Cerebral angiography

Cerebral angiography was inaugurated by Egas Rfoniz of Lisbon in 1926 and has now become one of the standard diagnostic methods of cerebral lesions. Lima’s book is the first systematic treatise on this subject published by the Portuguese school in the English language. The author has been associated as neurosurgeon with RIoniz for more than twenty years, and the combined material of these two investigators comprises more than two thousand angiographies, a numbcr unsurpassed anywhere. Lima corroborates, amplifies and in some rases revises Moniz’ fundamental work which had bcen published previously in the French and German literature. The subject matter is covered in $ell organized and critical fashion, but unfortunately too little attention is paid to the numerous publications on angiography which appeared in Scandinavian, American and German literature, especially after the war. After reviewing the history of angiography, its technique is discussed. Lima advocates surgical exposure of the common carotid artery low a t the neck in preference to the percutaneous technique now practiced in many centers. He performs carotid angiography bilaterally in one sitting under local anesthesia and obtains routinely three lateral films for each injection (the first film to show the arterial phase, the second the early venous phase, and the third the late venous phase). AP projections are rarely used, and stereoscopic films never taken. The next chapter deals in detail with the normal arteriogram and phlebogram obtained by vertebral and carotid injection. Then follows a description of the typical displacements and deformities of cerebral vessels caused by intracranial tumors and, hydrocephalus. I n the next section the angioarchitectonic pattern of cerebral tumors is described. This chapter is particularly interesting and informative since Lima has done much original work on the circulation of meningiomas. The typical double blood supply of meningiomas through branches of the external and internal carotid arteries is discussed, and also the relation of ,angiographic pictures to modification of the circulation time is analyzed. The chapter on cerebral aneurysm is relatively brief but vascular malformations are discussed at length. Angiography offers an important aid i n the diagnosis of cerebral vascular occlusion. Special attention is given to the not uncommon thrombosis of the cervical portion of the carotid artery. This condition produces a characteristic clinical syndrome and can be easily recognized by low cervical carotid angiography.