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Biomedical subjects

E Houdart

Publications and source records attributed to E Houdart.

At least 37 records · Page 2Linked to original sources
PubMed2000

Linac radiosurgery for cerebral arteriovenous malformations: results in 169 patients.

PURPOSE: To present the SALT group results using Linac radiosurgery (RS) for AVM in 169 evaluable patients treated from January 1990 thru December 1993. METHODS AND MATERIALS: Median age was 33 years (range 6-68 years). Irradiation was the only treatment in 55% patients. Other treatment modalities had been used prior to RS in 45%: one or more embolizations in 36%, surgery in 6%, and embolization and surgery in 3% patients. Nidus were supratentorial in 94% patients, infratentorial in 6% patients. Circular 15 MV x-ray minibeams (6-20 mm) were delivered in coronal arcs by a GE-CGR Saturne 43 Linac. Patient set-up included a Betti arm-chair, a Talairach frame. Prescribed peripheral dose was 25 Gy on the 60%-70% isodose (max dose 100%). Arteriographic results were reassessed in December 1997 at 48 to 96 months follow-up. RESULTS: The overall obliteration rate (OR) was 64% (108/169). AVM volumes ranged from 280 to 19,920 mm(3), median 2460 mm(3). OR was 70% for AVM </= 4200 mm(3) 4200 mm(3) (p 25 mm (p = 0.04). OR was 71%, in the absence of embolization, vs. 54% for previously embolized nidus (p = 0.03). OR was 71% for monocentric RS vs. 54% for multi-isocenters (p 28 Gy vs. 55% for values </= 28 Gy (p 79% vs. 57% for lower values (p 17 Gy, vs. 59% for mLd </= 16 Gy (p 40%, vs. 54% for mLi </= 40% (p 85% vs. 60% for CR </= 84% (NS). For patients treated according to our protocol, i.e., 24-26 Gy on the 60%-70% isodoses, OR was higher (68%) than for other patients (47%) (p = 0.02). After multivariate analysis, absence of previous embolization and mono isocentric-irradiation were independent factors predicting obliteration. Complications were: recurrent hemorrhage, 4 patients (1 patient died); brain necrosis on MRI, 2 patients; subsequent epilepsy, 4 patients; other subsequent neurologic deficits, 3 patients. CONCLUSION: Overall OR was 64% (48-96 months follow-up). After monovariate analysis higher ORs were associated with smaller volumes </= 4200 mm(3), smaller nidus size </= 25 mm, absence of prior embolization, monoisocentric RS, higher values for mean and minimum lesion doses and compliance to our protocol. Higher values for the peripheral dose and isodose tended to give better results. Multivariate analysis showed that the absence of prior embolization and monoisocentric irradiation were independent factors predicting successful irradiation.

Adolescent↗
PubMed2000

Central retinal artery occlusion associated with head or neck pain revealing spontaneous internal carotid artery dissection.

PURPOSE: To report two cases of head or neck pain and central retinal artery occlusion associated with spontaneous dissection of the ipsilateral internal carotid artery. METHODS: Case reports. RESULTS: We describe two cases of sudden visual loss caused by central retinal artery occlusion. Both cases were preceded by ipsilateral headaches or neck pain and tinnitus. The patient had no other neurological signs or history of trauma. In both cases, cerebral angiography revealed ipsilateral internal carotid artery dissection. CONCLUSION: Ipsilateral headache or neck pain with tinnitus preceding central retinal artery occlusion is highly suggestive of internal carotid artery dissection. Early diagnosis and treatment may reduce the risk of hemispheric stroke.

Adult↗
PubMed2000

Aneurysm of a dural sigmoid sinus: a novel vascular cause of pulsatile tinnitus.

We report a newly evidenced cause of venous pulsatile tinnitus--the aneurysm of a dural sigmoid sinus. A 33-year-old patient presented with an incapacitating pulsatile tinnitus of 6 months' duration in the left ear. The radiological workup evidenced an aneurysm of the left sigmoid sinus. Selective endovascular coil occlusion of the aneurysm was followed by complete resolution of the tinnitus.

Adult↗
PubMed1999

Combined management of intracranial aneurysms by surgical and endovascular treatment. Modalities and results from a series of 395 cases.

