Digital Subtraction Angiography (DSA) of cerebral vasculature demonstrating endovascular stroke modeling. Figure A shows a baseline angiogram illustrating normal cerebral vascular anatomy, specifically the circle of Willis and its branching territories. The vessels appear as curvilinear, branching structures with smooth contours and uniform contrast opacification. Figure B captures an interventional procedure where a microcatheter and microguide wire are used to deploy a balloon. A red arrow identifies the inflated balloon catheter positioned within the M1 segment of the Middle Cerebral Artery (MCA). The balloon is visible as a radio-opaque, elongated distension causing temporary focal occlusion of the vessel to mimic an ischemic stroke event. This imaging serves as a demonstration of procedural neuro-intervention, focusing on the Middle Cerebral Artery (MCA) anatomy and the application of balloon-occlusion techniques for clinical or experimental modeling of ischemic cerebrovascular disease.

Cerebral digital subtraction angiography (DSA) images illustrating complex neurovascular pathology. Panel A shows a right internal carotid artery (ICA) angiogram in both standard and 3D reconstruction modes, revealing a saccular aneurysm at the posterior communicating artery (PCoA) segment. Panel B depicts the left carotid system, highlighting significant focal stenosis at the origin of the internal carotid artery, resulting in compromised distal contrast opacification and delayed perfusion. Panel C demonstrates left vertebral artery angiography, illustrating the posterior circulation and its involvement in the patient's vascular anomalies. The imaging series serves as a diagnostic tool for evaluating bilateral carotid artery communicating aneurysms and concomitant severe atherosclerotic stenosis. These findings are clinically significant in the context of neurosurgical planning for aneurysm clipping or endovascular coiling and stenting to mitigate the risk of subarachnoid hemorrhage and ischemic stroke.

Imaging modality and technique: Cerebral Digital Subtraction Angiography (DSA) with selective vertebral and posterior circulation catheterization, featuring arterial, capillary, and venous phase acquisitions. The study targets a posterior fossa mass, most consistent with a cerebellar hemangioblastoma. The vascular tumor is hypervascular, with prominent feeding arteries and a conspicuous early draining venous plexus. In this case, large feeders arise from the posterior inferior cerebellar arteries and/or other cerebellar branches, producing a pronounced tumor blush that persists through the venous phase as a deep, densely opacified nidus. The peritumoral vessels are tortuous, and draining veins reach the tentorial or straight sinuses through a crowded venous network. The lesion is typically solid-cystic, well circumscribed, and can be extrinsic to the fourth ventricle; however, angiography emphasizes the vascular component. Radiographic differential considerations include other vascular cerebellar tumors such as pilocytic astrocytoma with vascularity and meningioma with sinus involvement in the posterior fossa, though meningiomas are less common in this location. Clinically, cerebellar hemangioblastomas are associated with von Hippel-Lindau syndrome in younger patients and can present with ataxia, headaches, and hydrocephalus from mass effect. The diagnostic significance lies in recognizing the characteristic arteriovenous pattern: multiple feeders, enlarged draining veins, and a deep tumor blush, guiding surgical planning or preoperative embolization decisions.

Digital subtraction angiography (DSA) of a left common carotid artery injection, displaying anteroposterior (AP, a–d) and lateral (e–g) views across multiple vascular phases. The imaging demonstrates a significantly enlarged and tortuous left middle cerebral artery (MCA). Key anatomical findings include multiple lateral striate arteries originating from the proximal M1 segment, a small vessel arising from the distal M1 segment (yellow arrow), and an additional branch originating from the proximal M2 segment (blue arrow). Hemodynamic characteristics show persistent visualization of the large MCA through the capillary phase (b, e), venous phase (c, f), and sinus phase (d, g), indicating delayed transit or slow outflow. Crucially, there is an absence of early venous drainage during the late arterial and capillary phases, which helps differentiate this arterial variation from high-flow arteriovenous shunts such as arteriovenous malformations (AVMs) or fistulas (AVFs).

