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The cross section areas of the vessels that form the torcular and the manner in which flow is distributed to the right and to the left lateral sinus.

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T H E CROSS SECTION AREAS O F THE VESSELS
THAT FORM T H E TORCUTJAR A N D THE S I AS S ER
IN WHICH mow IS DISTRIBUTED TO
TIIH RIGHT AND T O THE TiEFT
LATERAL SINUS
T\VO
FIGURES
Iiecent work on the analysis of blood from the internal
ji:gi~lai* veins of man (Lciinos and Qibhs, ’32) a i d the
measurement of flow through these vessels (Gibbs, TJeiiiiox
aiid Gibbs, ’34) raises the question as to whether or not the
two jugular veins drain identical regions in each hemisphei*e.
Froin the clinical standpoint the important applicatioiis of the
Tohe~-()uic.’ccnstcclttclst make desirable a fuller understanding of the size and manner of connection of the tributaries t o
the iiitcrnal jugular veins.
I’ll E V I 0 YS 1N T E S T I G A T I O N S
Studies by Knott (1882), Dumont (1894), Heiirici aiid
Kikuclii (’03), Jlannu ( ’08) aiid E~dmards( ’32) indicate that
the torcular is not usually a single chamber into which the
superior sagittal and straight sinuses drain and from which
the two latei.al sinuses take origin, but a complex system of
anastomosing channels. Although the manner iu which these
channels connect is exceedingly variable, it would alqwar that
there is a tendency for the superior sugittal sinus to connect
hy its largest branch with the right lateral sinus and f o r the
straight sinus to connect by its largest branch n7ith the left
419
420
E. L. GIBBS A N D F. A. GIRBS
lateral sinus. All who have studied the sinuses in the occipital region stress the great variation that occurs in their
size and arrangement. No one except Mannu and Edwards
has based his work upon the study of casts. Mannu made
metal casts of forty-two torcnlars and described their appearance. His report contains drawings of seventeen casts.
Edwards has made wax casts of the terminal positions of the
lateral sinuses and of the inferior petrosal sinuses i n fifty
cases and has measured their cross section area. He points
out that there is a definite relationship between the arrangement of the vessels at the torcular arid the cross section areas
of the terminal portions of the lateral sinuses. I n his report
he shows photographs of casts of four types of torcular.
Seither l l a n n u nor Edwards, however, interested himself
especially in the cross section area of the vessels that form
the torcular, nor in the flow conditions that arise in this
complex of anastoniosing channels.
hIATEIUAL A N D METHOD
The material on which this study is based consisted of
specimens of falx, tentorium and occipital dura, removed in
a single piece at the time of postmortem examination. Only
specimens from adults were used. No case was included i n
which there was evidence that a pathological process had
altered the form o r arrangement of the sinuses.
Dissection of fifty torculars convinced us that it is inipossible by this method to obtain knowledge of the exact form
or manlier of connectioii of the vessels forming the torcular.
Celloidin casts were therefore made of twenty-five torculars
and measurements were made of these casts. It was realized
that even with a satisfactory knowledge of the cross section
area of the vessels it would be hazardous to predict what effect
a given arrangement would have upon flow. W e determined,
therefore, t o perfuse the sinuses before making a cast, in
order actually to observe how the flow from the superior
sagittal sinus and from the straight sinus was directed.
The torcular and surrounding dura were spread over a clay
inodel having the general conformation of the occipital lobes
SINUSES F O R M I N G THE TORCULAK
421
and cerebellum. A colored fluid was perfused through the
straight sinus from a Marriot flask at a pressure of 110 mm.
of water. Clear water was perfused through the superior
sagittal sinus from a similar flask at the same pressure. Care
was taken to remove all air from the sinuses. Flow from each
lateral sinus was collected. B y means of a colorimeter the
amount of flow contributed to the right and left lateral sinuses
by the superior sagittal sinus and by the straight sinus was
determined. This procedure was carried out on twenty
torculas. Four torculars, casts of which were later made,
were not perfused because of uncontrollable leaks from
tributary vessels.
Casts were made as follows: with the torcula on the clay
model of the occipital lobes and cerebellum, a solution of
20 per cent celloidin in acetone was injected through one
lateral sinus. When the injection mass began to ooze from a
cut vessel, the vessel was ligated. If the vessel could not
be ligated because of its small size or position, a stream of
a i r was directed on the leak and the celloidin mass partly
hardened. The whole mass was allowed to harden and the
dura removed by dissection. The cross section area of all
vessels, except the tentorial sinuses, was determined by
measuring 36 radii of each vessel about a centimeter from
the torcula. The torcular was fastened with clay on a t u r n
table in such a position that the cross section to be measured
lay over the center of the table and the plane of the cross
section was parallel to the surface of the table. B y means
of a lever SO fixed that its tip swung in an a r c passing through
the center of the table, it was possible to determine the distance of the surface of the vessel from a point in its cross
section. The distance of the point on the surface in contact
with the lever tip from the 'center' was recorded with the table
at an arbitrarily chosen starting position. The table with
the attached torcular was then rotated through 10" and
another reading made of the distance of the surface in contact
with the pointer from the 'center.' This process was continued until the starting position was again reached. The
422
E. L. GIBBS A N D F. A. GIBBS
36 radii so obtained were plotted on radial graph paper.
