Combined use of digital subtraction angiography and MRI for radiosurgery and stereoencephalography

The authors report their experience with the combined use of digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) for the stereotactic placement of intracerebral electrodes in epilepsy and for the radiosurgical treatment of otherwise inoperable arteriovenous malformations of the brain. Both imaging techniques, when used in conjunction, have been found most useful and complementary. For deep electrode placement, they permit optimal visualization of the cerebral structures to be reached by the electrode array while allowing the avoidance of vessels in the vicinity. For radiosurgery of arteriovenous malformations, DSA provides optimal visualization of the feeders and of the malformation itself, while the MRI reveals the cerebral structures to be spared by the photon beam of the linear accelerator. A discussion of their respective roles is presented, with the specific question as to whether MRI alone could be used for both procedures.