Vertebral Angiography Research Articles

Brain Stone in Cerebellum

Idiopathic brain stone (Averback, 1977), or intracranial pathologically calcified lesion with unknown etiology, is very rare. A case of idiopathic brain stone in the cerebellum is reported. The patient, a 28-year-old female, was admitted because of sudden onset of severe vertigo and nausea. Plain computed tomography scan revealed a spotty high density area at the right dentate nucleus of the cerebellum which was not enhanced by contrast media. Vertebral angiography did not show any stain or abnormal vasculatures even with a prolonged injection method. Surgery was performed with the aide of sector scanning ultrasonography. The surgical specimen showed scattered calcium deposits without any vascular or neoplastic component.

Neurofibromatosis with Extracranial Vertebral Arteriovenous Fistulae

A 38-year-old female was hospitalized complaining of left cervical pain. On physical examination, bruits were audible in the painful region. Plain X-rays of the cervical spine showed widening of intervertebral foramina and scalloping of the vertebral bodies at C2-C5. Left vertebral angiography disclosed aneurysmal dilatation and arteriovenous fistulae at the C3 and C4-C5 levels of the artery. The right vertebral artery, bilateral occipital arteries, left thyrocervical trunk, and costocervical trunk were associated with the fistulae as collateral pathways to the left vertebral artery. In a sequential procedure, the left vertebral artery was clipped just proximal to the posterior inferior cerebellar artery, the lower fistula was occluded by a detachable balloon, and muscle was packed to the abnormal vessel close to the upper fistula. After treatment the bruits diminished and the radiculomyelopathy abated. Arteriovenous fistulae should arouse suspicion of neurofibromatosis. Auscultation of the neck and angiography are recommended for patients with neurofibromatosis presenting with radiculomyelopathy. Intravascular surgery with a detachable balloon is considered very effective for extracranial vertebral arteriovenous fistulae.

第3脳室経由で到達した高位脳底動脈瘤

There are two major approaches to a basilar top aneurysm: one is the subtemporal method developed by Drake, and the other is the pterional method developed by Yasargil. In either approach, however, it is hazardous and difficult to approach a basilar top aneurysm with megadolichobasilar anomaly because strong retraction of brain, nerve and vessel is required.A case of a ruptured basilar top aneurysm with megadolichobasilar anomaly successfully treated directly through the third ventricle is reported.A 62-year-old woman was admitted with consciousness disturbance.A plain CT scan on admission demonstrated massive and diffuse subarachnoid hemorrhage and a clot in the third ventricle.The left vertebral angiography demonstrated a 5×5mm basilar top aneurysm with megadolichobasilar anomaly 24mm distant from the dorsum sellae.The aneurysm was considered to be inaccessible by conventional approaches because of its high position. Therefore, we applied a new approach, described below.The operation was performed two days after the onset of symptoms, using a bifrontal craniotomy. Dissecting the interhemispheric fissure, we approached the third ventricle via the lamina terminalis. Evacuating the clot in the third ventricle, the basilar top aneurysm was visualized. After dissecting the neck of the aneurysm and perforators, clipping was performed.The postoperative course was uneventful.The surgical key points and the prospective view in approaching via the lamina terminalis and through the third ventricle for a high position basilar top aneurysm are discussed in this paper.

Vertebral Artery Angiography and Migraine-Like Symptoms: Hauge's Studies Reconsidered

Vertebral Artery Angiography and Migraine-Like Symptoms: Hauge's Studies Reconsidered

Arterial compression of the fifth cranial nerve causing trigeminal neuralgia: angiographic findings.

A common cause of trigeminal neuralgia (TN) is compression of the root of the fifth cranial nerve by a tortuous basilar artery or one of its branches. Microvascular decompression surgery has proved valuable in relieving the symptoms of these patients with nerve compression. We performed vertebral angiography on 22 patients with TN. The angiographic appearances were compared with the findings obtained from an anatomic study in which the positions of 20 trigeminal nerves in the skull were determined radiographically in 12 cadavers. By using this information, we were able to predict the presence of arterial-nerve compression in 20 of the 22 patients, and these positions were later confirmed at surgery. We describe the angiographic findings in patients with TN as well as the findings in a control group of 159 individuals with no history of TN. From these preliminary results, angiography appears to be valuable in the preoperative evaluation of patients with TN.

Direct spinal arteriovenous fistula: a new type of spinal AVM

A patient presenting with progressive paraparesis was found to have a spinal arteriovenous fistula at the T3-4 vertebral level. The lesion consisted of a direct communication of the anterior spinal artery with a very distended venous varix that drained mostly superiorly to the posterior fossa and simulated a posterior fossa arteriovenous malformation (AVM) on vertebral angiography. The patient was treated by surgical ligation of the fistula through an anterior transthoracic approach. He deteriorated abruptly on the 4th postoperative day, probably because of retrograde thrombosis of the enlarged anterior spinal artery. Over the next few months, he improved to the point of being able to walk with crutches. He has also regained sphincter control. The different types of spinal AVM's are reviewed. Our case does not fit into any of these groups. A new category, Type IV, is proposed to designate direct arteriovenous fistulas involving the intrinsic arterial supply of the spinal cord.

