The Diagnostic Value of Carotid Arteriography

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CEREBRAL angiography is now almost universally recognized as a valuable addition to the diagnostic armamentarium of the neurologic surgeon. A clearly defined picture of the vessels of the brain, whether normal or abnormal, is most useful in helping the surgeon decide in favor of or against an intracranial operation. This is especially true in cases of vascular malformations, aneurysms, thromboses of the venous sinuses, and other lesions which do not cause displacement or distortion of the ventricular system.

The feasibility of injecting a radio-opaque medium into the arteries supplying the brain and its coverings, with a view to outlining the intracranial vessels by x-rays, was demonstrated by Egas Moniz,1 a Portuguese neurosurgeon, in 1927. Since his original description, the methods and materials utilized have varied considerably. All modifications have been made with the intention of obtaining clearer and more diagnostic pictures, with a minimum of risk to the patient.

Many elaborate technics have been developed in order to obtain certain specific views of the cerebral circulation; these have recently included the use of the x-ray motion picture camera. However, it is unnecessary to use complicated equipment in taking cerebral angiograms. Usually only single posteroanterior and lateral views are required to establish the presence or absence of the suspected lesion. Variations in the timing of the exposures may be helpful, as the arterial, capillary and venous phases of the circulation may be photographed at will.

Injection of one vertebral artery will outline the vessels in the posterior fossa bilaterally if the. . .



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