Embolization of vascular and neoplastic lesions of the head, neck, and spine may be performed either as primary therapy (particularly for lesions which are difficult to approach surgically) or preoperatively to decrease blood loss. Polyvinyl alcohol foam (PAF) offers a number of advantages over other embolic material, including biocompatibility, promotion of progressive thrombosis and fibrosis, permanence, compressibility, and manageability. The clinical cases illustrate the kinds of lesions that are amenable to embolization, including arteriovenous malformations, arteriovenous fistulas, meningiomas, and nasopharyngeal tumors. Techniques and possible complications are discussed.

Four cases of brainstem stroke syndromes followed mechanical cervical manipulation; vascular injury was confirmed angiographically. A comprehensive review of the literature on vertebrobasilar injuries disclosed the various mechanisms of injury and pathogenesis of subsequent vascular complications following cervical manipulation. Emphasis is given to the potentially devastating neurological complications, particularly in view of the increasing utilization of chiropractic therapy.

Nine patients with redundant lumbar nerve root syndrome were identified using positive-contrast myelography, seven with metrizamide and two with iophendylate. Serpiginous intradural filling defects occurred in conjunction with a complete or partial extradural block and spinal stenosis. These redundant nerve roots were seen on the cephalic side of the block. Eight of the nine patients had pseudoclaudication. One case was found incidentally during a cervical myelogram. This series is presented to demonstrate the characteristic myelographic pattern that should be recognized and differentiated from tortuous intradural blood vessels. Possible causes are discussed.

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The effectiveness of a combined approach of embolization and operation for cervical vascular malformations is stressed. Lesions that seem to be inoperable may have their blood flow sufficiently reduced by preoperative embolization to allow surgical extirpation. Polyvinyl alcohol foam is an ideal embolic agent; not only may it be used preoperatively, but its permanency allows it to be used for primary therapy.