Interventional neuroradiology (surgical neuroanglography)

The applications and effectiveness of surgical neuroangiography, or interventional neuroradiology of the head, neck, spine and brain are rapidly increasing. These procedures are used in the management of a variety of vascular lesions, either preoperatively or as the primary mode of treatment. Lesions that can be approached by the endovascular route, vascular neoplasms (benign or malignant), vasculas malformations (arterial, venous, or mixed), hemangiomas, arteriovenous fistulas, vessel lacerations, and extracranial or intracranial aneurysms are discussed, as are infusion chemotherapy and angioplasties of atherosclerotic or vasospastic extracranial or intracranial vessels. The various catheters or delivery systems and embolic agents, including conventional or special microcatheters, balloon catheters of various lumens, detachable balloons of silicone and latex, open-ended guide wires, and steerable microwires, as well as various embolic agents, either particulated or liquid, and including cytotoxic agents, are described. Functional vascular anatomy of the collateral circulation is reviewed, including extracerebral to intracerebral anastomases and the supply to the transcranial nerves. The use of chemical testing with Amytal and Xylocaine and electrophysiologic monitoring for safe embolization is demonstrated