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Biomedical subjects

L Pierot

Publications and source records attributed to L Pierot.

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

Functional MRI in double cortex: functionality of heterotopia.

A 12-year-old boy with epilepsy and subcortical laminar heterotopia (band heterotopia) underwent a functional MRI protocol to study voluntary motor activity in the hand. Finger tapping produced an activation of a contralateral limited and focused frontal cortical area both in the subcortical band heterotopia and the overlying cortex. Despite its epileptogenic activity, subcortical laminar heterotopia seems to be responsible for part of the functional activity of the brain. This has to be pointed out for epilepsy surgery resecting cortical dysplasia.

Action Potentials↗
PubMed1999

Postoperative aneurysm remnants: endovascular treatment as an alternative to further surgery.

Because further surgery on postoperative aneurysm remnants can be difficult and lead to significant morbidity and mortality, endovascular treatment, using controlled detachable coils, was performed in three patients with such remnants. The endovascular approach was technically more difficult in these cases than in previously untreated patients. In one case, the "remodelling" technique was necessary. Given the successful outcome in these patients, endovascular treatment can be proposed as an alternative to another operation, when further surgery appears too risky or is refused by the patient.

Adult↗
PubMed1999

Giant-cell tumour involving the cranial vault: imaging and treatment.

A giant-cell tumour involving the cranial vault was diagnosed in a 37-year-old man who presented with a large swelling at the vertex. The role of imaging in the diagnosis and treatment of this tumour is described. On CT and MRI the appearances were nonspecific and the diagnosis was established by histological examination after removal of the tumour. A preoperative angiogram showed a tumour blush and before surgery, embolisation was performed via the percutaneous and transarterial routes.

Adult↗
PubMed1999

Percutaneous biopsy of the thoracic and lumbar spine: transpedicular approach under fluoroscopic guidance.

Eighteen patients with vertebral lesions located in the thoracic or lumbar spine underwent percutaneous biopsy performed via a transpedicular approach under fluoroscopic guidance. This technique led to an accurate diagnosis in 16 cases (89%). No complications were encountered. For percutaneous lumbar and thoracic vertebral biopsy, the transpedicular approach is a safe and accurate alternative to the posterolateral approach.

Adult↗
PubMed1998

Radionuclide cisternography in spontaneous intracranial hypotension.

We report a case of spontaneous intracranial hypotension (SIH) that was investigated using cranial MRI and radionuclide cisternography. Radionuclide imaging was remarkable, showing direct signs of diffuse asymmetric leakage and indirect signs of cerebrospinal fluid (CSF) hypotension consisting of slow CSF circulation to the convexity and rapid appearance of urinary bladder activity. The MRI appearance was also suggestive of SIH, with diffuse meningeal enhancement. Treatment with autologous blood injection at the level of the radionuclide spinal leakage was useful, resulting in disappearance of SIH symptoms.

Adult↗
PubMed1998

Combined neurosurgical and neuroradiological treatment of a complex superior sagittal sinus dural fistula: technical note.

OBJECTIVE AND IMPORTANCE: Dural arteriovenous fistulas of the superior sagittal sinus (SSS) account for 8% of intracranial dural fistulas. Their association with a thrombosis of the posterior part of the SSS is rare. In such cases, the usual neurosurgical and endovascular approaches cannot provide a good technical solution for treatment of the lesion, and a combined neurosurgical and neuroradiological approach is therefore needed. CLINICAL PRESENTATION: A 68-year-old man presented with rapidly evolving dementia. Cerebral angiography revealed a dural arteriovenous fistula of the SSS associated with thrombosis of the posterior part of the SSS. Various endovascular and neurosurgical approaches failed to cure the fistula. INTERVENTION: A burr hole was drilled in the frontal region, in the neurosurgical room. The patient was then transferred to the angiographic room, and the SSS was occluded using free spirals. CONCLUSION: This procedure led to a complete anatomic cure of the fistula, and a slow clinical improvement was observed.

Aged↗
PubMed1998

Local intraarterial fibrinolysis of thromboemboli occurring during endovascular treatment of intracerebral aneurysm: a comparison of anatomic results and clinical outcome.

PURPOSE: We describe our therapeutic strategy and correlate the anatomic results and clinical outcomes in patients who received immediate fibrinolytic therapy for thromboembolic complications occurring during endovascular treatment of an intracerebral aneurysm. METHODS: The medical records and angiographic examinations of 19 patients were reviewed. All endovascular procedures were performed with the patients under general anesthesia and fully heparinized. Thirteen patients received an intravenous bolus injection of aspirin. Thromboemboli occurred during catheterization or insertion of embolic material (Guglielmi detachable coils or mechanical detachable spirals) or in the first hours after the intervention. Clot distribution was within the MCA territory in 14 patients, the ACA in three patients, and the basilar trunk in two patients. A continuous intraarterial injection of urokinase was administered immediately, either superselectively distal to the thrombus or selectively within or closely proximal to the thrombus. In nine cases, chemical lysis was combined with mechanical clot fragmentation. Initial anatomic recanalization as well as clinical outcome at 3 months were evaluated. RESULTS: Ten patients showed complete recanalization and nine patients showed partial recanalization. Fourteen patients had a good clinical recovery. One patient was moderately disabled and two were severely disabled according to their scores on the Glasgow outcome scale. Two patients died, one as a consequence of the preexisting subarachnoid hemorrhage and the other because of a large intracerebral hematoma that developed after fibrinolysis. Of the 14 patients with a good clinical outcome, nine exhibited complete recanalization and five partial recanalization. CONCLUSION: Pharmacological thrombolysis seems to be a safe and efficient therapy that facilitates the natural fibrinolytic process, increasing the rate of recanalization in thromboembolic events. Clot fragmentation and superselective drug infusion appear to improve the rate of recanalization. Complete recanalization increases the chance of a better clinical outcome; however, clinical outcome does not always correspond to recanalization and vice versa.

