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The brain

Interventional neuroradiology

Interventional neuroradiology is the treatment of CNS lesions by catheter techniques. The procedures are technically demanding and a comprehensive knowledge of the different types of catheters and embolization materials is required. The commonest procedures are occlusion of arterio-venous fistula with detachable balloons, for example occlusion of fistula between the carotid siphon and the cavernous sinus (Fig. 49), and partial or total embolization of arterio-venous malformations (Fig. 50),

a	Figure 49. Lateral angiogram showing a fistula between the carotid siphon and the cavernous sinus. a) Cavernous sinus filled with contrast medium (arrow) and drainage via the superior ophthalmic vein and the inferior petrosal sinus. b) The fistula has been occluded with a balloon (arrow) detached from a special catheter.
b

intracerebral or dural, with small particles or special glue. Another nonoperative treatment method for arterio-venous malformations is radiotherapy in the form of stereotactic gamma or proton therapy. Preoperative embolization of meningioma is performed only occasionally. Techniques for obliteration of arterial aneurysms and dilatation at vessel spasm are developing rapidly.

a	Figure 50. AP angiogram (a) of temporal arteriovenous malformation (horizontal arrow) with draining vein (vertical arrow). After super-selective catheterization and injection of glue the angiogram appears normal (b).
b

Kjell Bergstrom and Giuseppe Scotti