Therapeutic angiography in neuroradiology. Classical data, recent advances and perspectives.

This report summarizes the extraordinary development of the neuroradiological entrance into the treatment of massive vascular malformations of the head and spine, also highly vascularized tumors, by embolization accomplished with the appropriate type of catheter and highly refined technique, in collaboration with the surgeons of neurology, ophthalmology, otolaryngology, and of the vascular system.

[Angiodysplasia or vascular malformations of the cervical spine (author's transl)].

Following exploration by angiography , 45 patients with cervical spine malformations ( out of 220 cervicocephalic examinations for vascular malformations), were treated by embolization. The 45 cases included 13 facial lesions, 4 pharyngolaryngeal lesions, 2 cervical venous ectasias, 4 arteriovenous fistulae of the vertebral artery, 19 medullary lesions, and 3 pseudomalformations (hemangiopericytomas). Though embolization is difficult it is of value in definitely vascular occlusions (follow-up for 3 years), and miniaturization of catheters and balloon sounds enables very selective occlusion of vascular tumors or malformations to be carried out, micro-emboli of 30 to 500 mu have been obtained.

[Therapeutic embolization for traumatic renal haemorrhage. 11 cases (author's transl)].

Therapeutic embolization by means of autologous clots or fragments of gelatin sponge was carried out in 11 patients suffering from renal haemorrhage of traumatic origin (5 needle biopsies, 3 surgical operations, 2 external traumas, 1 penetrating wound). Arterio-venous fistulae were present in 6 cases and arterial lesions in 5. Performed with a fine catheter, embolization was highly selective for the segmental arteries involved.

Place of embolization in the treatment of severe epistaxis.

On the basis of long-term study on embolization for severe epistaxis, the authors show the different indications and results of this relatively new method; and 54 cases are presented including Rendu-Osler diseases, primary and traumatic epistaxis, or those due to vascular malformation and benign or malignant tumors. Embolization can prove a very effective method in most cases.

[Bilateral nephrectomy by embolization of the renal arteries: a report on five cases (author's transl)].

Selective bilateral renal artery embolization was performed in 5 patients because of severe hypertension not responding to conventional medical treatment, in two patients on repeated dialysis; severe nephrotic syndromes with chronic renal insufficiency in the three other patients. A significant drop in blood pressure occurred in only two of the hypertensive patients, about 40 days after embolization. Bilateral surgical nephrectomy was required in the other patient because of persistence of residual vascularization and high RAP.

[The risk of ligation of the external carotid in the treatment of cervico-facial angiodysplasia. A plea for this technique to be abandoned, and current radiosurgical solutions; based upon 13 cases of ligation amongst 200 angiomas explored (author's transl)].

After describing the different collateral sytems between the various cervicocephalic arteries, the authors indicate the consequences of ligation of the external carotid. This ligation proves to totally ineffective for distal vascular lesions and severely compromises the possibilities of later treatment.

[Cervico-cephalic vascular malformations. Current treatment protocol. Apropos of 230 cases].

In the light of 230 cases of vascular malformations in the cervico-facial region and the scalp treated over a 7 year period, the value of embolization is specified. Embolization permits effective treatment of the complications of these lesions, in particular haemorrhage. The reduction of swelling that can be obtained is always marked, but often incomplete : this is largely due to an associated hypertrophy of the neighbouring nonangiomatous tissues : such hypertrophy most often necessitates plastic surgery in order to obtain complete correction of the local disfigurement.

[Treatment by a direct surgical approach of a false arterio-venous traumatic aneurysm between the vertebral artery and the internal jugular vein at the level of the atlas (author's transl)].

The authors report a case of traumatic arteriovenous fistula between the vertebral artery and the internal jugular vein at the level of the atlas, treated successfully by a direct surgical approach which permitted exclusion after simple dissection. The relative ease of the surgical approach of the suboccipital segment of the vertebral artery may permit one to extend this technique to other more common indications, in particular due to atheroma.

[Embolization of the renal arteries or "medical nephrectomy" in amyloidosis nephrotic syndromes. 2 cases (author's transl)].

Some nephrotic syndroms have a very poor prognosis (life threatening) because of the protidic loss, even if the renal fonction is still normal. Only a binephrectomy can prevent this true protidic diabetes. In order, to avoid the inconvenients of surgery which can be a major problem with patients having cicatrization difficulties, a bilateral embolization of the renal arteries was done.

Moyamoya disease and intracerebral hematoma. Clinical pathological report.

This report concerns a hypertensive woman who suffered a stroke at the age of 51 and recovered from left hemiparesis after 3 to 4 months. During the subsequent 24 years she had four seizures which involved the left arm and face and became generalized, ending with left hemiparesis, from which she recovered after 4 to 5 days. Carotid angiography was performed in 1967, 1973 and 1974 and the characteristic picture of moyamoya disease was demonstrated.

[The value of embolization in severe epistaxis. Indications and methods (author's transl)].

When performed by a team who are experienced in the use of embolization of the external carotid region, this procedure is nowadays a safe and extremely effective method for treating severe, massive, uncontrolled, recurrent epistaxis. Arteriography shows the site of bleeding, the nature of the lesion, and the arteries affected. When carried out by the femoral or common carotid route, this method was effective in 52 cases of severe epistaxis of various origins: essential epistaxis, or from hypertension, trauma, Rendu Osler's disease, vascular malformations, carotidocavernous fistulae, benign or malignant tumors, hematological affections, or hemostatic disorders.