The selective occlusion of saccular intracranial aneurysms may be achieved by two techniques: microsurgical clipping and endovascular coiling. Each of them have particular indications which need to be defined. We report on a series in which both techniques were applied. From September 1992 to June 1996, 395 consecutive patients with small or large aneurysm were treated either by surgery (N = 102) or by endovascular coiling (N = 293). Coiling was chosen each time the shape of the aneurysm seemed to be appropriate for this treatment: narrow neck and ratio neck diameter by sac diameter less than one third. Satisfactory results with complete or subtotal obliteration and no recanalization on the following controls at 1, 6, 12 and 36 months, were obtained in 92% before retreatment and in 98.8% after retreatment. Unsatisfactory results were observed after surgery in 7 cases and in 25 cases after embolization. After retreatment, it remains 3 post-surgical and 2 post-endovascular cases. In the overall series, good and excellent clinical outcome was noted in 90% for small aneurysms and in 86.5% for large ones; mortality was of 4.8%. In a series in which were applied both types of treatment, surgery in 25% and endovascular technique in 75%, good results in terms of aneurysm occlusion and clinical results were achieved. These results are as good as the best series in which surgery was the only choice. Therefore with appropriate selection, endovascular treatment is a good alternative for treatment of the majority of saccular aneurysms.

Adult↗
PubMed1999

Secondary postpartum hemorrhage: treatment with selective arterial embolization.

PURPOSE: To evaluate the efficacy and safety of selective arterial embolization of the uterine arteries in the management of intractable delayed postpartum hemorrhage. MATERIALS AND METHODS: Fourteen consecutive women with secondary postpartum hemorrhage were treated with selective embolization of the uterine arteries. In all cases, hemostatic embolization was performed because of intractable hemorrhage that could not be controlled with the administration of uterotonic drugs or with uterine curettage. RESULTS: The causes of bleeding included genital tract tears in four women and endometritis in eight women; the endometritis was associated with proved, retained portions of placenta in four women. In two women, no evident cause of bleeding was found before angiography. Angiography revealed extravasation in three women. A false aneurysm of the uterine artery was found in two women. In one patient, an arteriovenous fistula was observed. Immediate resolution of external bleeding was observed in all women. No complication related to embolization was found. Normal menstruation resumed in all women. CONCLUSION: Selective arterial embolization of the uterine arteries is a safe and effective means of controlling secondary postpartum hemorrhage.

Adult↗
PubMed1999

[Evolution of angiographic signs of venous hypertension and clinical signs of intracranial hypertension in intracranial dural arteriovenous fistulas].