**Imaging Modality:** Digital Subtraction Angiography (DSA), lateral projection. **Anatomical Region:** Skull base and cervical carotid artery distribution. **Observed Pathology:** Glomus jugulare tumor (paraganglioma). The image demonstrates a highly vascularized, lobulated mass located at the level of the jugular bulb. **Characteristic Visual Features:** - **Tumor Blush:** A dense, intense, and persistent capillary opacification (blush) is evident during the arterial phase, characteristic of hypervascular skull base tumors. - **Arterial Supply:** Multiple hypertrophied feeding arteries are visible branching from the external carotid artery system toward the lesion. - **Mass Effect:** The lesion is situated in the posteroinferior aspect of the petrous temporal bone, adjacent to the carotid bifurcations and the internal carotid artery (ICA) siphon. - **Vascular Architecture:** Disorganized neovascularization within the tumor matrix, appearing as a "sunburst" or mottled enhancement pattern. **Key Diagnostic Features:** The location at the jugular foramen combined with the rapid, intense vascular blush on angiography is pathognomonic for a glomus jugulare tumor, differentiating it from less vascularized schwannomas or meningiomas in the same region.

This composite educational image illustrates the diagnostic features of a glomus jugulare tumor (paraganglioma) within the left temporal bone through three imaging modalities. Panel A is an axial FLAIR MRI showing a heterogeneous, predominantly isointense mass in the jugular foramen region. It exhibits the characteristic 'salt and pepper sign,' where 'pepper' represents hypointense signal voids from high-flow vessels and 'salt' represents hyperintense foci from slow-flow vessels or hemorrhage. Panel B is an axial CT scan of the same anatomical region, highlighting the aggressive nature of the lesion through visible destruction and permeative erosion of the surrounding petrous temporal bone and jugular fossa (indicated by arrows). Panel C is an external carotid angiogram demonstrating a dense 'tumor blush' (black arrow), confirming the hypervascular nature of the mass. These multimodal findings—hypervascularity on angiography, bony destruction on CT, and the salt-and-pepper appearance on MRI—are pathognomonic for a glomus jugulare tumor. This content is intended for advanced medical education in neuroradiology and otolaryngology.

This dual-panel image displays diagnostic modalities for a Glomus tympanicum paraganglioma in a patient with pulsatile tinnitus. Panel A is a superselective Digital Subtraction Angiography (DSA) frame demonstrating a microcatheter positioned within a tortuous feeding vessel. A focal, irregular area of dense contrast opacification (tumor blush) is visible, indicating the hypervascular nature of the lesion prior to embolization. Panel B is an axial contrast-enhanced, fat-saturated T1-weighted Magnetic Resonance Image (ce-T1 fs MRI) of the skull base. It reveals a small, intensely enhancing soft tissue mass located in 'loco typico' within the left middle ear cavity, adjacent to the temporal bone. The mass is hyperintense relative to the surrounding brain parenchyma and musculature. These images illustrate the complementary roles of MRI for anatomical localization and DSA for vascular characterization of glomus tumors.

This composite of four lateral-view diagnostic images documents the preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA) via direct puncture. Image (a) is a pre-interventional digital subtraction angiography (DSA) showing a hypervascular tumor mass with dense pathological blush and disorganized vessel architecture. Image (b) captures the procedural stage, demonstrating the needle position during direct percutaneous puncture of the lesion for the administration of embolic agents. Image (c) presents the post-interventional control DSA, illustrating a marked devascularization of the tumor bed and the near-total disappearance of the previously visible vascular blush, confirming successful occlusion of the feeding vessels. Image (d) is a post-interventional radiograph without digital subtraction, showing the accumulation of radio-opaque embolic material within the tumor margins against the anatomical background of the skull base and facial bones. The series serves as an educational example of interventional neuroradiology techniques used to reduce intraoperative hemorrhage during subsequent surgical resection of benign but highly vascular head and neck tumors.

This composite of four images demonstrates the interventional radiology stages of preoperative embolization for a Juvenile Nasopharyngeal Angiofibroma (JNA). Panel (a) is an intraprocedural Digital Subtraction Angiography (DSA) in a posteroanterior (PA) view, showing superselective injection of the distal internal maxillary artery prior to embolization, highlighting the tumor's dense vascular blush. Panels (b) and (c) are post-procedural DSA images in a lateral-lateral (LL) view, illustrating the successful embolization of the lesion's right and left sides, respectively. These views show a near-complete absence of the previously noted vascular blush in the embolized territories. Panel (d) is a post-procedural fluoroscopy frame providing a wide view of the facial skeleton, confirming excellent technical results with the stabilization of the embolic agent (Onyx 18) within the feeder vessels. The primary educational focus is the use of endovascular techniques to achieve devascularization of a hypervascular skull base tumor to minimize intraoperative blood loss during subsequent surgical resection.

