Sinography, Especially with Reference to Block Dissection of the Neck

Abstract

Sinography is a roentgenographic method of charting exactly the venous return flow from the skull originally developed by the writer during the nineteen-thirties when numerous cases of sigmoid sinus thrombosis occurred. In connection with the increasingly common operation of block dissection of the neck, interest has revived in finding the various pathways for the venous return from the skull. As a rule, both jugular veins can be resected concurrently without untoward consequences. However, in three personal cases and according to the experience of some colleagues serious sequelae have been found. For this reason one must caution against indiscriminate and unnecessary occlusion of the jugular veins bilaterally. Sinography is exemplified by roentgenograms, showing exactly the venous flow from the skull. The conclusions are that (1) before the blood flow from the head is disturbed by neck dissection or other surgical interference, the capacity of the venous return on either side should be elucidated; (2) the jugular vein should not be sacrificed unnecessarily on the side which appears to have the best venous flow; and (3) since both sinography and earlier mass anatomical and roentgenological examinations show that the relevant findings are fairly consistent with the relative size of the jugular foramen, an examination as simple as cranial roentgenography may suffice for an evaluation of the conditions.