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1.
AJNR Am J Neuroradiol ; 44(3): 291-296, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36759143

RESUMO

BACKGROUND AND PURPOSE: Some Woven EndoBridge devices present a persistent intradevice opacification at imaging follow-up, described as the Bicêtre Occlusion Scale Score 1 (BOSS 1) phenomenon. The clinical implications remain unknown. We aimed here to analyze the factors influencing this occurrence and to precisely describe the evolution of BOSS 1 with time using conebeam CT. MATERIALS AND METHODS: We retrospectively analyzed a prospectively maintained Woven EndoBridge database at our tertiary center and included all patients with isolated BOSS 1 and BOSS 1 associated with small neck remnant (BOSS 1 + 2). RESULTS: Two hundred sixty-seven aneurysms were treated with a Woven EndoBridge device between July 2012 and December 2021. Follow-up with DSA was available for 220 aneurysms (median, 5 months), among which BOSS 1 and 1 + 2 were found in 9.1% (20/220) (95% CI, 5.5%-12.7%). A second DSA follow-up (median, 17 months) was performed in 15 of these 20 aneurysms, which revealed that 40% had evolved to complete Woven EndoBridge occlusion, 33% showed a decreased persistent opacification, and 27% remained stable. BOSS 1 was significantly associated with postoperative antiplatelet medication, a lower aneurysm aspect ratio, and the use of the Woven EndoBridge 17 (P < .05). The average Woven EndoBridge shape modification was less pronounced in the BOSS 1 population (P < .02). None of the BOSS 1 or 1 + 2 aneurysms required retreatment or were associated with hemorrhage occurrence. CONCLUSIONS: Isolated persistent flow inside the Woven EndoBridge device at follow-up is rare and notably associated with antiplatelet prescription. It seems to present a benign course in most cases.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Humanos , Resultado do Tratamento , Estudos Retrospectivos , Aneurisma Intracraniano/terapia , Procedimentos Endovasculares/métodos , Embolização Terapêutica/métodos , Tomografia Computadorizada por Raios X
2.
AJNR Am J Neuroradiol ; 42(8): 1479-1485, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34117022

RESUMO

BACKGROUND AND PURPOSE: Woven EndoBridge (WEB) devices are increasingly used to treat intracranial aneurysms. A1 asymmetry contributes to anterior communicating artery aneurysm formation and to treatment instability after coiling. We sought to evaluate whether A1 asymmetry had an impact on angiographic outcome in anterior communicating artery aneurysms treated with the WEB. MATERIALS AND METHODS: Anterior communicating artery aneurysms treated between July 2012 and July 2020 with the WEB from an institutional review board-approved database were reviewed. A1 asymmetry was categorized as the following: absence of the A1 segment on 1 side (unilateral A1) versus bilateral A1. Univariate and multivariable analyses assessed independent predictors of adequate (WEB Occlusion Scale A, B, and C) and complete occlusion (WEB Occlusion Scale A and B). RESULTS: Forty-eight individual aneurysms (47 patients) were included in the final analysis, of which 16 (33%) were acutely ruptured. The mean size was 6.5 (SD, 2.2) mm. Adequate and complete occlusion was achieved in 33 (69%) and 30 (63%) cases, respectively. Unilateral A1 was associated with significantly higher rates of adequate (92% versus 60% for bilateral A1; P = .03) and complete occlusion (92% versus 50% for bilateral A1; P < .01). Multivariable logistic regression confirmed unilateral A1 as an independent predictor of both adequate (OR = 10.6; 95% CI, 1.6-220.7; P = .04) and complete occlusion (OR = 9.5, 95% CI, 1.5-190.2; P = .04. A sensitivity analysis comparing unilateral "functional" A1 with bilateral "functional" A1 showed similar results. WEB shape modification was not influenced by the unilateral A1 configuration (P = .70). CONCLUSIONS: Anterior communicating artery aneurysms with a unilateral A1 configuration treated with WEB devices are associated with better angiographic outcome than those with bilateral A1. This finding supports the hypothesis that WEB devices are resistant to unilateral flow in the aneurysm as opposed to coils.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Estudos Retrospectivos , Resultado do Tratamento
3.
AJNR Am J Neuroradiol ; 42(7): 1276-1281, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33926902