Dural arteriovenous fistulas (dAVFs) can cause cerebral venous hypertension (VHT). The most common mechanism is due to the fact that some dAVFs can drain retrogradelly in cortical (better defined as leptomeningeal) veins (directly or after drainage in a dural sinus) causing venous engorgement and consequently an impairment of the cerebral venous drainage. However, more rarely, dAVFs without a cortical venous drainage can also be responsible for VHT probably due to dAVF shunts causing insufficient antegrade cerebral venous drainage. In addition, dAVFs are often associated with stenosis and/or thrombosis of dural sinus(es) which can worsen the VHT. Raised pressure within the superior sagittal sinus causes impeded cerebrospinal reabsorption in the arachnoid villi allowing increased intracranial pressure. The venous engorgement in the cortical veins can cause a venous congestive encephalopathy analogous to the venous congestive myelopathy of the spinal dural AVFs. Clinically VHT can cause not only symptoms related to increased intracranial pressure but also seizures, neurological deficits, impairment of the cognitive functions and dementia. An important aspect is the risk of hemorrhage in dAVFs with a leptomeningeal venous drainage leading to VHT. Although the term VHT sensu strictu should be used if venous pressure measurements are performed, angiographic criteria for VHT such as delayed circulation time, venous engorgement and abnormal visualization of the cerebral veins are well established. The purpose of our study was to evaluate the angiographic signs of VHT in patients with dAVF and to study the course of the VHT and of the clinical signs of increased intracranial pressure before and after dAVF endovascular treatment. A retrospective chart analysis of 22 patients (13 males, 9 females) ranging in age from 20 to 87 years (mean: 53 ys.) with a dAVF associated with angiographic signs of VHT was performed. Ten dAVFs were located on the transverse/sigmoid sinus(es), 6 on the superior sagittal sinus, 3 on the petro-tentorial incisura, 1 on the inferior petrosal sinus, 1 on the anterior ethmoidal region and 1 on the Galen vein region. All dAVFs had a retrograde leptomeningeal venous drainage. Stenosis or thrombosis of the dural AVF sinus was observed in 17 cases and stenosis or thrombosis of another sinus(es) and/or of the jugular vein in 8 cases. In 11 patients, the angiographic signs of VHT were global affecting the entire cerebral venous drainage and, in the other 11 patients, the VHT was focal. The VHT caused clinical symptoms of increased intracranial pressure in 18 patients. Other clinical findings included: bruit (11 cases), seizures (3 cases), vertigo (3 cases), visual deficits (2 cases) and impairment of cognitive functions (4 cases). Three patients presented hemorrhage (one parenchymal hematoma, one hemorrhagic infarction and one subarachnoid hemorrhage). The 4 patients without clinical symptoms of increased intracranial pressure presented only bruit in 2 cases, bruit and vertigo in 1 case, bruit and hemorrhagic infarction in another one. The dAVFs were treated by endovascular therapy (arterial approach: 3 cases, venous approach: 6 cases and both arterial and venous approach: 13 cases). Endovascular sessions ranged from 1 to 7 (mean: 2.8) for each patient. After the endovascular treatment, in 12 patients with complete occlusion of the dAVF, the disappearance of angiographic signs of VHT and clinical cure were observed. In 8 patients with partial occlusion of the dAVF, the disappearance of angiographic signs of VHT and clinical cure were observed in 4 cases (almost complete dAVF occlusion in 2 cases); in the other 4 cases, only reduction the angiographic signs of VHT and clinical improvement were obtained. In all 16 patients who were clinically cured angiographic signs of VHT disappeared despite the persistence of dAVF shunts as observed in 4 cases. (ABSTRACT TRUNCATED)

Adult↗
PubMed1999

Thrombosis of angiographic catheters in humans: experimental study.

One of the major problems in the use of catheters is their thrombogenicity since the embolization of clots near the central nervous system or the coronary arteries can cause permanent damage. Catheter thrombogenicity was evaluated in humans during angiographic procedures by their tendency to become occluded. Characterization of catheters was achieved using roughness measurements, FTIR with ATR, DSC and ESCA. The catheters were 5 commercially available catheters, made mainly of polyethylene, Pebax or polyamide sterilized and ready for clinical use. Thirty-one patients due to have an angiographic procedure and with normal blood and hemodynamic parameters were included in the study. The 50 cm catheter test sample was inserted through an introducer into the femoral artery at the beginning of an angiographic procedure. The outcoming blood flow rate (BFR) was continuously monitored by a special computerized device for 15 min or until the total amount of blood reached 30 ml. The angiographic procedure was then normally resumed. DSC and FTIR showed results consistent with the expected composition of catheters. ESCA results showed very high Si/C ratios and could not be explained in all instances. Occlusion of the catheters occurred in 44% of the cases and the average time to obtain occlusion was 8.5 min (3-15 min). Values of the decrease rate of BFR in ml/min2 allowed separation of the catheters into 3 groups of low, medium and high thrombogenicity. However, occlusion occurred at least one time for each type of catheter. Blood volume and BFR curves vs. time allowed the determination of 3 main types of thrombotic behavior: type I shows no significant reduction of BFR; type II shows a progressive decrease in flow rate; type III is much less frequent and shows an abrupt decrease of BFR either quickly followed by a compensatory increase and resuming of a steady flow or by abrupt occlusion. In type II curves the pattern of occlusion follows a classical diffusion model because the Peclet number is greater than 1 and then the classical Higbie solution for diffusion could be used. The most thrombogenic material was the smoothest. There was no correlation between surface chemical composition and thrombogenicity. However, catheters that were based on PE appeared less thrombogenic than PA catheters in this study.

