VOL.

No.

123,

MAGNIFICATION

ANGIOGRAPHY*

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IDENTIFYING

THE OF

HARVEY

By

CAPSULAR

ACOUSTIC

I. WILNER,

NEUROMAS M.D.,

DETROIT,

‘J’HE

recent

spot ization seen

of by

We

have

utilizing

with

focal

giography

have

studied

within

MATERIAL

selective

the

several

tumor

confirmed microscope. AND

well acous-

had

been

successfully

in more neuromas, the

A preshaped catheter

was

confines.

the

right

surgically

ml.

Renografin

or

tra-arterially, at a flow sequence

artery

M.D.

performed

than only

benefit

of

patients

50

the

last

6

magnification

angiography.

angiogclus-

METHOD

vertebral

has

at our hospital with acoustic patients

magnification identified abnormal

AUSTIN,

MICHIGAN

visualnot

DONALD

and

techniques.

vessels were the dissecting

Although

small

excellent

structures

recently

vessels

of the

enabled

conventional

of

These

has

important

tic neuromas raphy and ters

perfection

tube

VASCULATURE

an-

onds,

3’

No.

French

selectively left

vertebral

6o per using

polyethylene

placed

cent an

into

artery.

was

2

films

automatic

every

to

injected

rate of 3 ml. per second. extended over a period

exposing

either Six

second

7

in-

injector

The of

10

for

film secthe

Harvey

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32

3 seconds, remainder

initial

for the

then of the

Magnification Siemens

speed

0.2

film,

film study.

I

factors mm.

each

of the

to the

Transfacial

the most

at

providing

cation, against

produce

least

the

lower and

informative

tube

the

of

high-

neuromas

physicians

with

Positive ele40

magnifi-

head

auditory

1975

to

provide

diagnostic

testing,

hearing

chal-

agraphy,

and well

myelography

described

ments

caused

of

not

eleclamin-

have

changes3’4

pathognomonic

of a cerebellopontine Vertebral angiography understanding

particularly

loss, abnormal characteristic

tronystagmography, been

is gave

continue

a difficult

discriminatory

border. projections

JANUARY,

lenge.

kilovoltage

3 times patient’s

views.

Austin

DISCUSSION

use

tube,

grid,

Towne

Donald

second

in the 95-100 range, and milliampere-second averaging between 10 and 12. The vating Schonander table can be raised inches

and

Acoustic

include

microfocus

removal

I. Wilner

angle

the

only

has

findings

mass. increased

vascular

by

displace-

the

neuroma,

our

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VOL.

No.

123,

displacing

Magnification

s

the

antopaque

i

but

by

associated

nosis

cerebellar

The in

tric

angle

brain

brain

hooker

masses

such

as

gliomas,

tumors

be

may

middle

fossa

rounded

demonstrates

neuromas masses

The

11-D)

neuroma. the

typical

outline

present having

capsule.

tion

of the which

the vessels

evalua-

the

cirtumor.

surgically a

central

which

contains

often

structures

seen by

becomes such

as the

hemisphere

facial

and

series

seen

views 2

Figure

definitely

show

the

conventional

the aid

il-C;

2,

(Fig.

4,

fine

demonstrated but

and

of magnificaand

3, il-C).

il-C;

and vessels

magnification

difficult

to delineate

methods. stains

are

C

capsular

Towne

capsular

with were

B and within

these

in

with (Fig. cases

,

vascularity

our

best

techniques last

Meningioma

in

increased In

were

were

with

capsule.

which

cerebellar

angiography,

as hypo-

that

and

“stain”

caused

approach

preoperative

surrounding

tissue.

was

proper

the

Most

stem,

arachnoidal

trans

Choosing boundaries

and intrans-

a

portion

to adjacent

brain

combined

a detailed

vessels

and this

and

vessels

adherent

and

necessitates

iil

numerous

operative

approaches.

Figure

is the

The upon tumor size by suboccipital,

cumscribed

capsular

by

shown

techniques depend clude craniotomy

of the

core

It

epidermoids,

microscopic

tion

vascular

eccen-

diagnostic modality. Sophisticated

labyrinthine,

stem diag-

aneurysms,

meningiomas,

stem

metastatic

and

occasional

hemangioblastomas,

33

medi ,. (B) 1 projec ion ( times magni cation) of the arterial phase. vessels (arrow) are noted. The left superior cerebellar artery is pushed medially (C) Venous phase of the same injection series. The tumor capsular vessels The left petrosal vein is displaced laterally (arrow).

Abnormal tumor capsular and upwards (arrowhead). (arrows) are still apparent.

changes.

Angiography

more

homoge-

5,

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I. Wilner

Harvey

34

and

Donald

Austin

JANUARY,

1975

v (arrowcerebellar :vesseuroma en tional r (arrowthe right ). No

neous

than

the

stippled

Abnormal these

neuroma.

distinguish Epidermoid

ported itv

tumors

to have and

appearance

abnormal

pathologically

vessels

in 4 of the Lateral was

have

not

capsular do

the also

of

meningeal tumors.

been

re-

anterior

neuromas inferior

of

associated semilunar

this

vessel

cerebellar was

may

elevate artery,

confirmed

of the

with

tumor

petrosal

vein

involvement

of

ganglion. SUMMARY

such Five

Although

presented.

vascular-

show

not

a finding.

sion

the

cases

displacement

the depres-

surgically

cases

of

angiographically

are

Magnification visualization

acoustic techniques

of

the

studied

neuromas presented.

fine

enhance capsular

vessels

the of

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VOL.

No.

123,

Magnification

s

Angiography

35

‘ ;...

3

,\,. ,‘‘...

I

-

B

D I1’

5, Case v. (A) Tomogram canalicular acoustic neuroma

these

mal of

tumors.

When

vessels

are

in the anteroposterior is demonstrated.

Wii

taken with Pantopaque. A large partially extraof any impression upon the superior portion of the contrast material is against involvement of the semilunar ganglion. (B) Conventional transfacial view. The left anterior inferior cerebellar artery (arrow) is poorly seen when compared to the right (arrows). No stain is noted. (C) Towne projection ( times magnification) of the early arterial phase, taken immediately following B. The basilar artery (arrowhead) and the 2 posterior inferior cerebellar arteries (arrows) are noted. (D) ‘I’owne projection (, times magnification) of the late arterial phase. The abnormal capsular vessels (arrow) and the circumscribed branches of the left posterior inferior cerebellar artery surrounding the tumor (arrows) are now apparent.

FIG.

shown,

probably

these

The

tery.

abnor2.

I. Wilner,

7.

1949,

pathognomonic

a neuroma.

Harvey

plane lack

M.I).

of

M.,

3.

extra-axial

mas. 4.

1968,

VALVASSORI,

WILNER,

REFERENCES 1. ATKINSON,

W.

J. Anterior

internal

inferior

cerebellar

ar-

material.

Psychiat.,

G., and HANAFEE, W. cerebellar artery: its radioand significance in diagnosis tumors of posterior fossa. Radi-

90,

281-287.

G. E. Diagnosis

Seminars H. I.,

KNIGHTON,

&

WILsoN,

inferior anatomy

ology,

Neurosurg.,

137-151.

IAKAHASHI,

Anterior graphic

Department of Radiology Harper Hospital 3825 Brush Street Detroit, Michigan 48201

Neurol.,

/2,

of acoustic in Roentgenol., 1969, 4, IIENTON, J. L., EYLER, W.

R. S. Tomographic auditory Radiology,

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neuro17

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R.,

and

evaluation

using positive 95, 95-99.

contrast

of