RESUMO

BACKGROUND AND PURPOSE: The Woven EndoBridge has proved to be a safe and effective treatment, especially for wide-neck intracranial aneurysms. The recent fifth-generation Woven EndoBridge came with smaller devices. The purpose of this study was to assess the safety and efficiency of Woven EndoBridge treatment of small and very small aneurysms. MATERIALS AND METHODS: Between September 2017 and March 2020, all consecutive patients treated with a 3- or 3.5 mm-width Woven EndoBridge device were included in this retrospective intention-to-treat study. Clinical and radiologic findings were evaluated at immediate and last-available follow-up. Angiographic outcome was assessed by an external expert reader. RESULTS: One hundred twenty-eight aneurysms were treated with a fifth-generation Woven EndoBridge device including 29 with a width of ≤3.5 mm. Ten aneurysms were ruptured (34%). In 3 cases (10%), Woven EndoBridge treatment could not be performed because the aneurysm was still too small for the smallest available Woven EndoBridge device and another endovascular strategy was chosen. The median follow-up time was 11.2 months. Complete and adequate occlusion was obtained in 71% and 90% of the treated aneurysms, respectively. Retreatment was needed in 2 cases (10%). Symptomatic ischemic complications leading to transient neurologic deficits occurred in 2 cases (7%) (1 procedure-related and 1 device-related) but with full spontaneous recovery at discharge. CONCLUSIONS: The fifth-generation Woven EndoBridge device seems to be a safe and technically feasible treatment for both ruptured and unruptured small and very small intracranial aneurysms, with satisfactory occlusion rates on midterm follow-up. However, further study is needed to evaluate longer-term efficiency.


Assuntos
Aneurisma Intracraniano , Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
AJNR Am J Neuroradiol ; 39(6): 1065-1067, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29599170

RESUMO

Our aim was to compare the detectability of aneurysmal wall enhancement in unruptured intracranial aneurysms between conventional and motion-sensitized driven equilibrium-prepared postcontrast 3D T1-weighted TSE sequences (sampling perfection with applicationoptimized contrasts by using different flip angle evolution, SPACE). Twenty-two patients with 30 unruptured intracranial aneurysms were scanned at 3T. Aneurysmal wall enhancement was more significantly detected using conventional compared with motion-sensitized driven equilibrium-prepared SPACE sequences (10/30 versus 2/30, P < .0001). Contrast-to-noise ratio measurements did not differ between conventional and motion-sensitized driven equilibrium-prepared sequences (P = .51). Flowing blood can mimic aneurysmal wall enhancement using conventional SPACE sequences with potential implications for patient care.


Assuntos
Artefatos , Circulação Cerebrovascular , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
5.
AJNR Am J Neuroradiol ; 37(3): 475-80, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26514605

RESUMO

BACKGROUND AND PURPOSE: Intracranial aneurysm treatment with flow diverters has shown satisfying results in terms of aneurysm occlusion, and while some cases of delayed intraparenchymal hemorrhage have been described, no systematic analysis of the risk factors affecting its occurrence has been conducted in a large series of patients. This retrospective analysis of delayed intraparenchymal hemorrhage after flow-diverter treatment is a multicenter, retrospective study using a large series of treated patients to analyze factors affecting the occurrence of delayed intraparenchymal hemorrhage. MATERIALS AND METHODS: Patients treated with flow diverters and presenting with delayed intraparenchymal hemorrhage were included from December 2007 to December 2014 in 7 participating centers in France. Patient and aneurysm characteristics were recorded as were characteristics of bleeding (size, lateralization, and time to bleed), treatment, and clinical outcome after 1, 3, and 6 months. RESULTS: Delayed intraparenchymal hemorrhage occurred in 11 patients between 1 and 21 days after the procedure. In 10 of these patients, hemorrhages were ipsilateral to the treated aneurysms. Five of the 11 underwent surgery, and 9 of the 11 had good clinical outcomes at 6 months (mRS ≤2). CONCLUSIONS: The pathogenesis of delayed intraparenchymal hemorrhage occurring after flow-diverter treatment remains unclear. The multidisciplinary management of delayed intraparenchymal hemorrhage yields a relatively low morbidity-mortality rate compared with the initial clinical presentation.


