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Serge Bracard

Publications and source records attributed to Serge Bracard.

10 recordsLinked to original sources
PubMed2006

Congenital paravertebral arteriovenous fistula: a case report.

Congenital paraspinal arteriovenous fistulae are rare and usually diagnosed after neurologic or cardiovascular manifestations. They may be discovered unexpectedly in children during clinical examination, which reveals the presence of a vascular murmur. The association with multicystic kidney is exceptional. We report 1 case with thoracic localization of a congenital paraspinal arteriovenous fistula associated with a multicystic kidney in a 3-year-old boy who was treated by endovascular embolization.

Arteriovenous Fistula↗
PubMed2006

Current diagnostic modalities for intracranial aneurysms.

Aneurysm diagnosis has evolved considerably over the last years. Technological advances have brought CT angiography and MR angiography to the forefront of ruptured and nonruptured intracranial aneurysm diagnosis. This article highlights current diagnostic modalities for intracranial aneurysms.

Cerebral Angiography↗
PubMed2005

Topotecan as a radiosensitizer in the treatment of children with malignant diffuse brainstem gliomas: results of a French Society of Paediatric Oncology Phase II Study.

BACKGROUND: The current Phase II study was conducted to evaluate the survival and toxicity observed in children with newly diagnosed brainstem gliomas who were treated with the daily radiotherapy with topotecan used as a radiosensitizer. METHODS: Eligible patients were those ages 3-18 years with previously untreated tumors arising in the pons diagnosed within the previous 6 months. Histologic confirmation was not mandatory provided that the clinical and magnetic resonance imaging findings were typical for a diffusely infiltrating brainstem lesion. Treatment was comprised of a 6-week course of topotecan administered intravenously at a dose of 0.4 mg/m(2)/day over 30 minutes within 1 hour before irradiation. Radiotherapy was comprised of a once-daily treatment of 1.8 grays (Gy) per fraction to a total dose of 54 Gy. RESULTS: Thirty-two patients were included in the current study between August 2000 and October 2002. All patients completed the combined treatment in accordance with the treatment design. Only partial responses were observed, occurring in 40% of the patients. The 9-month and 12-month survival rates were 34.4% +/- 8% and 25.5% +/- 8%, respectively. The median duration of survival for these 32 patients was 8.3 months. An intratumoral cystic/necrotic change was observed in five patients, with clinical impairment noted in two patients. One intratumoral hemorrhage occurred during radiotherapy, and was associated with transitory neurologic impairment. CONCLUSIONS: The findings of the current study regarding newly diagnosed brainstem glioma patients treated with topotecan given as a radiosensitizing agent did not reproduce the encouraging results obtained in preclinical studies. Therefore, the concomitant combination of topotecan and radiotherapy at this schedule and these doses cannot be recommended for the treatment of patients with brainstem gliomas.

Adolescent↗
PubMed2005

Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume.

Our purpose was to evaluate the postoperative aneurysm occlusion volume and clinical results of treating unruptured intracranial aneurysm using three-dimensional (3D) coils. Over a 2-year period 62 aneurysms (39 with a neck < or =4 mm, 23 with a neck >4 mm) in 62 patients in five participating centres were treated. The procedure consisted, firstly, of framing the aneurysm with one or more spherical 3D coils, and secondly, of filling it with two-dimensional (2D) helical coils. Anatomical and clinical results were evaluated by univariate analysis. Multivariate analysis was used to identify independent predictors of these results. For neck sizes < or =4 and >4 mm, angiographic occlusion was complete in 31 (79%) and 16 (70%) aneurysms, respectively; the mean percentage of occlusion volume was 31.4% and 29.5%, respectively, and postoperative morbidity was 3% and 4%, respectively, with no significant differences between the two groups. There were no deaths. However, occlusion volume correlated with sac size (P = 0.037) and sac-to-neck ratio <1.5 (P = 0.073), except when three or more 3D coils per aneurysm were used (P = 0.516 and P = 0.308, respectively). Occlusion volume correlated with the number of 3D coils per aneurysm (P < 0.001) and was an independent predictor of angiographic complete occlusion (P = 0.002). The use of the largest number of 3D coils per aneurysm was safe and may improve the postoperative volume and angiographic occlusion of aneurysms with a neck >4 mm, provided the sac-to-neck ratio is > or =1.5.

Adult↗
PubMed2004

Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results.

