Angiogram at NYPresbysterian Hospital  - 26Oct2004
The final pre-op test was a double angio-gram designed to look at the 
vascular structures in the back of the neck "from the inside".    

The basic idea is to pass tubing from the groin in the two femoral arteries 
up past the heart and into the two vertebral arteries.  

Foremost it is important to confirm and amplify the information from the 
MRA that there is good blood flow in the LEFT vertebral artery and in the 
cross feeds near the base of the brain in case the surgery "takes" the right 
one.  This was established, although it is not the intent of the surgery 
to remove the right artery.

The second important test is to see whether the tumor itself is particular 
"vascular", i.e. does it have a reasonably large artery supplying it.  If so 
a balloon occlusion would be placed in that artery cutting off such blood 
flow for the surgery.  As anticipated with a chordoma, the tumor is not 
very vascular and no occlusion is done.

This test requires sedation to a rather fuzzy level of consciousness.  The 
IV used for this will remain in my arm for the start of anesthesia tomorrow.   

The "hard" part comes at the end when two doctors have to now stop these 
femoral arteries from bleeding with manual pressure.   My right leg in 
particular proves troublesome and I am told I will have to stay roughly 
horizontal for several hours.

I am then transferred by ambulance to Memorial Sloan-Keterring.   I am a bit 
nauseous from the drugs as well.  Candace is given a sleeper chair so she can 
spend the night with me before the actual surgery.