Assuntos
Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/cirurgia , Adulto , Procedimentos Endovasculares/métodos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
7.
Neurochirurgie ; 59(3): 133-7, 2013 Jun.
Artigo em Francês | MEDLINE | ID: mdl-23806764

RESUMO

Intracranial dural arteriovenous fistulae with perimedullary venous drainage are unusual type of vascular brain malformations. Patients may present with a rapidly progressive ascending myelopathy associated with autonomic dysfunction, which can cause a misdiagnosis and delay the therapeutic management. These clinical signs must be quickly recognized to avoid a poor outcome. The authors report the case of a 60-year-old woman presenting with a progressive myelopathy due to a dural arteriovenous fistula with perimedullary venous drainage. The diagnosis was suspected on brain-spinal MRI and confirmed by brain arteriography visualizing the arteriovenous shunt in the middle segment of the superior petrous sinus. MRI showed edema in the medulla oblongata. The treatment was performed early by endovascular glue embolization of the arteriovenous shunt and of the origin of the vein. Brain arteriography and clinical follow-up, one month later, showed complete disappearance of the dural fistula and regression of clinical symptoms. MRI control showed the reduction of the brain stem edema. Because of the early pejorative prognosis of these kinds of fistulae, early diagnosis and treatment are needed.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/patologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Medula Espinal/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Artéria Carótida Interna/patologia , Artéria Carótida Interna/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Angiografia Cerebral , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Exame Neurológico , Procedimentos Neurocirúrgicos , Prognóstico , Resultado do Tratamento
8.
Colorectal Dis ; 13(6): 689-96, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20236144

RESUMO

AIM: Sacral nerve stimulation (SNS) has a place in the treatment algorithm for faecal incontinence (FI). However, after implantation, 15-30% of patients with FI fail to respond for unknown reasons. We investigated the effect of SNS on continence and quality of life (QOL) and tried to identify specific predictive factors of the success of permanent SNS in the treatment of FI. METHOD: Two hundred consecutive patients (six men; median age = 60; range 16-81) underwent permanent implantation for FI. The severity of FI was evaluated by the Cleveland Clinic Score. Quality of life was evaluated by the French version of the American Society of Colon and Rectal Surgeons (ASCRS) quality of life questionnaire (FIQL). All patients underwent a preoperative evaluation. After permanent implantation, severity and QOL scores were reevaluated after six and 12 months and then once a year. RESULTS: The severity scores were significantly reduced during SNS (P = 0.001). QOL improved in all domains. At the 6-month follow-up, the clinical outcome of the permanent implant was not affected by age, gender, duration of symptoms, QOL, main causes of FI, anorectal manometry or endoanal ultrasound results. Only loose stool consistency (P = 0.01), persistent FI even though diarrhoea was controlled by medical treatment (P = 0.004), and low stimulation intensity (P = 0.02) were associated with improved short-term outcomes. Multivariate analysis confirmed that loose stool consistency and low stimulation intensity were related to a favourable outcome. CONCLUSION: Stool consistency and low stimulation intensity have been identified as predictive factors for the short-term outcome of SNS.


Assuntos
Terapia por Estimulação Elétrica , Incontinência Fecal/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletrodos Implantados/efeitos adversos , Incontinência Fecal/cirurgia , Fezes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Qualidade de Vida , Análise de Regressão , Região Sacrococcígea/inervação , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
10.
AJNR Am J Neuroradiol ; 30(10): 1986-92, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19679641

RESUMO

BACKGROUND AND PURPOSE: The endovascular treatment (EVT) of cerebral aneurysms has experienced a revolution since 1991 with the introduction of platinum coil technology. During the past 10 years, there has been significant study of the feasibility of this technique, and clinical results of EVT have been published. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms still remains unknown. The purpose of this study was to evaluate the stability of anatomic occlusion of aneurysms and to assess the rate of recanalization and retreatment of these aneurysms. MATERIALS AND METHODS: Between January 1998 and December 2003, 1036 aneurysms (804 ruptured and 232 nonruptured) were treated consecutively with GDC coils in 5 neuroradiology centers. Procedural feasibility, acute angiographic occlusion results, morbidity, and mortality associated with this technique were assessed. All patients were regularly followed by digital subtraction angiography and MR imaging each year after treatment. RESULTS: Initial acute angiographic results in 1036 aneurysms demonstrated total occlusion in 731 patients (70.5%), subtotal occlusion in 252 (24.3%), incomplete occlusion in 20 (1.9%), and failures in 33% (3.3%) aneurysms. A remodeling technique was used in 10%. A second procedure was performed for 72 aneurysms (7%). The total aneurysm follow-up time was 49,923 months (4160.25 aneurysm-years). The retreatment period was either in the months following initial treatment in aneurysms incompletely occluded or in years due to recanalization or de novo aneurysms. Fewer than 5 patients rebled during 10 years of follow-up. Long-term follow-up angiograms were obtained in 899 aneurysms, with 646 total, 230 subtotal, and 23 incomplete results. CONCLUSIONS: Long-term follow-up of cerebral aneurysms is necessary to depict recanalization. Only 7% of the aneurysms were retreated. Use of bare coils gives a good long-term level of occlusion.