Selective External Carotid Angiography and its Clinical Applications

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.

Acoustic Neurinoma with Early Venous Drainage and Caput Medusae-like Vasculature on Angiogram

It has been considered that acoustic neurinomas are hypovascular tumors on angiogram. Recent angiographical analysis, however, revealed that some of them showed tumor stain, capsular stain, and even arteriovenous shunt. The problem with operation on the acoustic neurinoma with a peculiar vasculature on angiogram has not been discussed in previous reports. In this paper, the neuroradiological findings of a unique case are described, in conjunction with the operative problem. A case of huge acoustic neurinoma with early venous drainage and caput medusae-like vasculature on angiogram is presented. The patient was a 46-year-old woman suffering from dizziness and gait disturbance. On admission, she had bilateral choked disc, left fifth and seventh nerve palsy, and left cerebellar signs. The audiogram showed scale out on the left, carolic test and auditory brain stem response were nil on the left side. On computed tomography, a huge, heterogeneously enhanced mass was detected in the left cerebellopontine angle. Vertebral angiography revealed that the tumor was supplied by the anterior inferior cerebellar artery and ascending pharyngeal artery. Caput medusae-like vasculature was visualized in arterial and capillary phases, and abnormal draining veins were also opacified in these phases. They were considered to be an arteriovenous fistula. At operation, the abnormal vasculature looked like an arteriovenous malformation on the tumor capsule, which made the surgical procedure of dissecting the tumor from the pons extremely difficult.

Vertebral Dissecting Aneurysm associated with Medial Mucoid Degeneration

An autopsy case of intracranial vertebral dissecting aneurysm associated with medial mucoid degeneration is reported and 54 cases of vertebro-basilar dissecting aneurysm in the literature are reviewed. A 37-year-old man with history of hypertension was admitted in a semicomatose state. Computed tomographic scan showed severe subarachnoid hemorrhage (SAH), especially in the posterior fossa with ventricular reflux, and vertebral angiography disclosed a fusiform dilatation with proximal narrowing of the left vertebral artery and narrowing in the midportion of the basilar artery. Continuous ventricular drainage was performed, but the patient died from rebleeding on the 14th hospital day. Autopsy revealed massive SAH around the brain stem and a fusiform aneurysm of the left vertebral artery. Microscopic examination demonstrated a local thickening of the wall with tearing of the intima and the media. A hematoma between the media and the adventitia communicated with the true lumen of the artery. The muscular layer was replaced by myxomatous connective tissue. The basilar artery had mild fibrous thickening of the intima and duplication of the internal elastica. The medial mucoid degeneration was discovered by iron-colloid stain in the intracranial arteries, especially in the vertebro-basilar system. However, arteriosclerotic change was minimal. The authors emphasize that SAH as initial symptom and hypertension as predisposition occur more frequently in vertebro-basilar dissecting aneurysms than previously described.

Surgical Evacuation of a Pontine Hematoma due to Rupture of a Capillary Telangiectasis in a Young Patient

A 17-year-old female presented with a small pontine hematoma considered as having arisen from rupture of a capillary telangiectasis. Vertebral angiography showed fenestration of the left distal vertebral artery without any vascular anomaly in the pons. Histological examination of the surgical specimen verified the presence of a capillary telangiectasis adjacent to the hematoma. Rupture of a capillary telangiectasis as the source of pontine hematoma is very rarely documented histologically in surviving patients.

Ascending Pharyngeal vertebral Anastomosis with Bilateral Absence of Vertebral Arteries

The authors encountered a patient with an anomalous external carotid-vertebral anastomosis, which was found incidentally during examination for a recurrent pituitary adenoma. Left carotid angiography demonstrated a muscular branch of the ascending pharyngeal artery feeding the left vertebral artery, while bilateral retrograde vertebral angiography failed to demonstrate the origins of either vertebral artery. To our knowledge, this is the first documented case of ascending pharyngealvertebral anastomosis associated with the bilateral absence of vertebral arteries at their origins.

Multicentric hemangioblastomas in the cerebellum

An 18-year-old female patient who had been diagnosed as having von Hippel-Lindau disease was admitted to our hospital with signs of increased intracranial pressure. Computed tomographic examination and vertebral angiography revealed the presence of five multicentric cerebellar nodules, of which three had newly occurred in the opposite hemisphere, probably sometime during the 3 years before admission. This case gives us some insights into the biological multipotentiality of cerebellar hemangioblastoma. We stress that close observation is absolutely necessary for this unique group of tumors, even after total excision.

Arteriovenous malformation of the spinal cord in a 17-month-old child.

