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Biomedical subjects

L Spelle

Publications and source records attributed to L Spelle.

At least 19 recordsLinked to original sources
PubMed2006

Direct cervical arterial access for intracranial endovascular treatment.

INTRODUCTION: Tortuous vasculature is a cause of failure of endovascular treatment of intracranial vascular lesions. We report our experience of direct cervical accesses in patients in whom the arterial femoral route was not attainable. METHODS: In this retrospective study, 42 direct punctures of the carotid or the vertebral arteries at the neck were performed in 38 patients. The vessel harboring the intracranial lesion was punctured at the neck above the main tortuosity, a sheath was then positioned under fluoroscopic control to allow a stable access to the intracranial circulation. After the procedure, the sheath was removed and hemostasis was gained either by manual compression or by an arterial closure device (4 of 42, 9%). RESULTS: The cervical route allowed access to all intracranial lesions in all 42 procedures. A complication was encountered in six procedures (14%) related to the direct puncture. In 2 of the 42 procedures (4%), a transient vasospasm was encountered. A cervical hematoma formed in 3 of the 42 procedures (7%) after sheath withdrawal (one patient in whom an 8F sheath had been used, required surgical evacuation of a hematoma compressing the upper airways; the other patients did well without surgical evacuation). In the remaining patient (1 of 42 procedures, 2%), a small asymptomatic aneurysm at the puncture site was seen on the follow-up angiogram. CONCLUSION: Direct cervical arterial approaches to accessing the intracranial circulation is effective in patients in whom the femoral route does not allow the navigation and stabilization of guiding catheters.

Adult↗
PubMed2006

[Transarterial embolisation of intracranial dural arteriovenous malformations with ethylene vinyl alcohol copolymer (Onyx18)].

OBJECTIVE: To report our recent experience in transarterial embolisation of dural arteriovenous malformations (DAVM) using a new liquid embolic agent, Onyx18. PATIENTS AND METHODS: 6 patients were enrolled in this series. Clinical presentation was separated into 2 groups: aggressive (n=2), non aggressive (n=4). The DAVM was located at the superior sagittal sinus (n=1), at the transverse sinus (n=2), at the condylian canal (n=1), in the lesser sphenoid wing region (n=1), and in the tentorium region (n=1). The DAVM drained directly into a condylian or a cortical vein for three patients and into a venous sinus with cortical venous reflux for the three others. In this latter situation, the sinus was anatomically excluded from the normal brain venous drainage. RESULTS: A full brain angiogram including both internal carotid arteries, both external carotid arteries and ipsilateral vertebral artery, was performed before and after each treatment. The feeder chosen after a selective catheterisation for Onyx18 injection was always meningeal. Each treatment consisted of a single Onyx injection after one unique feeder catheterisation. Complete anatomical exclusion of the DAVM was achieved and demonstrated by the post treatment angiogram in all cases. There was no clinical complication after the treatment. CONCLUSION: Onyx18 used is a safe treatment for DAVMs. When its injection is performed in optimal conditions, it fills the total DAVM and its drainage vein or sinus after a single arterial feeder catheterisation.

Aged↗
PubMed2006

Ellipsoid approximation versus 3D rotational angiography in the volumetric assessment of intracranial aneurysms.

