Accurate Placement of Artificial Emboli

The management of large angiomatous malformations of the brain has long concerned the neurological surgeon. The use of hypothermia, allowing temporary interruption of the carotid and vertebral arteries in the neck or of the large feeding arteries intracranially, has frequently permitted an aggressive and successful surgical approach. A considerable number of these lesions, however, remain too extensive and formidable for direct resection. Since the angiomas cause neurological symptoms by either bleeding or diverting blood into a pathological shunt to the detriment of adjacent areas which become ischemic, some form of rational treatment is needed. Neither ligation of the great vessels in the neck nor x-ray therapy has been found helpful.1 Luessenhop and Spence2described an ingenious method whereby artificial emboli were introduced into the carotid artery in the neck and stated, "The differential in blood flow between an arteriovenous malformation and the surrounding brain, plus the differential in