Guided by these radii the perimeter was drawn in and the area
enclosed determined with the aid of a planimeter. I n the case
of the tentorial sinuses the cross section area was calculated
from the average radius. The values obtained were always
mult,iplied by a factor, experinientally determined to correct
for shrinkage of the celloidin.
TABLE 1
I~i.stribrrlion of
CENT O F S T R . s.
PI,()\\- C O N T R I H . TO
IWI:
CASE NO.
1,t.Lat.S.
Itt.1Jat.S.
1
2
3
4
61
0
100
100
7.i
2"
"3
24
39
100
0
0
23
0
0
0
0
14
0
0
22
24
20
0
48
0
100
42
,
100
100
I no
86
in0
100
78
76
80
100
32
100
0
.7 8
Bverage
-~
22
I
78
>
8
9
10
'
11
12
14
15
16
17
18
19
'
1
21
in0
1
1
f/oir,
by the forcttlnr
clisT O F SLT. SAO. IWI: c l i w O F RT. IAT.
5 . FlrO\V CONTIIIB. T O
S. F l r O \ V CONTI1113. BY
IW:
Rt.Lat.S.
:)!I
62
6 .i
53
51
63
GO
36
33
100
.56
33
70
24
1.i
88
20
42
46
G9
<j
6
1At.JA;it.S.
1
48
3 -3
47
49
37
40
64
47
0
44
47
30
76
85
12
80
38
Str.S.
31
16
0
24
0
5
8
70
87
100
100
99
100
100
100
100
98
100
100
97
93
84
100
76
100
9; <
92
44
6
9.5
.
4i
30
13
0
0
1
0
0
0
0
Sup.9ag.S.
2
0
0
3
I
i w t C P X T OF LT. L . ~ T .
S. FI.O\V C O N T R I B . BY
Str.S.
1
0
13
16
3
10
12
Sup.9ag.S.
99
1on
18
87
84
97
90
88
78
90
0
86
72
71
93
90
7.i
92
93
100
82
17
84
CJ 0
10
100
14
28
26
7
in
2.5
8
7
C)
ItE SULT S
A . Flow
It will be seen from table 1 that the straight sinus coiltributed the greater part of its flow to the left lateral sinus in
eighteen of the twenty cases (90 per cent). The superior
sagittal sinus contributed the greater part of its flow to the
right lateral sinuses in fourteen out of the twenty cases (70
per cent). The average composition of a sample from the left
423
SINUSES F O R M I N G T H E TOBCULAR
lateral sinus was 16.3 per cent straight sinus fluid and 83.5
per cent superior sagittal sinus fluid. The average composition of a sample from the right lateral sinus was 5.5 per cent
straight sinus fluid and 94.5 per cent superior sagittal sinus
fluid.
B. Cross sectioa area
The cross section areas of the vessels forming the torcular
can be seen in table 2. The average value for the straight
sinus was 14.8 sq.mm.; f o r the superior sagittal sinus 28.7
TABLE 2
Cross .sec?ion arcs
CASE NO.
in
squaw nrillimeters of vessrls f o r m i n g the torciilar
SUP.SAG.S. S T R A I G H T S .
LATIRAL
Rt.
1
2
3
4
5
8
30.0
17.9
22.4
32.7
40.3
24.4
30.2
32.4
1)
10
11
12
13
14
1.5
1G
17
18
19
21
-u
99
23
24
25
26
27
28
Average
-
,
24.7
21.7
Lt. 23.6
Rt. 20.9
15.5
18.8
21.7
34.0
23.9
26.6
39.0
21.6
46.0
25.5
Lt. 16.9
R t . 23.6
24.9
23.7
313
28.7
,
1
18.9
9.9
9.2
22.2
2.i.4
17.9
10.6
28.2
18.4
6.6
I
16.4
1
13.4
1;:;
,
14.9
1.5.1
23.6
4.0
6.6
12.0
12.8
11.8
17.1
12.8
.i.0
14.8
'
S.
1'Eh7TORIAL S.
Lt.
66.4
25.6
43.0
36.2
3.i.9
25.7
26.6
26.9
41.8
13.1
23.4
17.3
l.i.4
24.0
36.5
13.4
13.8
35..?
