Intravenous digital subtraction angiography of the intracranial veins and dural sinuses.

When combined with computed tomography, IV DSA is usually of sufficient quality to replace conventional angiography in most patients with abnormalities of the larger intracranial veins and sinuses. Preoperatively, IV DSA can be used to evaluate normal anatomic variations of venous outflow to determine what sinuses can be safely occluded if necessary in the region of the temporal bone, jugular fossa, and base of the skull. Patients with glomus jugular tumors and carotid-cavernous fistulas also need conventional angiograms to define the feeding vessels of these lesions for obliteration by embolization or surgery.