This intraoperative clinical photograph captures a surgical dissection during a deep-plane rhytidectomy (facelift) in the preauricular and temporal region. The image illustrates the anatomical relationship between tissue layers and the facial nerve. A skin flap, labeled 'A', is retracted superiorly, revealing the superficial musculoaponeurotic system (SMAS) layer, labeled 'B'. Deep to the elevated SMAS, the temporal (frontal) division of the facial nerve is identified by white arrowheads as it courses over the zygomatic arch (marked with arrows). A white annotation line represents Pitanguy's line, a surgical landmark extending from the tragus to a point 1.5 cm above the lateral eyebrow, used to estimate the trajectory of the frontal branch of the facial nerve. The photograph highlights an anatomical variation where the nerve emerges more posteriorly than typically reported. The surgical field includes the external ear with packing, local hemostasis, and surrounding surgical drapes. This visual is used to teach surgical anatomy, flap elevation techniques, and the importance of nerve preservation during aesthetic maxillofacial or plastic surgery.

This clinical photograph displays a cadaveric dissection of the right hemiface, highlighting critical surgical anatomy for rhytidectomy (facelift). The skin and subcutaneous tissue are reflected medially, and the superficial muscular aponeurotic system (SMAS) and parotid gland have been removed to expose the underlying facial nerve branches and musculature. Key landmarks identified include the masseter, orbicularis oculi, zygomaticus major (ZM), platysma, and depressor anguli oris (DAO). Black arrows indicate the superior set (zygomatic branches) passing inferior to the zygomatic ligament (red arrow) into the 'sub-SMAS danger zone' deep to the ZM. Green arrows identify the buccal branches of the facial nerve. The inferior set of black arrows shows the marginal mandibular branch traveling past the mandibular osseocutaneous ligament (red arrow) to innervate the DAO on its deep surface. This visual serves as an educational guide for identifying facial nerve danger zones during deep-plane surgical dissection to avoid iatrogenic nerve injury.

This intraoperative clinical photograph captures a key step in a rhytidectomy (facelift) surgical procedure. The image shows the facial and cervical region of a patient in a supine position, with the head oriented towards the left. A significant cutaneous flap has been undermined and is being retracted. Surgical instruments, including forceps and a retractor, are utilized by gloved hands to apply posterosuperior traction to the excess skin flap, following the tragus-Darwin’s tubercle line. Blue surgical markings, including an arrow indicating the primary force vector, are visible on the skin surface. The underlying subcutaneous tissue and SMAS (Superficial Muscular Aponeurotic System) layers are partially exposed near the preauricular area. This visual demonstrates the surgical management of skin laxity and the tension-free realignment of facial tissues during aesthetic or reconstructive surgery. The focus is on the biomechanical manipulation of the skin flap to achieve optimal redraping before excision of the redundant tissue.

This clinical intraoperative photograph displays a left-sided parotidectomy field utilizing a modified facelift incision (MFI). The image illustrates the distinct surgical layers and anatomical structures exposed during the procedure. A thin superficial skin flap (indicated by a small horizontal arrow) is retracted superiorly using surgical hooks. Below this, a secondary, thicker flap consisting of the superficial musculoaponeurotic system (SMAS) is being manipulated with forceps (marked by a solid vertical arrow). Deep to the SMAS layer, the intermittent dashed arrow points toward the parotid capsule area. The sternocleidomastoid muscle (indicated by a star) is visible in the posterior-inferior aspect of the surgical bed. The ear is positioned centrally and slightly to the right of the dissection field, serving as a primary landmark for the MFI approach. The photograph demonstrates the anatomical plane between the subcutaneous tissue and the SMAS, as well as the surgical exposure of the parotid region required for tumor resection and subsequent reconstructive advancement of the SMAS flap.