Myelographic Examination of the Posterior Fossa with Positive Contrast Medium

Abstract

A novel method for outlining the structures around the foramen magnum and in the posterior fossa has been described in detail. This procedure utilizes the instillation of Pantopaque in the spinal subarachnoid space; the patient is placed securely on a tilting table which will permit the manipulations that make it possible to distribute the contrast medium to the desired locations. A striking degree of visualization is obtained, making this technic a valuable tool in distinguishing correctable lesions at the craniospinal junction, such as tumors and aneurysms, from purely degenerative lesions that may have identical signs and symptoms. The normal and abnormal findings in a group of 204 patients, of whom 179 had neurologic signs and symptoms referable to the high cervical -posterior fossa, are presented in illustration of this technic. The method has proved safe and rewarding, and we now consider positive-contrast visualization the method of choice for the demonstration of masses and certain developmental anomalies in the region of the foramen magnum. It is also of a valuable adjunct in some cases in which the pneumogram or angiogram has failed to give a definitive answer.