Recent successes and failures in radiographic and radioisotopic angiography of the spinal cord

Radiographic visualization of the arteries of the thoracolumbar segment of the spinal cord has been consistently obtained since the introduction of the selective arteriographic technique. The successful demonstration of the cervical cord vessels is improved if, in addition to the vertebral arteries, both costocervical trunks are also injected. Nevertheless, we still fail to adequately visualize the cervical cord vasculature in about 20 per cent of the cases. Attempts to demonstrate spinal cord vessels in man, by non-selective techniques with potentiation of aortographic methods, have failed. Visualization of well individualized normal spinal cord veins is rarely obtained. Some observations made during our angiographic studies of 70 cases of arteriovenous malformation of the spinal cord, are reported. Technical advice is offered to improve the demonstration of feeders in this frequent pathological lesion of the spinal cord. The first observation of a cord arteriovenous malformation associated with a similar malformation of the brain is reported. Spinal subarachnoidal bleeding is an unexpectedly rare complication encountered almost exclusively in cases where a concomitant arterial aneurysm is present. In patients suspected of harbouring an arteriovenous malformation of the thoracolumbar spinal cord, the dangerous possibility of needle penetration within the lesion should be considered before attempting a lumbar myelography. In some instances, one may pass directly to arteriographic studies avoiding myelography. An alternative screening procedure is the newly introduced radioisotope spinal cord angiography. Certain angiographic observations in tumours, obstructive vascular disease, trauma, and radiation damage of the spinal cord are commented upon.