Assuntos
Embolização Terapêutica/instrumentação , Embolização Terapêutica/mortalidade , Aneurisma Intracraniano/mortalidade , Aneurisma Intracraniano/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Estudos de Coortes , Feminino , Seguimentos , França/epidemiologia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Platina , Recidiva , Resultado do Tratamento , Adulto Jovem
11.
Respir Physiol Neurobiol ; 167(2): 208-13, 2009 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-19410663

RESUMO

Our aim was to determine whether ventilation and swallowing tasks can modify oropharyngeal cortical motor organisation. Mylohyoid motor-evoked potentials (MEP) induced by non-focal (NF) and focal (F) magnetic stimulations were recorded in nine healthy volunteers four times, with 1 week between each recording. Baseline values were evaluated and their reproducibility was assessed 1 week later. Thereafter, the subjects were asked to perform swallowing and ventilation tasks in random order 15 min per day for 1 week. The NF MEP amplitudes after the swallowing and ventilation tasks increased after effortful swallows (p<0.001) and ventilation efforts (p<0.001). The F MEP amplitudes obtained after focal cortical stimulations increased after effortful swallows (p<0.01) and ventilation efforts (p<0.05). The cortical magnitude of the oropharyngeal muscle representation increased after swallowing practice (p<0.01). In conclusion, swallowing and ventilation tasks modified the motor cortex of oropharyngeal muscles and should be evaluated for use in rehabilitation strategies.


Assuntos
Mapeamento Encefálico , Deglutição/fisiologia , Córtex Motor/fisiologia , Boca/inervação , Faringe/inervação , Ventilação Pulmonar/fisiologia , Adulto , Eletromiografia , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Masculino , Estimulação Magnética Transcraniana
12.
Neurogastroenterol Motil ; 21(4): 411-9, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19126187

RESUMO

Although sacral nerve root stimulation (SNS) can result in a symptomatic improvement of faecal incontinence, the mechanism of action remains unknown. The aim of this study was to assess whether short-term magnetic SNS can inhibit pharmacologically induced propulsive colonic contractions. Twelve healthy volunteers (median age: 43.5 years old) were studied on two separate occasions and randomized into either active (15 Hz, 100% output intensity for 5 s min(-1) for 30 min) or sham rapid rate lumbosacral magnetic stimulation (rLSMS). Colorectal motility was recorded with a manometric catheter located at the most proximal transducer in the left colon and the most distal, in the rectum. Colonic contractions were provoked by instilling Bisacodyl. The effects of rLSMS on colonic, sigmoid and rectal contractions were monitored and recorded after Bisacodyl instillation. The appearance of high-amplitude contractions propagated or not (HAC/HAPC) provoked by Bisacodyl instillation was significantly delayed during active compared to sham stimulation (P = 0.03). There was no difference in the characteristics of HAC/HAPC (i.e. frequency, amplitude, duration, velocity of propagation) or the motility index with active or sham stimulation. The perception of urgency tended to be decreased with rLSMS following Bisacodyl instillation. The catheter was expulsed within a median of 16.5 min (range 8-39) after Bisacodyl administration during active stimulation compared to 14 min (range 5-40) during sham stimulation (P = 0.03). This study suggests that rLSMS could delay the appearance of the first Bisacodyl-induced colonic contractions.