BACKGROUND AND PURPOSE: The purpose of this study was to compare the volumetric results of intracranial aneurysms obtained by calculation of the volume of an ellipsoid with those obtained with 3D rotational angiography (3D-RA). METHODS: First, the precision of 3D-RA in the assessment of volumetric measurement of intracranial aneurysm had to be established. The 3D-RA gave an overestimation of 4% to 5.5% of the actual volume of a spherical object. Then, 484 consecutive human intracranial aneurysms were studied with 3D-RA, allowing the determination of their volume. In the meantime, aneurysm dimensions (height and width) were measured on the 3D pictures generated by the 3D-RA. The aneurysm volumes were obtained by considering the aneurysm shape to be ellipsoidal, according to the formula: (formula in text). RESULTS: The calculated aneurysm volume (V(calc)) overestimated by 15 +/- 38% the volume given by 3D-RA. Taking into account a 10% margin of error, 227 (47%) aneurysms were overestimated by 44 +/- 34%, whereas 113 (23%) aneurysms were underestimated by 25 +/- 12%. Only 144 (30%) aneurysms had calculated and 3D-RA results within the limits of 10% of discrepancy. Concordance was good for pericallosal and basilar tip aneurysms (mean overestimation of 6 +/- 22% and 8 +/- 27%, respectively). Conversely, there was a high discrepancy between calculated and 3D-RA results for posterior communicating artery aneurysms (mean overestimation of 22 +/- 44%). CONCLUSION: The calculation of the volume based on aneurysm dimensions is relatively accurate for pericallosal and basilar tip aneurysms, probably owing to their spherical or elliptic shape. Conversely, this formula is not adequate for irregularly shaped lesions, such as posterior communicating aneurysms.

Angiography↗
PubMed2005

[Endovascular treatment of unruptured middle cerebral artery aneurysms].

INTRODUCTION: Middle cerebral artery aneurysms (MCA) often present an unusual anatomical feature for the endovascular treatment and are frequently sent to surgery. We report our experience in the endovascular treatment of unruptured MCA aneurysms and compare it with results from the neurosurgical literature. PATIENTS AND METHODS: In this retrospective study were included all patients with unruptured MCA aneurysms treated in our institution between November 1998 and December 2003. 3D imaging was performed in all cases to determine precisely the relationship between aneurysm and parent artery. The degree of occlusion of the aneurysms was estimated according to Raymond's classification. The neurological state was evaluated according to the Rankin scale and was re-evaluated at the time of each follow-up. RESULTS: Eighty four patients with 100 aneurysms were analysed. Ninety aneurysms were treated by endovascular approach. Nine aneurysms were sent to surgery, after 3D imaging analyses or failed endovascular treatment. In one patient, related to the aneurysm configuration, a conservative attitude has been adopted. Four giant aneurysms were treated by parent vessel occlusion and 86 aneurysms were selectively occluded. The remodelling technique with balloon was performed in 58.1% of cases. Eight patients presented a new neurological deficit. The deficit was transient in six cases, and permanent in 2 cases. There was no mortality in this series. In 86 aneurysms selectively treated, there were 87.2% good results (grades A and B). Seventy one aneurysms (82.5%) treated were controlled between 3 and 58 months with a 19.6 months average. Recurrences were observed in 25.3% of cases. They were major in 9.8% and retreatment was performed. CONCLUSION: We report the feasibility of the endovascular treatment of MCA aneurysms previously estimated untreatable. Per procedural 3D imaging and remodelling technique were fundamental tools in the management of these aneurysms.

Adult↗
PubMed2004

Increasing the packing of small aneurysms with soft coils: an in vitro study.

The aim of this study was to determine whether or not the use of Soft and Ultra Soft Guglielmi detachable coils (GDCs) may improve the packing of cerebral aneurysms. Six coiling scenarios of a silicone aneurysm model were conducted using Standard, Soft, and Ultra Soft GDCs. Coils were introduced up to the point when the adjunct of one more coil caused protrusion out of the aneurysm sac. Packing ratios (volume of coils/aneurysm volume) ranged between 30 and 55%. The highest degree of packing was achieved with the combination of Soft GDC-18 coils and Ultra Soft GDC-10 coils. There is a positive relationship between the use of Soft and Ultra Soft GDC coils and greater aneurysm filling.

Embolization, Therapeutic↗
PubMed2004

[Intracranial arteriovenous malformations: review of epidemiologic and genetic data].

