Color-coded Duplex Sonography Of Cerebral Bridging Veins Entering Superior Saggital Sinus And Cerebral Venous Outflow

Objectives Based on the prophase result of cadavers of the coworkers, the cerebral bridging veins (BVs) entering superior saggital sinus (SSS) and cerebral venous outflow were observed by color-coded duplex sonography, in order to provide new hemodynamic reference data for further hemodynamic study of the cerebral venous, and to provide morphologic and hemodynamic basis for related desease.Methods 1. Twenty patients undergoing selective craniotomy one years ago and having a good recovery underwent color-coded duplex sonography. The morphologic and hemodynamic data were measured through the surgical bone window. 2. Twenty volunteer underwent color-coded duplex sonography. The hemodynamic data in the lower-most point, the middle point, the upper-most point and the right or the left side of the internal jugular vein (IJV) were measured. The chang of the hemodynamic data in the IJV and vertebral vein (VV) under different body position and central venous pressure were measured in the middle point of IJV.Results 1. Color-coded duplex sonography of BVs entering SSS:①The BVs formed two clusters along the SSS: anterior group and posterior group. The number of the anterior group BVs was 3.1±1.4, the diameter was 2.7±0.7 mm, the angle was 96±33°, the mean flow velocity was 10.0±2.8 cm/s, and the blood flow volume was 28.21±14.88 ml/min. The number of the posterior group BVs was 5.8±1.0, the diameter was 3.2±1.2 mm, the angle was 41±24°, the mean flow velocity was 11.4±2.8 cm/s, and the blood flow volume was 48.12±38.13 ml/min. The number, diameter, the mean flow velocity, and the blood flow volume of the posterior group BVs were larger than anterior group.②C ompared to observation in cadavers, the number of BVs was less, and the diameter of BVs was larger. There was no defference in DSA and sonography.③When the BV entering SSS with less than 90 degree, the turbulent flow was found in the SSS and BV besides dural entreance. 2. Color-coded duplex sonography of the cerebral venous outflow:①The cross section area, velocity, and the blood flow volume in the lower-most point of IJV were more than the middle and the upper-most point of IJV. There were no difference between IJV besides the onset of internal carotid artery and the superior part of IJV.②65% and 45% of the IJV was right side advantages in supine position and sitting position separately. The blood flow volume in the right side were 91% and 41% more than left side in supine position and sitting position respectively.③Quient breathing, the outflow of IJV was 94% of total outflow in supine position. In sitting position, the cross section area and the blood flow volume in IJV dropped, and the velocity, and the blood flow volume in VV increased. In sitting position, the outflow of VV was 45% of total outflow, and 78% of the cerebral venous outflow were extra-jugular venous system.④Pressure breathing, the outflow of IJV increased lightly in supine position. In sitting position, the cross section area and the blood flow volume in IJV increased rapidly, and exceeded the outflow in supine position. The velocity, and the blood flow volume in VV decreased rapidly.Conclusion 1. The morphological and hemodynamic feature of BVs entering into SSS can be measured through the surgical bone window by color-coded duplex sonography. 2. There are bilateral difference of the IJV. The measurment of IJV besides the onset of internal carotid artery is easily and precisely. 3. With quient breathing, IJV and VVs is the most path of the outflow of cerebral venous system in supine position and sittiong position separately. With pressure breathing, IJV is the most path all in supine position and sitting position.