Angiography↗
PubMed1999

Spinal vascular malformations: endovascular therapy

Over the past 30 years, the development of diagnostic spinal angiography has led to effective endovascular techniques for treatment of spinal vascular malformations. Specific locations, size, rapidity of shunt, and clinical presentation determine the best treatment and prognosis.

Journal Article↗
PubMed1999

Major complications of percutaneous embolization of skull-base tumors.

The technique of direct intratumoral injection of permanent liquid polymerizing agent was initially described in 1994 and has evolved significantly with experience. We report complications that occurred in two patients during injection of Histoacryl and offer suggestions to prevent such complications in the future. In one patient, the glue settled in the right middle cerebral artery; in the second, the glue entered the left ophthalmic artery through a collateral branch. Although the fundamental injection technique has not changed, we suggest additional precautions and modifications to make this procedure a safer and more valuable element in the overall management of patients with difficult skull-base tumors.

Adolescent↗
PubMed1998

[What future for intracranial angioplasty?].

Atheromatous stenosis of the intracranial arteries is a major cause of ischemic cerebral events. To date, treatment has been medical. Percutaneous balloon angioplasty can be used to dilate intracranial arterial stenosis with an 80% success rate. This technique is still under evaluation but can be indicated in symptomatic patients after failure of a well-conducted anti-thrombotic regimen.

Angioplasty, Balloon↗
PubMed1998

Therapeutic approach to arteriovenous malformations of the tongue.

Arteriovenous malformations (AVM) are developmental errors with a high complication rate because they are hemodynamically active. The aim of our study is to evaluate management of the rare subgroup of tongue AVM. From 1982 to 1994, 25 patients with AVM of the tongue presented to our department. All patients were discussed in our multidisciplinary staff consultation and were treated by embolization, surgery, or were followed-up clinically with no intervention. Thirteen patients were asymptomatic in a hemodynamically quiescent phase and did not require any kind of intervention. The 12 others underwent embolization procedures following which 6 became stable, 2 had complementary surgery, 1 was lost to follow-up, 1 had two minor bleeding episodes without the need for hospitalization, and 2 were improved. Arteriovenous malformations of the tongue must be followed clinically and treated only if they become active. Permanent embolization with a polymerizing liquid administered through supra-selective catheterization or by direct puncture of the malformation is recommended.

Adolescent↗
PubMed1998

Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow.

OBJECTIVES: A retrospective study was carried out on 13 patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with isolated or associated signs of intracranial hypertension. METHODS: Nine patients presented with symptoms of intracranial hypertension at the time of diagnosis. Ocular fundoscopy available in 12 patients showed bilateral papilloedema in eight and optic disk atrophy in four. Clinical evolution was particularly noticeable in five patients because of chronic (two patients) or acute (after lumbar shunting or puncture: three patients, one death) tonsillar herniation. RESULTS: Two patients had a type I fistula (drainage into a sinus, with a normal antegrade flow direction). The remaining 11 had type II fistulas (drainage into a sinus, with abnormal retrograde venous drainage into sinuses or cortical veins). Stenosis or thrombosis of the sinus(es) distal to the fistula was present in five patients. The cerebral venous drainage was abnormal in all patients. CONCLUSION: Type II (and some type I) DAVFs may present as isolated intracranial hypertension mimicking benign intracranial hypertension. Normal cerebral angiography should be added as a fifth criterion of benign intracranial hypertension. The cerebral venous drainage pattern must be carefully studied by contralateral carotid and vertebral artery injections to correctly evaluate the impairment of the cerebral venous outflow. Lumbar CSF diversion (puncture or shunting) may induce acute tonsillar herniation and should be avoided absolutely. DAVF may induce intracranial hypertension, which has a poor long term prognosis and may lead to an important loss of visual acuity and chronic tonsillar herniation. Consequently, patients with intracranial hypertension must be treated, even aggressively, to obliterate the fistula or at least to reduce the arterial flow and to restore a normal cerebral venous drainage. The endovascular treatment may associate arterial or transvenous embolisation and/or surgery. Patients in whom the fistula is not obliterated after an endovascular therapeutic procedure, need continuous clinical and angiographical follow up.

