Unveiling the Invisible: Manuel Balado and the Dawn of Iodoventriculography in Neurosurgery

Introduction: The early development of iodoventriculography represented a transformative phase in neurosurgery, opening new diagnostic avenues for ventricular pathologies. Initiated by Manuel Balado, this method introduced the use of iodinated contrast within the ventricles, thus facilitating the visualization of midline structures and enabling the diagnosis of intracranial lesions. This study explores Balado’s foundational work, highlighting its historical relevance and lasting impact on neurodiagnostic advancements.

Methods: This study involved a retrospective examination of historical accounts, emphasizing Balado’s iodoventriculography technique as documented in early neurosurgical records. The analysis focused on the technical process, choice of contrast medium, and patient outcomes. Additionally, comparisons were drawn with modern contrast techniques to underscore the evolution of this diagnostic approach.

Results: By employing Lipiodol as a contrast agent, Balado’s technique enabled clear visualization of the third and fourth ventricles, offering crucial information on tumor localization, hydrocephalus, and ventricular obstructions. In a subsequent review by Balado’s colleague Carrillo of 500 cases, few complications were reported, attesting to the method’s safety and effectiveness. This approach set the stage for safer contrast imaging studies, providing essential insights into midline structures. Over time, modifications such as the introduction of Pantopaque further enhanced diagnostic precision, minimizing adverse effects.

Conclusion : Balado's pioneering contributions to iodoventriculography profoundly enhanced the diagnostic capabilities for ventricular pathologies and laid groundwork for current neuroradiological practices. His innovative approach demonstrates the value of early diagnostic ingenuity in neurosurgery and offers a significant historical context for today’s imaging techniques. Revisiting historical diagnostic methodologies can yield valuable insights, enriching our understanding of neuroimaging’s roots and potentially guiding future advancements.