PubMed Health⌕ Search

Biomedical subjects

A Weill

Publications and source records attributed to A Weill.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Endovascular treatment of intracranial aneurysms].

Over recent years, an increasing number of patients with intracranial aneurysms are treated by endovascular techniques, which have the advantage of avoiding craniotomy and retraction of cerebral parenchyma, while reducing the postoperative hospital stay. The key concept is that aneurysm is a disease of the arterial wall and that treatment must ideally only concern the vessel. The short-term efficacy of endovascular treatment has been established, especially for the prevention of early rebleeding, but its long-term efficacy has not yet been formally demonstrated due insufficient follow-up. Ideally, the management of intracranial aneurysms should be based on close collaboration between neurosurgeons and interventional neuroradiologists and the approach (conventional surgery or endovascular) should be discussed case by case.

Aftercare↗
PubMed1998

Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement.

The aim of our study was to describe the technique of percutaneous injection of acrylic surgical cement into acetabulum malignancies [percutaneous acetabuloplasty (PCA)] and determine its efficiency in relieving pain. Eighteen patients (8 men, 10 women; aged 40-81 years) with painful acetabular malignancies (18 lesions; 17 metastases, 1 multifocal bone sarcoma) were treated with PCA. Procedures were done using lateral approach with fluoroscopic guidance. The 18 procedures were evaluated and resulted in 4 (22 %) total improvement, 7 (39 %) clear improvement, 4 (22 %) moderate improvement, 1 (6 %) no improvement, and 2 (11 %) worsening in keeping with a cement leak in contact with the sciatic nerve and a leak towards the joint. Follow-up ranged from 2 to 48 months (average 9.4 months). We observed 2 cases of recurrence of pain at 6 and 39 months, both in keeping with local tumoral progression. PCA of malignancies is a minimally invasive and low-cost procedure that provides immediate and long-term pain relief.

Acetabulum↗
PubMed1998

Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment.

PURPOSE: To determine the types of aneurysm that may be treated endovascularly with platinum detachable coils. MATERIALS AND METHODS: Two hundred eight patients with 236 intracranial berry aneurysms underwent endovascular coil embolization; 150 patients had subarachnoid hemorrhage at the time of presentation. RESULTS: Treatment was performed in 182 patients with 203 (86%) aneurysms (86%). Follow-up angiograms were obtained at 3 months in 160 cases of aneurysm. A second procedure was performed in 18 (11%) of these cases, and a third was performed in one case. Final follow-up results in 152 aneurysms demonstrated total occlusion in 123 (81%) cases, subtotal occlusion in 26 (17%) cases, and incomplete occlusion in three (2%) cases. All patients with subtotally occluded aneurysm were scheduled for later angiographic follow-up and any indicated repeat treatment. Technique-related morbidity rate was 4% (seven patients with permanent neurologic deficits due to clotting). Technique-related mortality rate was 2% (perioperative rupture in two, hematoma due to urokinase perfusion in one, rebleeding of the initial hematoma after excessive uncontrolled anticoagulation in one). Rebleeding occurred in one patient after incomplete occlusion. CONCLUSION: Endovascular coil embolization seems to be a reliable technique, with good anatomic and clinical results, that provides protection against rebleeding of ruptured aneurysms.

Aneurysm, Ruptured↗
PubMed1998

Giant aneurysms of the middle cerebral artery trifurcation treated with extracranial-intracranial arterial bypass and endovascular occlusion. Report of two cases.

Giant middle cerebral artery (MCA) trifurcation aneurysms that cannot be excluded directly can be treated by flow inversion achieved by creation of an extracranial-intracranial bypass distal to the aneurysm, followed by occlusion of the parent vessel proximal to the aneurysm. As opposed to surgical occlusion, endovascular occlusion avoids dissection of the aneurysm area, and the site of occlusion can be chosen according to the flow distribution demonstrated on angiography performed during test occlusions. Two patients with giant aneurysms of the MCA trifurcation benefited from flow inversion treatment. Forty-eight hours after an MCA-superficial temporal artery bypass had been created, the M1 segment was occluded by inserting a coil in the first patient and the internal carotid artery was occluded with balloons in the second patient (there was no communicating artery in the latter case). Both occlusions were performed immediately after a clinical test of occlusion tolerance. The patients were clinically intact during the postoperative course. Follow-up angiography performed 11 and 4 months, respectively, after vessel occlusion showed that the aneurysm occlusion was stable.

Adult↗
PubMed1998

Embolization of an orbital varix after surgical exposure.

