Angiographic Pattern of Space Occupying Lesions in the Anterior Cranial Fossa

ABSTRACT

Although reports have been assessed to locate lesions in the frontal lobe or anterior cranial fossa, the exact localization of the lesion is invariably difficult in neurological examination. However angiographic pattern is one of the most significant clue to the diagnosis of this area. For the past 2 years, from may in 1968 to December in 1970, we have analyzed angiographic patterns of space occupying lesion in the frontal lobe and anterior cranial fossa in a total of subsequent 100 cases. It is suggested that these lesions be classified into four groups according to their characteristic patterns and, for accurate localization and practical feasibility, their surgical approach. The characteristic angiographic patterns of each group are summarized as follows (Frontal-pole) A-P view 1. Round shift of A.C.A. 2. Flattening of carotid fork. 3. Elongation of AI. 4. No chekrein effect. 5. Sylvian point & M.C.A.... normal / (Fronto-central) A-P view 1. Round shift of A.C.A.-mild. 2. Checkrein effect. 3. Depression of M1. 4. Flattening or mushroom appearance of carotid-fork. 5. Sylvian point... normal. / Lateral view 1. Posterior displacement of A.C.A. 2. Vertical stretching of A2-A3. 3. Stretching of frontopolar artery. 4. Downward displacement of M2. 5. Depression of candelabra artery. 6. Closing of carotid siphon. 7. Ophthalmic artery... normal. / Lateral view 1. Rectangular erection of C1-M1. 2. Right angle of C1-C2. 3. Elevation of M2-M3. 4. P.C.A. & ant. Choroidal artery... better. / (Fronto-lateral) A-P view 1. Round shift of A.C.A. 2. Infrequent checkrein effect. 3. Flattering of carotid fork. 4. Vertical stretching of C1. 5. Sylvian point... normal. / Lateral view 1. Mild stretching of A2-A3. 2. Continuous line of C2-M2. 3. Depression of M2. 4. Stretching of candelabra artery. / (Fronto-basal) A. subfrontal; A-P view 1. Round or angular shift of A.C.A. 2. Flattening of carotid bifurcation. 3. No checkrein effect. 4. Sylvian point... normal. / Lateral view 1. Bowing and downward convexity of A.C.A. 2. Closing of carotid siphon. 3. Depression of sylvian artery group. 4. Enlargement of ophthalmic artery. B. Inferior frontal; A-P view and lateral view 1. Same as subfrontal lesions. 2. Relative preservation of A.C.A. branches. 3. Enlarged ophthalmic artery... mild. 4. Depression or elevation of M2.