Selective External Carotid Angiography and its Clinical Applications

Abstract

Selective external carotid angiography using Seldinger's technique was employed in 20 cases (9 tumors, 9 spontaneous carotid-cavernous fistulas [CCF], 2 others), and its clinical applications are discussed. Diagrams of normal external carotid angiogram were drawn on the basis of analysis of the films obtained from these 20 cases. Various clinical situations were then investigated as follows: 1) A case with a right temporal bone tumor, where the ophthalmic artery originated solely from the middle meningeal artery of the same side and fed the tumor. 2) Nine cases of spontaneous CCF. One case was an internal CCF, and eight were dural CCF. A case of dural CCF with feeders arising from the accessory meningeal artery, the artery of the foramen rotundum, vidian artery of the external carotid artery, as well as the C4 part of the internal carotid artery, is presented. 3) A case of left sphenoid ridge meningioma with extracranial extension via the base of the cranium. The proximal part of the external carotid artery was ligated. By vertebral and deep cervical angiographies, the external carotid artery was opacificated via the enlarged anastomoses between the occipital, vertebral, and deep cervical arteries. 4) A case of giant neurinoma in the right middle fossa with a feeder arising from the middle meningeal artery of the same side. Other lesions in the cranium, the face, and the scalp are also presented. Selective external carotid angiography proved valuable in the diagnosis of the extra and intracranial lesions.