The role of digital subtraction angiography in diagnosis of skull-base lesions.

Advances in radiographic diagnosis of skull-base lesions have made it possible to approach lesions formerly considered unresectable. The most important of these are the high-resolution computerized tomographic (CT) scanners with bone algorithms. In conjunction with their evaluations it is important to know in detail the vascular structures involved with the skull base. These include not only the jugular vein and bulb and lateral sinus associated with glomus tumor surgery but often the carotid artery associated with lesions of the jugular foramen and petrous apex. Conventional arteriograms have been the best way to evaluate the vascular system but were occasionally associated with some risk and much patient discomfort. New digital subtraction techniques (digital subtraction angiography [DSA] using an intravenous bolus injection of dye) are now yielding x-ray studies equal to or better than conventional arteriography. DSA will be described and the results of these studies of various lesions of the skull base will be presented in conjunction with the results of high-resolution CT scanning to show the complete workup of the skull-base lesion possible for an outpatient.