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I appreciate and fully concur with the comments by Dr Heimburger. In paragraph 3 of my previous letter, I listed some of the drawbacks of the lumbar approach for metrizamide cisternography and their influence on the dose-related complications of metrizamide. These are the very reasons for using the lateral C1-2 approach, which allows for the smallest total dose to be used.I heartily join Dr Heimburger in his admonition to all those who use metrizamide to be constantly aware of its potential complications and would add that this awareness must accompany the use of any contrast agent used in invasive neuroradiological procedures, since none is totally innocuous.
Wesolowski DP. Metrizamide Cisternography-Reply. JAMA. 1982;248(19):2451. doi:10.1001/jama.1982.03330190021018