Frontal venography is a technique where contrast dye is injected into the frontal vein or its tributaries to visualize the orbital veins. Radiographs are then taken to determine if there is an orbital space-occupying lesion in patients with unilateral exophthalmos. It can help diagnose the nature, site and size of orbital lesions when other imaging fails. The technique involves injecting contrast into the frontal vein to outline the venous drainage from the superior ophthalmic vein to the internal jugular vein. Proper positioning and subtraction techniques are important to clearly visualize the cavernous sinuses.

1. FRONTAL
VENOGRAPHY
P R E S E N T E R : - S A R U G O S A I N
B ATC H : - 2 0 1 7 ( 3 R D Y E A R )
R O L L N O : - 1 1 2

3. 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.

4. 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

5. 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.

6. • 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.

7. 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