Diagnostic Spinal Angiography
A diagnostic spinal angiogram is a medical procedure that offers an extremely precise evaluation of the blood vessels surrounding the spinal cord. During a spinal angiogram, highly specialized doctors (called neuro-angiographers) are able to observe arteries and veins by using modern sophisticated imaging equipment. In order to take pictures of the blood vessels, a contrast medium (or "dye") is gently injected through a small, soft, and flexible tube called a catheter. This catheter is inserted in the groin and carefully advanced into the targeted blood vessel under the guidance of low dose x-rays. As there is no sensation associated with the advancement of the catheter inside the blood vessels, diagnostic spinal angiography is generally performed under light sedation as an outpatient procedure (meaning that patients come for the procedure and go home the same day). In our practice, the majority of patient do not need general anesthesia. When they do, it is generally because of associated medical conditions. In that case, the angiogram is still most often performed as an outpatient procedure. Spinal angiography helps diagnosing medical conditions that involve the arteries and veins of the spinal cord. This typically includes spinal cord vascular malformations, such as dural arteriovenous fistulas (DAVF) and arteriovenous malformations (AVM), but also certain types of spinal cord stroke and disorders involving the spinal cord venous system, such as spinal venous thrombosis.
Intra-Arterial Retinoblastoma Treatment
This procedure involves administering melphalan hydrochloride, a chemotherapy agent, through the ophthalmic artery to treat intraocular retinoblastoma. Delivering the chemotherapy directly through the artery supplying the eye (ophthalmic artery) in certain patients with retinoblastoma is a safe and effective treatment alternative to conventional systemic chemotherapy, external beam radiation, and enucleation (surgical removal of the eye). Systemic chemotherapy involves injecting anti-cancer medications into a vein or giving them by mouth. This exposes the entire body to significant doses of chemotherapy, which can make the patient sick as it fights the cancer. Intra-arterial chemotherapy delivers the anti-cancer medication directly to the tumor via the ophthalmic artery, thereby transforming the treatment from systemic to local chemotherapy and limiting the complications and adverse events associated with toxicity from systemic chemotherapy.
Intra-Arterial Chemotherapy for Pontine Gliomas
A diffuse intrinsic pontine glioma (DIPG) is a type of tumor that grows in the pons of the brainstem. The pons is located at the base of the brain where it connects to the spinal cord. These tumors are difficult to treat because they grow within the normal brain tissue. This procedure involves administering melphalan hydrochloride, a chemotherapy agent, directly into the arteries that provide blood to this tumor. Delivering the chemotherapy through these arteries helps to the focus the chemotherapy agent directly on the tumor. This increases the dosage that the tumor receives and decreases the toxic effects of chemotherapy on the rest of the body.
Lymphatic malformations are a type of low-flow congenital vascular malformation. First line of therapy for this type of lesion is percutaneous sclerotherapy. This baby was treated with a single sclerotherapy session with doxycycline at three months of age. Clinical and ultrasonographic follow-up at one year showed no recurrence. The lymphatic malformation is treated by percutaneous sclerotherapy, in which a small needle is placed into the lesion and a sclerosing agent is injected.
Stent-Assisted Coil Embolization
A number of different endovascular and surgical options are available for the treatment of intracranial aneurysm. Choosing the best management depends on many factors including the size, shape and location of the intracranial aneurysm. Another consideration is whether or not the aneurysm has ruptured. For instance, if the patient had a right paraophthalmic (near the artery that branches to the eye) artery aneurysm that continued to increase in size after it was diagnosed. The image was obtained during a diagnostic cerebral angiogram. It shows the arteries of the right side of the brain viewed from the front. This type of image helps doctors study important features of blood vessels such as the size and shape of aneurysms. The aneurysm is seen as an outpouching or bulge on the vessel. This patient undergoes successful stent-assisted coil embolization and returns home in two days after the procedure.
- Neurovascular evaluation and interventions
- Embolization of intracranial and head & neck aneurysms
- Embolization of vascular malformations involving the brain, the head & neck region, and the spine & spinal cord:
- Arteriovenous malformations (AVM), arteriovenous fistulas (AVF), dural arteriovenous fistulas (DAVF), vein of Galen arteriovenous malformations (VGAM), and lymphatic malformations
- Intracranial venous disorders, including dural sinus stenosis and pseudo-tumor cerebri
- Embolization of tumors
- Intra-arterial chemotherapy for the treatment of tumors such as intraocular retinoblastoma and progressive diffuse intrinsic pontine gliomas
- Intracranial and extracranial angioplasty, stenting and stent-assisted coiling
- Stroke and stroke syndromes (i.e. arterial dissections, Moyamoya syndrome)
- Other vascular anomalies or syndromes (i.e. Sturge-Weber syndrome, arterial dolichoectasia, sinus pericranii)
- Spine Interventions including:
- Treatment of Tarlov's cysts
- Pain interventions
- Spine biopsy
- Radiofrequency tumor ablation