Estimation of prevalence and incidence rates in a disease is crucial to estimate the risk of the natural evolution of the disease. We have reviewed published data on intracranial AVM and have noted that reported estimated risks were quite variable mainly due to the lack of population-based prospective data. Nonetheless, estimation of these parameters can be made from selected populations. We will note also that there is no published data confirming a genetic origin for the most frequent group of sporadic AVM.

Cross-Sectional Studies↗
PubMed2004

[Cerebral arteriovenous malformations: evaluation of the hemorrhagic risk and its morbidity].

Evaluation of the hemorrhagic risk associated with intracranial arteriovenous malformation is a keypoint question for physicians involved in the management of these patients. Indeed, this hemorrhagic risk including its morbid-mortality consequences has to be balanced with the therapeutic risk. All the published studies have estimated the annual bleeding risk between 2 to 4%; a first hemorrhagic event is associated with an increased risk of a new bleeding. Mortality associated with AVM bleeding is estimated between 10 to 15%, with a 50% risk of morbidity. Factors associated with an increased risk of bleeding include existence of aneurysms (intranidal or flow related pedicular, proximal or distal) and some venous drainage patterns such as deep venous drainage or venous stenosis.

Cerebral Hemorrhage↗
PubMed2004

[Cerebral arteriovenous malformations and pregnancy: management of a dilemma].

Cerebral arteriovenous malformations (AVM) infrequently complicate pregnancy. The epidemiology and various treatment options of AVM complicating pregnancy are outlined. Although the medical treatment of the pregnant patient with an AVM is similar to that of nonpregnant patients, there are specific conditions that are relevant to these patients. Due to its rarity, no specific recommendations exist for the management of the pregnant AVM-patients. We propose some guidelines for the evaluation and treatment of pregnant patients with AVM.

Cerebral Angiography↗
PubMed2002

Unusual origin of the artery of Adamkiewicz from the fourth lumbar artery.

The main arterial supply of the dorso-lumbar spinal cord is usually derived from a single anterior radiculo-medullary artery called the artery of Adamkiewicz and referred to as having a middle or low location. In some cases, the artery origin is higher, and a vessel which arises in the lower part of the region supplements the supply of the anterior spinal artery. In the literature, those arteries have been described as arising from L3 upwards, and have never been previously described angiographically, to our knowledge, below this level, although Suh and Alexander and Gililan have mentioned this eventuality. Of the 4,000 spinal cord angiographies performed in our institution, we report three cases in which the fourth lumbar artery flows into the anterior spinal artery of the conus medullaris. This anatomical variant may explain the sometimes devastating post-operative neurological complications from a spinal cord infarction on surgery of the lumbar spine or the abdominal aorta below L3.

Adult↗
PubMed2002

[Endoluminal dilatations and stenosis of symptomatic vertebral arteries].

Surgical treatment of symptomatic atherosclerotic stenosis of vertebral arteries has been proposed for many years but this technique remains quite confidential due to technical difficulties and relatively high risks. Transluminal angioplasty has been proposed and we developed a simplified technique using coronary stent placement. The aim of this study was to evaluate the feasibility and efficacy of transluminal angiography with primary stenting for proximal stenosis for vertebral arteries. Eleven patients with symptomatic atherosclerotic stenosis of vertebral arteries were treated by trans luminal angioplasty with primary stent placement. Two patients, one with stenosis of the proximal vertebral artery and one with distal stenosis of the vertebral artery where only treated by transluminal angioplasty. In all cases transluminal angioplasty and stenting were feasible with restitution ad integrum of the diameter of the artery in 98 cases and with residual moderate stenose (<20%) in 5 cases. All patients were followed for more than one year, only one patient had recurrence of symptoms, but he stopped spontaneously the anti platteless drugs. Vertebro basilar symptoms disappeared completely in 12/13 cases and were improved in 1/13 cases. No restenose of the artery was observed on control (echodoppler) excepted in one case, where a tight stenose of pre vertebral sub clavian artery developed. Transluminal angioplasty for symptomatic stenosis of vertebral artery appears as a very successful technique with a low complication rate. It should be proposed in many cases of vertebrobasilar insufficiency related with tight vertebral artery stenosis.