BACKGROUND AND PURPOSE: Aneurysms with a wide neck constitute a persistent challenge for endovascular therapy with coils. Our purpose was to evaluate the immediate anatomic and clinical results of treating intracranial wide-necked aneurysms by using three-dimensional (3D) coils. METHODS: During a 2-year period, 160 aneurysms (116 with a neck < or = 4 mm, group A; 44 with a neck > 4 mm, group B) in 157 patients in eight participating centers were consecutively treated. The procedure consisted first of framing the aneurysm with one or more 3D spherical coils and then filling it with helical coils. Results were evaluated with univariate analysis. Multivariate analysis was used to identify independent predictors of these results. RESULTS: Angiographic occlusion was complete in 84 (72%) and 30 (68%) aneurysms in groups A and B, respectively. Mean percentage of volumic occlusion in these groups was 30.9% and 29.2%, respectively. Perioperative morbidity and mortality rates were 4%, respectively, in group A and 2%, respectively, in group B. No significant difference between the two groups was observed. However, percentage of volumic occlusion correlated with sac-to-neck ratio less than 1.5 (P =.061) and with sac size (P =.002) except when three or more 3D coils per aneurysm were used (P =.222). The better the percentage of volumic occlusion, the better the degree of angiographic occlusion (P =.004). Percentage of volumic occlusion was an independent predictor of angiographic complete occlusion (P =.001). World Federation of Neurological Surgeons subarachnoid hemorrhage scale grade 5 was an independent predictor of perioperative mortality (P =.043). CONCLUSION: Three-dimensional coils proved to be useful for improving coil packing and angiographic and volumic occlusion of aneurysms with a neck greater than 4 mm, at the time of treatment, provided the sac-to-neck ratio was 1.5 or greater, and the largest number of 3D coils were first positioned.

Adult↗
PubMed2003

Treatment of hemorrhagic intracranial dissections.

OBJECTIVE: To analyze the treatment options in hemorrhagic intracranial dissections. METHODS: This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS: EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died. CONCLUSION: EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

Adult↗
PubMed2003

[Is carotid resection a valuable option in advanced head and neck squamous cell carcinomas].

Head and neck squamous cell carcinomas may involve the carotid artery. Surgical treatment of these tumors is a difficult challenge, because of related morbidity and mortality. The aim of this study of international literature was to define the best preoperative and intraoperative strategy which permits carotid resection with acceptable neurologic risk. Pre-operative evaluation of cerebral tolerance to carotid occlusion is performed. If the patient has successfully completed the 30-minute temporary occlusion of the internal carotid artery, a permanent balloon occlusion is performed. Surgical treatment includes carotid resection with or without revascularization using an autogenous graft. Elective carotid resection without reconstruction results in cerebral complications in 0 to 25% of patients, and death in 0 to 30% of patients. If a reconstruction using a graft is performed, cerebral complications occur in 0 to 22% of patients, and death in 0 to 33% of patients. Anastomotic rupture occurs in 0 to 33% of patients. However, many authors reported no neurologic complications and no deaths after performing successful preoperative permanent balloon occlusion of the internal carotid associated with carotid resection. Carotid resection can be performed with an acceptable cerebral risk in selected patients. Preoperative carotid occlusion seems to result in decreased postoperative mortality and morbidity rates. Prospective studies should be done to clarify the benefit of this procedure.

Brain Ischemia↗
PubMedDate not supplied

Endovascular treatment of Hunt and Hess grade IV and V aneuryms.

BACKGROUND AND PURPOSE: Controversy still surrounds the question of when and how to manage cases of subarachnoid hemorrhage of Hunt and Hess grade IV and V aneurysms. Several authors are in favor of surgical treatment, reporting improved clinical outcomes and lower mortality rates. Considering that endovascular procedures are currently being increasingly used to treat aneurysms, we investigated their use in the management of subarachnoid bleeding in a retrospective review of 80 patients. METHODS: Eighty patients were admitted to our hospital between October 1992 and October 1998 with subarachnoid hemorrhage of Hunt and Hess grade IV and V aneurysms. Patients received standard resuscitation treatment, nimodipine to prevent vasospasm, CSF shunt when necessary, and selective occlusion with Guglielmi detachable coil. They were subsequently followed up for at least 1 year. Aneurysm occlusion was monitored with MR angiography and/or angiography at 6 months and at 1 year. RESULTS: Of the 80 patients, 42 (52.5%) did well (Glasgow Outcome Scale score of 1 or 2) (62% of the 56 patients with grade IV and 25% of the 24 patients with grade V aneurysms), seven (8.75%) presented with poor neurologic status (Glasgow Outcome Scale score of 3), and 30 (37.5%) died during the first 6 months (26.7% of the patients with grade IV and 62% of the patients with grade V aneurysms). One patient was lost to follow-up. The main causes of death were consequences of initial bleeding in the patients with grade V aneurysms and vasospasm in the patients with grade IV aneurysms. CONCLUSION: The results are at least as encouraging as the outcomes reported for the surgical series and suggest that early endovascular treatment of high grade hemorrhage is a feasible option, especially because endovascular maneuvers can be performed at any time, even during vasospasm.

Adolescent↗