The Influence of Modern Angiographic Techniques

Abstract

The question whether neuro-surgical intervention is indicated or feasible in the case of a cerebral arteriovenous angioma is nowadays determined to a large extent — depending on the location of the angioma — by the angiographic findings. During the past 20 years serial angiography and subtraction techniques have brought about important progress in the field of neurological diagnosis. A further advance is the possibility of a better demonstration of the vertebro-basilar system by means of the retrograde method via the brachial artery or with the aid of selective techniques using a femoral catheter. Over a period of many years success has been achieved in the adequate demonstration of angiomas in the infratentorial and supratentorial areas. Parallel with this, there has been a widening of the basis of indication for operation. The further development of neuro-surgical techniques — here mention might be made of the operation microscope — has extended still further the indications for operability. It was then asked whether it might not be possible to obtain a still better demonstration of the angiomas, their vascular supply and drainage systems. The demand for adequate angiographic diagnosis is frequently met today by rapid serial angiography. A good and adequate demonstration of all the arteries participating in the cerebral circulatory system must be regarded as the basic requirement. Thus, a widespread use of the vertebral angiogram has revealed even in case of vascular malformations in the supratentorial area that the branches of the posterior cerebral artery are involved to a greater or less high degree in the blood supply of these angiomas, which are supplied in the main from the carotid system, and may in individual cases constitute the sole source of supply.