Assuntos
Colo/inervação , Motilidade Gastrointestinal/fisiologia , Magnetoterapia , Raízes Nervosas Espinhais/fisiologia , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Região Sacrococcígea
13.
Int J Colorectal Dis ; 23(10): 993-7, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18594840

RESUMO

PURPOSE: Fecal incontinence (FI) is a debilitating condition that can be socially and personally incapacitating. A broad range of treatment options, often stepwise, are available, depending on severity. This prospective study reports a large single-centered series of patients who have benefited of temperature-controlled radio frequency (Secca) energy delivered to the anal canal. MATERIAL AND METHODS: This investigation was a single-center, nonrandomized, prospective, clinical study of a single patient group with each serving as the control. All patients had experienced FI for at least 3 months and had attempted, but were not satisfied, with the results of medical and/or surgical therapies. The study aims to evaluate changes in FI symptom scores and quality of life between the baseline and follow-up intervals. RESULTS: Between March 2005 and March 2006, 15 Secca procedures were performed. All 15 patients were alive and in contact with the investigational site at time of 12 months. There were no long term complications. The mean Wexner score improved from 14.07 (+/-4.5) at baseline to 12.33 (+/-4.6) at 1 year (p=0.02). The mean fecal incontinence quality of life of life score was only improved in the depression subscore. There were no changes in endoanal ultrasound and anorectal manometry. CONCLUSION: This prospective trial confirmed the safety of the Secca procedure. Although we demonstrated a significant improvement in the Wexner Score, these clinical results have to be mitigated because most patients remained in the moderate incontinences category as defined by the scoring system and did not improved their quality of life excepted in the depression subscore.


Assuntos
Ablação por Cateter/métodos , Incontinência Fecal/cirurgia , Adulto , Idoso , Canal Anal/diagnóstico por imagem , Canal Anal/fisiopatologia , Canal Anal/cirurgia , Endossonografia , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Satisfação do Paciente , Pressão , Estudos Prospectivos , Qualidade de Vida , Temperatura , Resultado do Tratamento
14.
AJNR Am J Neuroradiol ; 29(1): 63-8, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17925369

RESUMO

BACKGROUND AND PURPOSE: The purpose of our study was to evaluate the technical feasibility, morbidity and mortality, and durability of occlusion of unruptured aneurysms treated with Guglielmi detachable coils (GDCs) with a long-term follow-up. MATERIALS AND METHODS: Between January 1998 and January 2005, we treated 321 unruptured aneurysms with GDCs in 5 neuroradiologic institutions. During this period, 63% of unruptured aneurysms were treated by endovascular technique. Procedural feasibility, technical complications, morbidity and mortality, and acute and long-term angiographic occlusion were assessed. RESULTS: Overall technical feasibility of coiling treatment was 94%; 302 aneurysms were treated by endovascular technique. At the end of the initial procedure, acute occlusion was classified as complete in 207 cases (70%), subtotal in 84 cases (26.1%), and incomplete in 11 cases (3.9%). Ischemic complications were observed in 28 patients (9%); 8 patients (2.6%) had perforation of their aneurysms. Treatment-related morbidity was 14.4%, and morbidity with clinical complications was evaluated at 7.7% (n = 23 patients). Five patients (1.7%) died as a result of aneurysm perforation. Final follow-up angiograms, after 9 secondary treatments, demonstrated complete occlusion in 193 patients (69.5%), subtotal in 80 aneurysms (28.5%), and incomplete occlusion in 5 (1.8%). Nineteen patients were lost to follow-up (6.3%). CONCLUSION: Endovascular coiling with detachable coils is an attractive option for treatment of unruptured aneurysms. This method of treatment is safe with a low rate of complications. Prospective studies with longer follow-up periods are needed to assess the long-term durability of occlusion in unruptured aneurysms.


Assuntos
Embolização Terapêutica/instrumentação , Embolização Terapêutica/mortalidade , Aneurisma Intracraniano/mortalidade , Aneurisma Intracraniano/terapia , Medição de Risco/métodos , Adolescente , Adulto , Idoso , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/mortalidade , Dissecção Aórtica/terapia , Estudos de Viabilidade , Feminino , Seguimentos , França/epidemiologia , Humanos , Aneurisma Intracraniano/diagnóstico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
15.
AJNR Am J Neuroradiol ; 28(8): 1567-72, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17846214