We report a case of primary orbital varix treated by embolization with coils after surgical exposure and puncture of the venous ectasia. This method of treatment has the advantage of limiting traumatic dissection and avoiding difficult venous catheterization.

Adult↗
PubMed1998

Endovascular treatment of basilar tip aneurysms after direct puncture of the vertebral artery.

Basilar aneurysms that are not amenable to standard endovascular treatment via the femoral approach because catheterization is difficult pose a rare but serious problem. We present two cases of basilar tip aneurysms successfully treated by the endovascular route after direct puncture of the right vertebral artery. In both patients, the left vertebral artery was tortuous, small, and irregular, and the ostium of the right vertebral artery was not accessible by the femoral approach.

Catheterization, Peripheral↗
PubMed1997

Intracranial aneurysms: endovascular treatment with mechanical detachable spirals in 60 aneurysms.

PURPOSE: To evaluate preliminary results with endovascular treatment (EVT) of intracranial aneurysms with mechanical detachable spirals. MATERIALS AND METHODS: EVT with spirals was attempted in 57 patients with 60 aneurysms (47 berry, nine large, and four giant aneurysms). Thirty-seven patients had subarachnoid hemorrhage (three of whom were also treated for associated aneurysm), nine were asymptomatic, six had headache, three had mass effect, and two had neurologic deficits. RESULTS: EVT with the spirals was achieved in 55 (92%) of the 60 aneurysms. Of 42 treated berry aneurysms and 13 treated large and giant aneurysms, 33 berry and nine large and giant aneurysms underwent 3-month angiographic follow-up. Complete occlusion was attained in 23 berry and four large and giant aneurysms, subtotal occlusion (doubtful or obvious small neck remnant) was obtained in eight berry and four large and giant aneurysms, and incomplete occlusion was obtained in two berry aneurysms and one giant aneurysm. These results were obtained after one procedure in 21 patients, after two procedures in 19 patients, and after three procedures in two patients. Seven patients had complications that necessitated infusion of urokinase. Permanent neurologic deficits were found in three. There were no deaths. CONCLUSION: Good results were obtained with EVT of intracranial aneurysms with mechanical detachable spirals. These spirals are characterized by rapid detachment and low cost.

Adult↗
PubMed1997

[Reconstruction technic in the treatment of wide-neck intracranial aneurysms. Long-term angiographic and clinical results. Apropos of 56 cases].

PURPOSE: The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the aneurysmal sac, particularly the width of the neck. In this study we present a new technique to occlude wide neck aneurysms that involves the temporary inflation of a non-detachable balloon in front of the aneurysm neck during each coil placement. The aim of the study is to present the feasibility, efficacy and safety of this "remodeling technique" (RT) as compared to that of "normal" GDC treatment. MATERIAL AND METHOD: 56 aneurysms in 54 patients were selected for treatment with the RT. Thirty-seven (70%) of the patients presented with subarachnoid hemorrhage. Twenty-five (45%) of the aneurysms were located at the vertebrobasilar artery, 24 (43%) at the internal carotid artery, and seven at the level of smaller arteries. RESULTS: Treatment was achieved in 52 aneurysms in 50 patients. Two aneurysms which were initially not completely occluded underwent a second treatment using the RT. Final results (i.e. the last follow-up angiography or results at the end of the treatment for the cases that have not yet had follow-up) consisted of total occlusion in 40 cases (77%), sub-total occlusion in nine cases (17%), and incomplete occlusion in three cases (6%). Angiographic evidence of clotting was observed during the procedure in three cases, resulting in one permanent deficit (quadranopia). Rupture of the aneurysmal sac occurred during the procedure in three cases, all of which were asymptomatic in the follow-up. Thus, morbidity due to the technique was 1/52 (0.5%) and mortality was 0/56 patients. CONCLUSION: The remodeling technique allowed the treatment of 52 wide neck or badly shaped aneurysms that were not treatable without this technique. The results of occlusion with the RT seem better than those in our series of normal GDC treatment, and complications related to the technique are fewer. This technique thereby extends the spectrum of treatable aneurysms without increasing the risk incurred by treatment.

Adolescent↗
PubMed1997

[Percutaneous vertebral surgery. Technics and indications].