Aged↗
PubMed2001

Primary lateral sclerosis: further clarification.

Primary lateral sclerosis (PLS) has been defined as a rare. Non-hereditary disease characterized by progressive spinobulbar spasticity, related to the exclusive involvement of precentral pyramidal neurons, with secondary pyramidal tract degeneration and a preservation of anterior horn motor neurons, the latter allowing PLS to be distinguish from amyotrophic lateral sclerosis (ALS). However, a clear distinction between the two diseases remains a subject of debate. With this in mind, we assessed patients with meeting the previously published criteria for PLS in a prospective, longitudinal study. At regular intervals, we analyzed various clinical and electrophysiological parameters in nine patients with a diagnosis of PLS. We made a deltoid muscle biopsy and PET study.Our results provide evidence that degeneration in PLS is not restricted to the upper motor neurons but also affects the lower motor neurons. The distinction between ALS and PLS is related to the degree and stability of lower motor neuron involvement. In view of the similarities with ALS, we consider that PLS may represent a slowly progressive syndrome closely related to this disease.

Adult↗
PubMed2001

Case report of pallido-pyramidal disease with supplementary motor area involvement.

An C-flumazenil positron emission tomography (PET) study in a patient with pallido-pyramidal disease revealed a marked decrease in benzodiazepine-receptor density in the precentral gyrus cortex and the mesial frontal cortex. We suggest that, in addition to dysfunction of basal ganglia-dependent systems, degeneration of the supplementary motor area could also be involved in the patient's bradykinesia.

Adult↗
PubMed2001

Neuroimaging features of spontaneous intracranial hypotension.

We reviewed the cranial MRI and radionuclide cisternograms of four adults with postural headache indicating spontaneous intracranial hypotension (SIH). All four underwent clinical and radiological follow-up. MRI showed diffuse, thin meningeal enhancement; bilateral subdural fluid collections; and morphological abnormalities secondary to "sagging" of the brain. Radionuclide cisternography revealed direct or indirect signs of leakage of cerebrospinal fluid (CSF) along the spinal axis, and the symptoms resolved after the leak treated by epidural injection of blood at a level indicated by the cisternogram. The diffuse meningeal enhancement decreased but persisted on follow-up MRI, although the patients were asymptomatic. All morphologic abnormalities resolved during 3-5 months follow-up.

Adult↗
PubMed2000

Percutaneous transluminal angioplasty and stenting of the proximal vertebral artery for symptomatic stenosis.

BACKGROUND AND PURPOSE: Percutaneous transluminal angioplasty (PTA) for significant stenosis involving the origin of the vertebral artery is now a well established treatment for selected patients when posterior cerebral arterial circulation is compromised. Arterial spasm, dissection, and restenosis may occur in some instances, with subsequent hemodynamic compromise. To prevent these potential complications, we combined PTA of the vertebral artery with primary stenting, using coronary stents, in seven patients. We herein present our short- and intermediate-term results. METHODS: A total of seven lesions affecting the origin of the vertebral artery were treated by primary trans-stenotic coronary stent placement. All patients were symptomatic, fulfilling the general criteria for vertebral artery angioplasty. Patients were followed for up to 36 months after treatment. RESULTS: All seven lesions were successfully dilated. Residual stenosis was never greater than 20% in diameter. No perioperative complications occurred. Clinical follow-up showed immediate resolution or improvement of symptoms in all patients. One patient's condition deteriorated 15 months after stent placement because of atheromatous stenosis of the prevertebral segment in the ipsilateral subclavian artery. CONCLUSION: Stent placement to treat significant stenosis involving the origin of the vertebral artery is safe and effective for alleviating symptoms and improving blood flow to the posterior cerebral circulation. Coronary stent design seems to be particularly well suited to cover atherosclerotic lesions of the origin of the vertebral artery. The stent mesh probably prevents elastic recoil and early restenosis after PTA, as it does in coronary arteries.