Adult↗
PubMed1998

Management of intracranial aneurysms by surgical and endovascular treatment--modalities and results from a series of 395 cases.

The selective occlusion of saccular intracranial aneurysms may be achieved by two techniques: microsurgical clipping and endovascular coiling. Each of them have particular indications which need to be defined. From September 1992 to June 1996, 395 consecutive patients with small or large aneurysms were treated either by surgery (n = 102) or by endovascular coiling (n = 293). Coiling was chosen each time the shape of the aneurysm seemed to be appropriate for this treatment: narrow neck and ratio neck diameter by sac diameter less than one third. Satisfying results with complete or subtotal obliteration and no recanalization on the following controls at 1, 6, 12, and 36 months were obtained in 92% before retreatment and in 98.8% after retreatment. Unsatisfying results were observed after surgery in seven cases and in 25 cases after embolization. After retreatment, it remains three post-surgical and two post-endovascular cases. Good and excellent clinical outcome was noted in 90% for small aneurysms and in 86.5% for large ones. Mortality is of 4.8% in the overall series. In a series in which were applied both types of treatment, surgery in 25% and endovascular techniques in 75%, good results in terms of efficiency and clinical results were achieved. These results are as good as the best series in which surgery was the only choice. Therefore with appropriate selection, endovascular treatment is a good alternative for treatment of the majority of saccular aneurysms.

Adult↗
PubMed1997

[Cerebromeningeal hemorrhages in Rendu-Osler disease. 2 cases treated by embolization].

BACKGROUND: Treatment for cerebral vascular malformations in patients with hereditary hemorrhagic telangiectasia, also called Osler-Weber Rendu disease, has been greatly improved with advances in interventional neuroradiology. CASE REPORTS: Two patients with Osler-Weber Rendu disease experienced intracranial hemorrhage. In the first case, the disease was diagnosed at the age of 60 years in a man with recurrent epistaxis and numerous angiomas on the face and trunk as well as in the buccal cavity. The first neurological signs appeared seven years later and brain MRI revealed a 2-3 cm temporo-occipital arteriovenous malformation. Six months later sudden onset headache following exertion led to a CT-scan which showed tetraventricular hemorrhage. The second case was a 63-year-old man referred to neurosurgery for cerebromeningeal hemorrhage. Clinical examination and history taking found several small skin angiomas and a family and personal history of epistaxis. CT-scan revealed a dural fistula in the posterior fossa. Good clinical outcome was obtained in both cases by endovascular embolisation. DISCUSSION: Intracranial hemorrhage is observed in 2 to 3% of patients with Osler-Weber Rendu disease. Telangiectasia is not a pathognomonic sign and non-specific vascular malformations may be observed, particularly arteriovenous malformations or arterial aneurysms. Most can be reached by endovascular catheterism. Most of these usually unique malformations can be successfully treated by first-line embolisation.

Cerebral Hemorrhage↗
PubMed1997

Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage.

We review seven patients with intracranial dural arteriovenous fistulae (ICDAVF), each altering the initial type of venous drainage to one with a higher grading during long-term follow-up. Five were discovered due to symptoms of intracranial hypertension, two due to changes in tinnitus and one case following subarachnoid haemorrhage. In five cases, cortical venous drainage developed during the follow-up period. Three different mechanisms were observed: stenosis or thrombosis in the draining veins in 4 cases: increased arterial flow in 2; and the appearance o a new fistula site or extension of the initial shunt in 2. Type I and type II a fistulae which are not completely cured, require both close clinical observation and Doppler examinations in the follow-up period. Any charge in the clinical pictures indicates a repeat angiogram. Stenosis of the venous drain-age, forecasting later worsening in the venous outlet, requires more thorough angiographic follow-up.

Adult↗
PubMed1997

[Angioplasty of three intracranial vertebro-basilar atherosclerotic stenoses].

This report describes the successful use of transluminal angioplasty for tight atherosclerotic stenosis of the basilar or intra-cranial vertebral arteries in three patients presenting frequent symptoms that were unresponsive to antithrombotic therapy. Excellent clinical results have been obtained with a mean follow-up of 24 months. Larger studies are warranted to confirm efficacy and safety of this new technic.

Aged↗