Adult↗
PubMed1997

The endovascular approach in the management of patients with multiple intracranial aneurysms.

To investigate the role of endovascular treatment we performed a retrospective study of our patients with multiple intracranial aneurysms seen in our institution between October 1992 and March 1995. This period was chosen to study a homogeneous group of patients since the appearance of controlled detachable coils, and to obtain the largest number of patients with angiographic follow-up of the aneurysms treated. We studied 53 patients with a total of 128 aneurysms, in 46 of whom we treated 67 aneurysms by the endovascular approach. Of these, 5 aneurysms in 3 patients were treated by occlusion of the parent vessel and 62 aneurysms in 43 patients with coils, 52 with Guglielmi detachable coils and 10 with mechanically detachable spirals. Complete occlusion was obtained in 58 aneurysms, and partial occlusion in 9. The therapy caused permanent neurological deficit in 3 cases (6.5%), and there was 1 case of rebleeding (incomplete occlusion of the aneurysm). No deaths occurred. All aneurysms were treated in 29 of the 53 patients. Endovascular procedures were used for 16 patients (30%), surgery was performed in 1 patient (2%) and the two were combined in 12 (23%). In 23 of 53 cases (43%), unruptured aneurysms were left untreated, usually because of their small size. In 1 patient with unruptured aneurysms, the endovascular approach failed and the patient refused surgery.

Adult↗
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↗
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

Endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils.

The aim of this study was to evaluate endovascular treatment of anterior communicating artery aneurysms using Guglielmi detachable coils GDC. To obtain long-term follow-up, we selected patients treated between October 1992 and March 1994. Among the 251 berry aneurysms treated by detachable coils at our institution, 36 were located at the anterior communicating artery and treated with GDC. The most frequent clinical presentation in this group (86%) was subarachnoid haemorrhage (30 cases). There were 23 aneurysms which were completely and 6 were partially occluded. We did not treat 7 aneurysms. In 3 cases, no endovascular treatment was attempted either because the aneurysmal neck was not clearly distinct from the adjacent, or parent vessels (2 cases), or because the aneurysm sac was too small (1 case). In 4 cases, treatment failed because of atheroma of the cervical and intracranial vessels. Complications were, in the majority of cases, related to clotting (3 cases) with a good outcome in 2 cases and neurological sequelae in 1. In 1 case rupture of the aneurysm occurred during treatment. Endovascular packing was continued until complete occlusion of the aneurysm was achieved and no clinical complication was observed after the treatment. Two patients died as a result of complications of subarachnoid haemorrhage (vasospasm in one case, pulmonary complications in the other). Endovascular treatment using GDC is an efficient technique for treating anterior communicating artery aneurysms even in the acute phase of bleeding.

Adult↗
PubMed1996

Endovascular treatment of pericallosal artery aneurysms.

Recent technical developments have made endovascular treatment using controlled-detachable coils suitable for intracranial aneurysms. However, endovascular approach of the aneurysms of the pericallosal artery remains difficult because of their usual small size and their anatomical situation.

Adult↗
PubMed1996

Selective occlusion of basilar artery aneurysms using controlled detachable coils: report of 35 cases.

The development of new devices, especially controlled detachable coils, has made the endovascular approach one of the modalities for the treatment of intracranial aneurysms. We describe the treatment and present the results of 35 patients treated by selective occlusion of basilar artery aneurysms in our department during a period of 2 years (November 1992-November 1994). This period of time was chosen to analyze a homogeneous population treated since the introduction of controlled detachable coils and also to be able to have as many follow-up angiographic controls of the treated aneurysms as possible. The clinical presentation was subarachnoid hemorrhage in 32 patients and transient ischemic attack in 1 patient. In another two patients, the aneurysms were incidentally discovered. The majority of the aneurysms were berry aneurysms. The aneurysms were located at the basilar bifurcation (23 patients), at the basilar tip between the posterior cerebral artery and the superior cerebellar artery (5 patients), on the basilar trunk (3 patients), and at the vertebrobasilar junction (4 patients). Endovascular treatment using coils was achieved in 34 patients, using Guglielmi detachable coils (Target Therapeutics, San Jose, CA) in 29 patients and mechanical detachable spirals (Balt, Montmorency, France) in 5 patients. One patient died during the positioning of the first coil into the aneurysmal sac. Twenty-five of 35 aneurysms (73.5%) were completely occluded. Nine aneurysms (26.5%) were only partially (> 90%) occluded. No subsequent bleeding occurred during the follow-up period. Two patients treated in the acute phase of subarachnoid hemorrhage died days or weeks after endovascular treatment because of complications related to the natural history of subarachnoid hemorrhage (vasospasm in one patient and pulmonary complications in the other). In three patients, clotting occurred during the endovascular procedure. In all three patients, occlusion of the aneurysmal sac was achieved despite clotting. Urokinase was administered to two of the three patients. In the remaining patient, no fibrinolytic therapy was initiated. The clinical outcomes were excellent for all three patients. In this study, the morbidity-mortality rate of the endovascular technique is low (3%). If we include complications related to the subarachnoid bleeding, the morbidity-mortality rate remains low (8.8%) Regarding basilar artery aneurysms, endovascular treatment (selective occlusion by controlled detachable coils) is now useful for some patients, especially those with small aneurysms. However, long-term anatomic follow-up is needed to accurately evaluate the role of this treatment modality in the management of basilar aneurysms.

Adolescent↗
PubMed1995

Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

PURPOSE: To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. MATERIALS AND METHODS: Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. RESULTS: Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. CONCLUSION: This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.

Arteriovenous Fistula↗