FRONTAL

VENOGRAPHY
P R E S E N T E R : - S A R U G O S A I N

B A T C H : - 2 0 1 7 ( 3 R D Y E A R )

R O L L N O : - 1 1 2
INTRODUCTION

• Technique in which radio-opaque dye is injected in frontal vein or

its tributaries and then radiographs are taken to visualize ophthalmic
veins
• Usually performed to outline the orbital veins and to determine the
presence or absence of an orbital space-occupying lesion in patients
with unilateral exophthalmos.
INDICATIONS

• Visualize ophthalmic veins

• Helps in diagnosing nature, site and size of orbital lesions even
when plain x-rays or/and tomography fails
• Also helps in visualization of cavernous sinuses, measurements of
sellar width prior to trans-sphenoidal surgery and in diagnosing
orbital lesions during orbitory operation
TECHNIQUE
• Frontal vein injection is usually made with a s 23G scalp vein needle but where
feasible a 21G needle will allow more rapid flow of contrast and is preferred
when the veins are large and the venipuncture easy.
• A minimum of 10ml of contrast medium (280 Conray) is required to outline the
cavernous sinuses satisfactorily on both sides; and not infrequently selective
compression of veins on the forehead and supra-orbital ridge may be required
in order to fill both sides, if natural flow of the venous system is towards one
side, or if the veins are obstructed in the back of the orbit.
• Flow of blood down the facial veins is occluded by finger pressure.
• Reflux of contrast over the scalp prevented by placing a rubber band
around the hairline.
• Then injection of contrast into the frontal vein to demonstrate the
venous system in both orbits and to outline the venous drainage
back to the internal jugular i.e., to fill the superior ophthalmic vein,
cavernous sinus, inferior petrosal sinus and jugular bulb in
sequence.
• Subtraction technique is useful.
• No anesthetic is required for the examination so that it can be
performed safely on out-patients.
PROJECTION

• Mento-occipital or occipito-mental view:- in this the lower jaw is

projected below the level of the cavernous sinuses.
 This is important since there is often movement of the lower jaw
during the injection making good subtraction difficult.
 Over tilt and under tilt should be avoided.
 For the proper demonstration of the cavernous sinuses full
subtraction studies are essential