A case of arteriovenous malformation (AVM) of the cervical spinal cord occurring in a 17-month-old girl is reported. The initial symptom was quadriplegia of abrupt onset. Bilateral vertebral angiography disclosed 6 feeding arteries and a large draining vein. Complete obstruction of the blood supply to the AVM was confirmed angiographically, following cauterization and section of feeders via an anterior approach. Two years after the operation, the patient can sit and move all extremities with residual slight right hemiparesis. This report is the first operative case of cervical cord AVM in a child under 2 years of age.

Trigeminal neuralgia and hemifacial spasm caused by a tortuous vertebrobasilar system

The case of a 66-year-old woman who developed both trigeminal neuralgia and hemifacial spasm caused by a tortuous vertebrobasilar system is reported. Vertebral angiography showed a dilated and elongated basilar artery overlying the porus acusticus of the internal auditory canal. Double-contrast computed tomography scanning was very useful in evaluating this abnormality. Vascular decompression was performed by using a fenestration clip.

Meningiomas of the lateral ventricles. Clinical, neuroradiologic, and surgical considerations in 19 cases

The clinical and neuroradiologic findings and surgical results in a series of 19 patients with lateral ventricle meningioma, operated on during a 33-year period, are described. This experience is compared with that of previous workers and the following conclusions are drawn: (a) these tumors have no characteristic symptoms; (b) preoperative diagnosis requires both computed tomography scans and carotid and vertebral angiography; (c) the safest surgical approach is through a sagittal or oblique parietooccipital cortical incision to avoid damage to motor, visual, and speech areas of the cortex.

Haemangioblastoma of the brain. Computed tomography and angiographic studies in 17 patients.

Between 1975 and 1983, 17 patients who underwent surgery for haemangioblastomas of the brain (16 lesions occurring in the posterior fossa) were studied with CT scans (17 cases) and vertebral angiograms (15 cases). The CT scans were superior for demonstrating a cystic tumour, its topography in the posterior fossa, its relationship to the fourth ventricle, and the presence and degree of an obstructive hydrocephalus. The vertebral angiographies were more sensitive and specific than CT for revealing the vascular nature, and were imperative in order to establish the supply and drainage of the tumours. It is clear that CT and angiography each make an important contribution toward defining these tumours. Their association is necessary.

The effect on the development of cerebral vasospasm in the rat of lesioning of the peripheral and central catecholamine systems

An experimental SAH was produced in the rat by the intracisternal injection of blood. The animals were examined with bilateral vertebral angiography or autoradiographic CBF- and CMRgI-studies. A biphasic vasospasm was seen with a maximal acute spasm at ten minutes and a maximal late spasm at two days post SAH. On day two post SAH, CBF studies demonstrated focal low flow areas in the cortex and caudate-putamen. The CMRgI examinations revealed focal areas with deoxyglucose accumulation corresponding to the low flow areas, suggesting an anaerobic glycolysis. Adrenal demedullation did not change the degree of spasm. Cranial sympathectomy reduced the degree of late spasm by about 50%. Lesioning of the ascending CA pathways in the mesencephalon prior to the SAH, prevented the development of both the acute and the late spasm. It also prevented the development of the focal CBF and CMRgI changes.

The use of vertebral angiography for the recognition of spinal cord vascular injuries during birth injuries of the spine

For the correct interpretation of a number of pathological conditions that caused the death of the fetus and newborn, understanding the pathogenesis of birth injuries of the central nervous system, it is important to study the state of the vasculature of the spinal cord and, first of all, the vertebral arteries.

Hemangioblastoma with Massive Bleeding

A case of hemorrhage from hemangioblastoma is reported. A 52-year-old female was admitted with an episode of sudden-onset consciousness disturbance and double vision. Six years previously she had been treated by a ventriculo-peritoneal shunt, radiation therapy and partial removal of a cerebellar hemangioblastoma. Computed tomography showed a massive hemorrhage around the recurrent tumor in the left cerebellar hemisphere and a ventricular bleeding. Evacuation of the hematoma was immediately performed. The tumor could be removed only partially because it bled easily. Postoperative left vertebral and carotid angiography disclosed that the tumor was mainly supplied by the left superior cerebellar and the tentorial arteries. In the second operation, the left superior cerebellar artery was clipped temporarily through the subtemporal approach, and the tumor was extirpated totally through the suboccipital approach. Histological examination confirmed hemangioblastoma. Mechanism of the massive hemorrhage from hemangioblastoma is discussed.

当科における上位けい髄しゅようについて

We have experienced 6 patients of the upper cervical cord tumor (histological diagnoses were 3 meningiomas, 2 neurinomas, one metastasis of chorioepthelioma). The age of the patients ranged from 32 to 66 years, the median being 48 years. The considerable difficulty in early diagnosis is emphasized.When biceps tendon reflex and pronator reflex were hyperactive on asymmetry and Babinski reflex was positive, the upper cervical cord tumor should be also considered. And then, CT scan, CT myelography vertebral angiography are also indispensable to eefine the tumor size and the distribution of nutrient artery to the tumor.