RESUMO

BACKGROUND AND PURPOSE: We conducted a retrospective evaluation of the results of endovascular treatment (EVT) of middle cerebral artery aneurysms (MCAAs) in a center where embolization is the first treatment option considered. MATERIALS AND METHODS: Ninety-two MCAAs were diagnosed in 87 patients between September 2001 and January 2006. The strategy of treatment (endovascular versus surgical), the clinical and angiographic results of embolization, and the ensuing complications are described. RESULTS: Initially, 59 aneurysms (64.1%) in 55 patients were embolized, 18 (19.6%) were clipped, and 15 (16.3%) were not treated. Four endovascular procedures failed (7.3%), and 55 aneurysms in 51 patients were finally treated by embolization. During the procedure, complications occurred in 13 patients (25.5%) comprising 3 ruptures and 10 thromboembolisms. In the follow-up, 4 patients having a preoperative complication had a modified Rankin scale more than 2 (3 patients [5.9%]) or died (1 patient [2.0%]). Of the 55 embolized aneurysms, according to the Raymond scale, 23 (41.8%) were completely occluded, 24 (43.6%) retained a residual neck, and 8 (14.6%) were residual at the end of the first procedure. No bleeding was detected during the follow-up period in the embolized patients. CONCLUSION: EVT of MCAA is effective for preventing rebleeding episodes within the first year of treatment judging by historical controls. The real question is whether clipping or coiling of MCAAs is better in terms of reducing rebleeding rates and complications rates in the long term, and such a determination would require a far larger number of patients over a much longer observation period.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano/terapia , Adulto , Idoso , Aneurisma Roto/etiologia , Angiografia Cerebral , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Tromboembolia/etiologia , Falha de Tratamento , Resultado do Tratamento
16.
Neuroscience ; 148(3): 775-81, 2007 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-17693031

RESUMO

High-frequency/low-energy gastric electrical stimulation (GES) is an efficient therapy to treat gastric emptying-related disorders but its mechanism of action remains poorly understood. We aimed to assess the effects of high-frequency/low-energy GES on corticotropin-releasing factor (CRF)-producing neurons in the paraventricular nucleus of the hypothalamus (PVN), which are involved in gastric ileus induced by laparotomy. Two electrodes were implanted in the rat gastric antrum during laparotomy, then stimulation (amplitude: 2 mA; pulse duration 330 micros; frequency: 2 Hz; 1 min ON/2 min OFF) or sham stimulation (control group) were applied. Using immunohistochemistry, the number of c-Fos protein-expressing neurons (c-Fos protein-immunoreactive cells, Fos-IR) was quantified in the PVN after 1 h of stimulation. The number of neurons expressing simultaneously c-Fos protein and CRF mRNA was measured by means of immunocytochemistry combined with in situ hybridization. Finally, c-Fos and CRF mRNA levels in the hypothalamus were determined by in situ hybridization or quantitative reverse transcriptase-polymerase chain reaction. Fos-IR in the PVN was significantly decreased 1 h after GES (P<0.05) but was not affected by sub-diaphragmatic vagotomy. The number of neurons containing c-Fos protein and CRF mRNA was lower in the GES group compared with the control group (P<0.05). In addition, c-Fos and CRF mRNA levels in the PVN were significantly decreased by GES (P

Assuntos
Hormônio Liberador da Corticotropina/metabolismo , Terapia por Estimulação Elétrica , Pseudo-Obstrução Intestinal/terapia , Núcleo Hipotalâmico Paraventricular/metabolismo , Complicações Pós-Operatórias/terapia , Estômago/fisiopatologia , Animais , Contagem de Células , Hormônio Liberador da Corticotropina/genética , Modelos Animais de Doenças , Regulação para Baixo/fisiologia , Sistema Hipotálamo-Hipofisário/citologia , Sistema Hipotálamo-Hipofisário/metabolismo , Imuno-Histoquímica , Pseudo-Obstrução Intestinal/metabolismo , Pseudo-Obstrução Intestinal/fisiopatologia , Masculino , Complicações Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/fisiopatologia , Proteínas Proto-Oncogênicas c-fos/genética , Proteínas Proto-Oncogênicas c-fos/metabolismo , RNA Mensageiro/metabolismo , Ratos , Ratos Wistar , Estômago/inervação , Vagotomia
17.
Neurogastroenterol Motil ; 19(6): 453-8, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17564626

