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The successful treatment of a congenital vertebral fistula with the balloon catheter occlusion technique is reported. A new approach is presented (the occipital approach), based upon the pathological enlargement of the second intervertebral space anastomosis between occipital and vertebral arteries.

The principles underlying the use of embolisation in the management of tumours and vascular malformations of the head and neck are reviewed. The percutaneous angiographic technique is employed to embolise the lesion, producing the effects of haemostasis, reduction of tissue mass and relief of pain. Specific clinical applications are discussed with illustrative examples.

Many arguments lead us to think that a possible etiologic factor in idiopathic Bell's palsy is the ischemia of the facial nerve and that angiography could help in diagnosis: (1) the rapid progress of the paralysis; (2) the correlation between Bell's palsy occurring after embolization of the internal maxillary artery, the middle meningeal artery, the occipital or posterior auricular artery, and their participation in the blood supply of the facial nerve; (3) the already known ischemic third nerve paralysis reported in diabetes and extending further to the facial nerve. Even if it is technically impossible to study Bell's palsy by angiography, it is interesting to understand and consider some complications of embolization and perhaps to envisage a new kind of treatment.

In addition to the chemotherapy, surgery and physical treatments usually employed in the treatment of bony secondaries from renal tumours, the authors propose embolization. They have performed this procedure in 4 patients, using a mixture of isobutyl-2-cyanoacrylate and lipiodol. Arteriography is performed before and after the embolization which is carried out under local anaesthesia. Disappearance or relief of pain was obtained in each case. This technique in no way changes the prognosis of the disease, but it can improve the quality of life of these patients. A review of the literature reveals that metastases other than renal have already been embolized, as have primary malignant bone tumours. The authors describe their method, the incidents associated with treatment, the contra-indications and the supposed mechanism of the analgesic action of embolization.

Angiographic exploration of oral vascular malformations should be conducted according to a precise anatomical protocole, vascular malformation being able to be classified according to their degree of vascularity. Embolisation is an essential complementary procedure to diagnostic angiographic investigations, either as a definitive therapeutic act in certain localisations or as a pre-operative step.

Therapeutic embolization by means of autologous clots or fragments of gelatin sponge was carried out in 11 patients suffering from renal haemorrhage of traumatic origin (5 needle biopsies, 3 surgical operations, 2 external traumas, 1 penetrating wound). Arterio-venous fistulae were present in 6 cases and arterial lesions in 5. Performed with a fine catheter, embolization was highly selective for the segmental arteries involved. The clinical symptoms disappeared within less than 12 hours in three patients, within 2 to 4 days in five and within 15 days in one. In two patients haematuria was only temporarily arrested ; a second embolization could be performed in one of these, but nephrectomy was required in the other.

Three patients with bleeding into the bile ducts were explored by angiography. Two of them (severe post-operative bleeding and following needle-biopsy of the liver) were completely cured by highly selective arterial embolus production. No definite diagnosis was established in the third case (liver angioma with large artero-portal fistula). It can be seen from these observations, that angiography is essential in patients with bleeding into the bile ducts. The reason is not to establish the diagnosis but to find the precise location of the lesion and, under certain conditions, to apply radical treatment by highly selective arterial embolus production.

The authors have reviewed the experimental literature about the different agents used for endovascular embolization: clots, tissues, duramater, Gelfoam, oxydized cellulose, Ivalon, beads, microspheres, cyanoacrylates, silicone, barium. Each occlusive agent was studied in regard to its physical properties, injection methods, characteristics of obstruction, vascular reaction, and toxicity. The level and quality of obstruction obtained depend on many factors which are discussed.

Catheterization of the portal system by transhepatic percutaneous puncture may be difficult when atrophy of the liver, severe ascites, or thrombosis of the intrahepatic portal branches exists. It could be useful, in these cases, to employ "real time" ultrasonography to assist puncture of an intrahepatic portal branch. A case is reported in which this method was used to obtain percutaneous puncture of a left portal branch during obliteration of esophageal varices.

In the light of one case of post-embolisation lower moteur neurone facial paralysis, it was felt to be of interest to drawn attention to the possible role played by the middle meningeal artery: -- in the aetiogenesis of certain peripheral problems affecting the facial nerve during embolisation of the medial maxillary artery; -- in the direct recognition of a dangerous anatomical distribution. The easy identification of its endocrine branch and of the stylo-mastoid artery should reveal the mode of arterial distribution of the facial nerve: -- pure petrous; --petro-mastoid: -- pure mastoid; and hence to assess the risks run by patient during embolisation, according to the territory and the equipment.

During the last 4 years, 31 infants (ranging from 4 months and half to 15 years of age) were angiographied for different head and neck pathologies. 20 of them were embolized, among which 11 did not received additional treatment, and are still followed by the neuroradiologist. 45 superselectives arteriographies by femoral approach were performed, no morbidity nor mortality was noted. The authors emphasize the need to pay attention to the advantages of this technique when realized in specialised centers. The vascular characters of a lesion is not necessary nor a sufficient sign to make it a good indication for an embolization procedure. Finally, the neuroradiologist can be considered as a diagnostic and therapeutic specialist, the most competent to indicate (or contra indicate) an endovascular approach in a given situation.

Angiography was employed in 32 patients with cutaneous or subcutaneous angiomas of the face and scalp in order to establish diagnosis and assess results of therapy. Pre-treatment angiographic appearances as a function of their location are discussed, and the results of embolisation reported. Total surgical excision was possible whenever initial therapy had included embolisation, no complications being noted after embolisation, and no lesions becoming worse.