scanning crystal in the lateral or vertex position if one is interested in the sagittal sinus, or in the posteroanterior position with the neck maximally flexed if one is interested in the posterior sagittal and transverse sinuses. An J. Neurosurg. / Volume44 / March, 1976
9 isotope angiogram
intravenous injection of 10 to 15 mCi 99mTcis given. The isotope angiogram is recorded on magnetic tape. A segment of the sinus phase is selected by replaying the tape. The segment should begin after the isotope has largely cleared the cerebral veins and the sinuses have been clearly outlined, and should end a short time before the isotope has cleared the dural venous sinuses. This segment is summated on a 35-mm static film. Comment
In our experience thus far, isotope angiography has been of value in proving dural sinus patency beneath a depressed skull fracture, and also beneath a tumor of the skull (Fig. 1). In several cases this technique has demonstrated the transverse sinus to be hypoplastic on one side; in three of these cases it has been possible to confirm this finding by angiography (Fig. 2). This technique may help determine the position of the dural sinuses. We have used it in one case of Kleebatschadel's deformity of the skull in which it was helpful to know the position of the dural venous sinuses before a reconstructive procedure was undertaken and angiog393
j. P. Kapp, H. C. Alfred and T. Jones
F~. 1. Normal isotope sinograms in a patient with skull lesion overlying the left transverse sinus. Left: Isotope sinogram. Right: Contrast sinogram confirming patency of the transverse sinus and showing the lesion in the skull overlying the left transverse sinus.
Fx6. 2. Isotope sinogram (left) and contrast sinogram (right), showing hypoplastic left transverse sinus.
raphy was avoided in this case. The procedure appears on preliminary studies to be technically simple, noninvasive and without risk. 394
Address reprint requests to: John P. Kapp, M.D., 717 East 7th Street, Panama City, Florida 32401. J. Neurosurg. / Volume 44 / March, 1976