Aged↗
PubMed2000

[What's new in primary lateral sclerosis?].

Primary lateral sclerosis as a nosological entity distinct from amyotrophic lateral sclerosis has been the subject of controversy since it was first described in the nineteenth century. Primary lateral sclerosis has been defined as a rare, non-hereditary disease characterized by highly progressive spinobulbar spasticity, related to the exclusive loss of precentral pyramidal neurons, with secondary pyramidal tract degeneration and preservation of anterior horn motor neurons. We carried out a study in nine patients with a diagnosis of primary lateral sclerosis. Our clinical, electrophysiological and pathological investigations provide evidence that the disease has a heterogeneous clinical presentation and that degeneration is not restricted to the central motor system but also affects the lower motor neuron. In view of this similarity with amyotrophic lateral sclerosis, primary lateral sclerosis may represent a slowly progressive syndrome closely related to motor neuron disease and amyotrophic lateral sclerosis.

Adult↗
PubMed1999

Cystic fibrosis in adolescents and adults: fatty replacement of the pancreas--CT evaluation and functional correlation.

PURPOSE: To compare the computed tomographic (CT) features of pancreatic fatty replacement in adolescents and adults with cystic fibrosis (CF) with those in control subjects and to correlate the degree of fatty replacement with the functional status of the pancreas. MATERIALS AND METHODS: CT scans in 15 patients with CF (group 1) and in 15 control subjects without CF (group 2) were evaluated for thickness and degree of pancreatic fatty replacement. Thickness was measured at four anatomic levels. The pattern of pancreatic fatty replacement was visually evaluated in four pancreatic regions. Images were semiquantitatively analyzed by two readers. The degree of fatty replacement was correlated with the functional status of the pancreas. RESULTS: In group 1, pancreatic glandular tissue was significantly thinner (P < .001) and the degree of fatty replacement was significantly greater in the four regions (P < .001) than those in group 2. In Group 1, no relationship was found between the degree of pancreatic fatty replacement and that of pancreatic endocrine dysfunction. A significant relationship was found between the degree of fatty replacement and that of pancreatic exocrine dysfunction (P < .001). CONCLUSION: In patients with CF, pancreatic glandular tissue is significantly reduced in size. Pancreatic fatty replacement is the most frequent pattern in older patients with CF and correlates with pancreatic exocrine dysfunction.

Adipose Tissue↗
PubMed1999

Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils.

PURPOSE: To evaluate the stability of aneurysm occlusion at follow-up angiography after endovascular treatment (EVT) with detachable coils in intracranial berry aneurysms. MATERIALS AND METHODS: A total of 203 berry aneurysms (< 1.5 cm) were treated with EVT. Follow-up angiography at least 3 months later was performed in 169 cases. RESULTS: Complete occlusion of the aneurysm sac and neck was achieved in 148 aneurysms, subtotal occlusion in 18, and incomplete occlusion in three. Recurrence occurred between 3 and 40 months in 20 (14%) of the 148 totally occluded aneurysms. A second treatment was performed in five cases, was scheduled in one, and failed in one. The small neck remnant increased in size but did not require any retreatment in three cases, and the size of the neck remnant remained stable in 10 cases. Remnant regrowth occurred in six of the 18 subtotally occluded aneurysms. A second treatment was performed in three. Of the 169 cases, last follow-up angiography showed total occlusion in 133 cases, subtotal in 30, and incomplete in six. No rebleeding occurred. CONCLUSION: A very small recurrence may be observed at the level of the neck of the aneurysm at long-term follow-up angiography despite achieving total occlusion initially with detachable coils.

Cerebral Angiography↗