The angiographic configuration of intracerebral metastatic tumors.

Abstract

Within recent years attention has repeatedly been called to the significance of cerebral angiography as a means not only of ascertaining the presence and location of an intracranial space-taking lesion, but also of distinguishing between different types of neoplasm. Thus, the specific configurations, in the angiogram, of extracerebral meningioma and of malignant glioma have been described in a series of works, and may now be regarded as well established (Moniz, 19; Lima, 12, 13; Tonnis, 23; Lorenz, 15; Riechert, 20; Engeset, 8; Busch and Christensen, 4; Wickbom, 24; Torkildsen, 22; Miletti, 18; Culbreth et al., 7; Ethelberg, 9). To the angiographic changes in yet another group of intracranial neoplasms, namely intracerebral metastatic tumors, much less attention has been paid. This is the more notable, since, in view of considerations as to the appropriateness of the surgical measures to which these tumors may lead, we are specially interested in ascertaining their nature prior to operation. In dealing with the angiographic changes in extracerebral meningiomata, Lorenz (15) also considered those in non-metastatic sarcoma of dural or leptomeningeal origin. As for the vascular changes in the narrow sense, that is to say, the strictly endoneoplastic vascular arrangement, he succeeded in pointing out some features that may be used in the differentiation of sarcomata from meningiomata of the same localization and origin. If, however, the entire vascular configuration is taken into account, it would seem that, as judged from the angiograms, there is so striking a conformity between these extracerebral neoplasms as to lead to no difficulties in the differentiation of malignant growths originating in the osseous structures or the coverings of the brain from those within the brain itself, that is malignant gliomata, malignant papillomata, and metastatic tumors. Primary intracranial melanomata, as described by Christensen (5), have probably to be classified with Lorenz's sarcomata. Although, as far as we are aware, cerebral angiography has not been reported in cases of this type, it should be recalled that the primary melanomata on record originate from the coverings of the brain. and that the brain itself is not usually invaded. The angiographic changes in intracerebral metastatic tumors have been dealt with, among others, by Riechert (20), List and Hodges (14), Green and Arana (10), and Wickbom (24). Riechert has only touched upon the problem. List and Hodges and Green and Arana take the view that carcinomatous metastases have the same appearance in the angiogram as glioblastomata. Wickbom describes certain circumscribed abnormal vascular arrangements in about half of his series of 24 intracerebral metastatic tumors. The abnormal vascularization in the narrow sense only has been considered. These changes have been compared with certain definite angiographic types of glioblastoma and of meningioma.