RESUMO

This work aimed to study mylohyoid motor-evoked potentials (MHMEPs) and examined if it is related to chronic stroke dysphagia. Conduction time (CT) and amplitudes of the right and left MHMEPs in response to focal cortical magnetic stimulations over affected and unaffected hemispheres were recorded in 16 stroke patients with aspiration (n = 9) or residue (n = 7) and compared with eight control patients. In control group, MHMEPs were present on ipsilateral and contralateral sides after stimulation of both hemispheres and permitted to determine a dominant hemisphere. In stroke patients, after stimulation of the affected hemisphere, ipsilateral MEPs had a longer CT and lower amplitudes in patients with aspiration compared with patients with residue or control patients (P < 0.05). Contralateral CT was not different between the three groups, but amplitudes were lower in patients with residue and aspiration than in control patients (P < 0.01). In the unaffected hemisphere, MHMEPs were present, and not different between the three groups for the ipsilateral side and amplitudes were decreased in contralateral side in patients with residue. In conclusion, MHMEP alterations of the affected hemisphere related to chronic stroke dysphagia severity and were closed to normal in the unaffected hemisphere.


Assuntos
Encéfalo/fisiologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Potencial Evocado Motor/fisiologia , Músculos/inervação , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estimulação Elétrica , Feminino , Lateralidade Funcional , Humanos , Osso Hioide , Masculino , Pessoa de Meia-Idade , Músculos/fisiopatologia , Vias Neurais/fisiopatologia
18.
Neurochirurgie ; 53(2-3 Pt 2): 208-16, 2007 Jun.
Artigo em Francês | MEDLINE | ID: mdl-17507049

RESUMO

INTRODUCTION: The prevalence of cerebral cavernomas is about 0.5% in the general population. In contrast, spinal cord cavernomas are considered as rare. The objective of this study was to determine the natural history of spinal cord cavernomas in a multicentric study. METHODS: Clinical and neuroradiological findings were retrospectively collected. Diagnosis was based on pathological criteria or magnetic resonance (MR) findings. RESULTS: Fifty-three patients were included (26 males, 27 females). Mean age at onset of symptoms was 40.2 years (range: 11-80). Initial symptoms were progressive (32) and acute myelopathy (20). One patient was asymptomatic. Clinical symptoms were related to spinal cord compression (24) and hematomyelia (19). Cavernoma location was dorsal (41) and cervical (12.). MR findings consisted of hyperintense signal on T1 and T2 sequences (19 cases), mixed hyperintense and hypointense signal (33 cases), and hypointense signal on T1 and T2 sequences in 1 case. Mean size was 16.3 mm (range: 3-54). Forty patients underwent surgical resection. Improvement was observed in 20 patients and worsening of neurological symptoms in 11. Length of follow up was 7.1 years. At the end of the study, 26 patients were autonomous, 18 handicapped and 1 bedridden. CONCLUSION: This study provided precise data on the clinical and MR patterns of these lesions. The natural history is associated with a higher risk of hemorrhage recurrence, but is favorable in many operated patients. Microsurgery is the treatment of choice for most of these lesions.


Assuntos
Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Neoplasias da Medula Espinal/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Progressão da Doença , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/patologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia , Doenças Vasculares da Medula Espinal/etiologia , Doenças Vasculares da Medula Espinal/patologia , Resultado do Tratamento
19.
J Neuroradiol ; 34(2): 89-94, 2007 May.
Artigo em Francês | MEDLINE | ID: mdl-17320176

RESUMO

OBJECTIVES: To demonstrate the technical feasibility, safety and results of intracranial aneurysm treatment by coils of 0.018-inch diameter wire (GDC 18) for ruptured and non-ruptured intracranial aneurysms. MATERIALS AND METHODS: From a commune database from five neuroradiological centers, we analysed endovascular technique with Gugliemi Detachable Coils (GDC) 18, complications of technique, acute angiographic occlusion results and long-term angiographic follow-up. Sixty-six percent of aneurysms were ruptured. The mean size of treated aneurysms was 13.7 mm. RESULTS: Overall feasibility of coil 18 treatments was 95%. Acute angiographic results in 110 aneurysms demonstrated total occlusion in 63 aneurysms (57.2%), subtotal occlusion in 37 cases (33.6%), and incomplete occlusion in 10 cases (9%). A second treatment was performed in 15 cases; follow-up demonstrated 60 (61%) total occlusions, 32 (33%) subtotal occlusion and 5 (5%) incomplete. Five patients were lost to follow-up, and 8 patients had died. Stability of occlusion with these coils was 61%. CONCLUSION: Coiling of intracranial aneurysms, ruptured or non-ruptured, using coils with a wire diameter of 0.018-inch is safe, with no more complications than standard coils. Remodelling technique is possible. This type of coils must be considered for treatment of large aneurysms.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
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