40.2
4.2
32.0
24.2
32.9
23.9
17.9
.5.3
32.4
23.1
27.7
27.7
34.9
33.7
23.5
26.2
20.9
42.3
26.6
10.1
46.0
49.0
31.2
11.6
28.4
22.2
27.1
48.3
10.3
23.9
113
29.7
24.2
92
Rt.
+'
+
Lt.
.i.8
8.1
3.4
7.2
3.7
9.3
123
4.6
5.3
+
5.4
8.0
7.7
5.8
6.4
5.8
6.5
OCCIPITAL S.
+
+6.2
+
2.1
3.3
3.7
6.3
4.1
1.5
6.1
4.6
4.0
8.1
I
6.3
+
6.3
+
+ ,
3.4
5.0
63
6.1
I
6.6
5.8
8.3
~-
-~
7.0
' P l u s sign indicates that sinus was present, but not iiieasured because not fully
injected.
424
E. L. GIBBS A N D F. A . GIBBS
sq.mm.; for the right lateral sinus 29.7 sq.mm.; for the left
lateral sinus 24.2 sq.mm. and for the occipital sinus 7.0 sq.mm.
These values are represented graphically in figure 1.
All but six of the casts showed ;I. sinus running through the
tentorium approximately biscctiiig the 90" angle formed by
S.S.
Fig. 1 Average cross srction awns of vessels forming the torculnr (magnified
2.9 t i m e s ) . S.S., supcrior sagittal ; L T J . , l e f t lateral sinus ; R.L., right 1:ttcral
s i n u s ; S., straight simis ; T., tcntorial sinus; O., occipital siuus.
5.s
Fig. 2 Photograph of :I cast of the .icsst.ls forming the toreular. T., tentorial
sinus; S.S., superior sagittal sinus; S., straight sinus; L.L., left lateral sinus;
R.L., right lateral sinus.
SINUSES FORMING T H E TOIICULAR
425
the junctioii of the straight sinus with the lateral sinus (fig.
2 ) . These are the sinuses we have referred to as tentorial
sinuses. They are usually found on both the right and left
sides and are often quite large; in the fifteen cases in which
they were measured the cross section area averaged 6.5 sq.mm.
for the riglit and 6.1 sq.mm. for the left. They are not
specifically mentioned in any previous study of the veins of
this region. They receive blood from the superior cerebellar
veins and usually empty into the lateral sinus near the straight
sinus. Occasionally they empty directly into the straight
sinus. Their cross section area takes the form of a much
flattened ellipse, the long axis being in a plane with the
tent orium.
SUMMARY
1. Two sinuses in the tentorium, that previously have not
been specifically mentioned, are described and figured.
2. The torcular usually directs the greater part of the flow
from the straight sinus into the left lateral sinus and the
greater part of the flow from the superior sagittal sinus
into the right lateral sinus.
3. The cross section of any given vessel in the torcular is
extremely variable, even relative to the cross section area of
the other vessels in the same torcular.
4. The cross section area of the right lateral sinus tends
to be greater than that of the left lateral sinus.
426
E. L. G I B E 5 A N D 1". A . GIBBS
I 1
1'
I
T
li A T U RE: ('ITEl)
J . S . 1894 1,c.s sinus posterior d c r la dure-iii1m et l c pwssoir
d 'Iieropliilc clicz 1 'Iio~iiiiic. Nancy.
EDWAI{DS,
E;. A. 1932 Aiiatoiiiic v:iri:itions of tlic cranial veiloils sinuses. Arch.
Krwrol. :n1d I'sych., Ed. 26, p. 801.
ox A N D E. I,. (:IUI%S 1934 Cerebral blo
):iiiying epilcxptic, seizures in 11i:iii. ( I n prt
I I E S K I ( . I A N D K I K U ~ Y I1903
I
I)ic \T:~~.ic~t:ictcn
d c r occipit:ilcn Sin
(c.onflucws sinuu~ii)mid ilire kliiiisllclic~I h l e u t u n g . Ztschr. f . Olirc~iili.,
13~1.42, R. 321.
KSOTT, .J. F. 1882 011 tllc cerebral sinuses a n d their variations. .J. Anat.,
vol. 16, p. 27.
ox, \V. Y., a s n E. I,. (;ilr~ts 1932 I3lood flow i n t l i c s brain :ind leg of
iiinii, a n d tlic c.ll:ingcs indiiced by altcrntioii of 11lood g:rscs.
J . ("lin.
Invest., vol. 11, p. 1155.
MAxivu, A . 1908 11 conflacntc (lei scni dclla dnra iiindre. Intcrnat. .\Ionatschrift f . Anat. 11. I'liysiol., Bd. 21, S. 304.
~)UXOXT,
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flow, forma, vessels, area, section, cross, sinus, distributed, torcular, mannel, lateral, right, left
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