The Use of Vertebral Angiography in the Differential Diagnosis of Cerebello-Pontine Angle Lesions

Abstract

In recent years, vertebral angiography has been increasingly used to provide details of the exact site and probable nature of posterior fossa tumors, in a fashion similar to carotid angiography which has largely replaced air study as the definitive neuro-radiological investigation in cases of supratentorial tumor. Angiography has additional advantages in showing the relationship of the tumor to the major blood vessels, which is helpful in planning surgery and, particularly if performed under basal sedation, of carrying little risk of disturbance of intracranial dynamics. In large posterior fossa tumors, it is less liable, therefore, to cause deterioration in the patient’s state than encephalography or ventriculography. Vertebro-basilar angiography in combination with plain film findings will usually give enough information to make further neuro-radiological investigations unnecessary. This view is illustrated by review of 30 recent cerebello-pontine angle masses in which vertebral angiography was used to elucidate the clinical picture. The tumors, which presented over the past two years in The National Hospital, Queen Square, and Maida Vale Hospital, all had signs which made the diagnosis of a C. P. angle lesion certain on clinical grounds. There were no cases in which the potential diagnosis of a small acoustic neuroma was being considered and we do not necessarily use angiography as the primary contrast study in such cases.