Percutaneous vertebroplasty is a technique of interventional radiology, which allows to fulfill pathologic vertebral body with acrylic cement. This method is used to strengthen the vertebral body and reduce pain in some diseases involving the vertebra. Main indications are spine angiomas, metastases and osteoporosis. The vertebroplasty is realised under neuroleptanalgesia for cervical spine antero lateral way is used. For thoracic or lumbar vertebra, the way of approach is usually transpedicular; but in some cases, this approach is not possible: osteolysis of the pedicle, surgical osteosynthesis; in such cases, a postero lateral approach is realized. Technical incidents are not rare, but are usually asymptomatic. More frequent are venous filling with cement; the veins involved can be intra spinal (vertebral plexus) or paraspinal. Instead of this frequency pulmonary embolism in direct relation with the vertebroplasty where not reported. Extravasation in intervertebral disk or soft tissue can also be observed. This last incident can be in relation with the way of the needle or with a cortical rupture. Local complications are rare: rate of neurological deficit or infection is under 0.5%. Radicular pain is observed in 3.7% of cases. These complications are in close relation with the radiological involvement of the vertebra: cortical disruption, heterogeneous Lysis of the vertebral body. The frequency of complications is 1.3% in osteoporosis, 2.5% in spine angiomas and 10% in metastatic disease. Indications concern lesion involving the vertebral body: symptomatic spine angiomas; painful osteoporotic fractures after medical treatment or in patients with a high risk of decubitus complications; in metastatic disease, vertebroplasty is a way to consolidate the vertebral body and release pain. It can be usefull in recurrent pain after chemotherapy and/or radiotherapy, and also in unstable vertebra to obtain a stabilization before radiotherapic or chemotherapic treatment isolated or in combination with surgical osteosynthesis.

Acrylic Resins↗
PubMed1996

Posttraumatic spinal subarachnoid cyst.

A case of posttraumatic compressive subarachnoid cyst of the thoracic spine studied by MR myelography, and myelo-CT is reported. This cyst was surgically confirmed and treated by shunting.

Adolescent↗
PubMed1996

The role of CT in evaluation of the effectiveness of embolisation of spinal dural arteriovenous fistulae with N-butyl cyanoacrylate.

A failed embolisation of a spinal dural arteriovenous fistula (AVF), because a pedicular injection has not reached the initial venous compartment, must be identified immediately, to allow prompt surgery and thus avoid clinical deterioration. The purpose of our study was to determine the role of CT in confirming a complete cure just after embolisation with N-butyl cyanoacrylate (NBCA). Seven patients embolised for spinal dural AVFs with perimedullary venous drainage had an immediate postembolisation CT scan. In six patients a complete cure was achieved, with a normal postembolisation angiogram in five cases. Just after injection of NBCA, we were unable to determine on plain films whether or not the glue had reached the draining vein in six of seven cases. The postembolisation CT showed various patterns: in two cured patients, the glue was visible in the inner surface of the dura mater and therefore on the venous side. In five cases, the glue was approaching the dura mater around the cord or seemed to reach its surface: in the four patients cured, the glue column was 7-18 mm high, whereas it was less than 2 mm high in the patient with angiographic proof of recurrent fistula. The follow-up angiogram remains the only way to confirm a durable cure. We suggest that immediate postembolisation CT may help in assessing endovascular treatment of spinal dural AVFs.

Adult↗
PubMed1996

Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement.

PURPOSE: To determine the efficacy of percutaneous vertebroplasty in treating spinal metastases that result in pain or instability. MATERIALS AND METHODS: Thirty-seven patients (20 men, 17 women; aged 33-86 years) underwent 52 percutaneous injections of surgical cement into a vertebra (vertebroplasty) with fluoroscopic guidance in 40 procedures. Vertebroplasty was performed for analgesia in 29 procedures, stabilization of the vertebral column in five procedures, and both in six procedures. RESULTS: Twenty-four of the 33 procedures performed for analgesia that were evaluated resulted in clear improvement; seven, moderate improvement; and two, no improvement. Improvement was stable in 73% of patients at 6 months. In the procedure performed for stabilization, no displacement of treated vertebrae was observed (mean follow-up, 13 months). Three patients had transient radiculopathy due to cement extrusion, and two patients had transient difficulty in swallowing. CONCLUSION: Vertebroplasty of metastases is a minimally invasive procedure that provides immediate and long-term pain relief and contributes to spinal stabilization.

Adult↗
PubMed1995

[Percutaneous vertebroplasty].

Vertebroplasty is a new therapeutic method which by way of filling with acrylic cement in the vertebral body gives a stabilization of the vertebra and an antalgic effect in painful lesions involving the spine. Main indications consist of spine angiomas, metastases and osteoporotic fractures involving the vertebral body. In most patients, vertebroplasty gives a very good and durable antalgic effect as in cases of angiomas or metastases as in post-therapeutic sequellae in malignant hematosarcomas. In osteoporotic fractures, antalgic effect is obtained very rapidly, but the follow-up is actually insufficient to evaluate the long term benefit.

Hemangioma↗