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Biomedical subjects

G Debrun

Publications and source records attributed to G Debrun.

At least 37 records · Page 2Linked to original sources
PubMed1986

Aneurysm of the ICA petrous segment treated by balloon entrapment after EC-IC bypass. Case report.

A 44-year-old man experienced the sudden onset of horizontal diplopia and hemifacial numbness. Arteriography demonstrated a left intrapetrous carotid artery aneurysm. The patient was successfully treated with a left superficial temporal artery to middle cerebral artery bypass followed by balloon entrapment of the aneurysm. There have been at least 40 previously reported cases of aneurysms of the petrous portion of the carotid artery. These aneurysms can be mycotic, traumatic, or developmental in origin. They can present with massive otorrhagia or epistaxis from acute rupture or with decreased hearing and paresis of the fifth through eighth cranial nerves and, less frequently, of the ninth, 10th, and 12th cranial nerves caused by direct pressure. They can also produce pulsatile tinnitus, and sometimes they are discovered as a retrotympanic vascular mass during otological examination. The treatment of choice is carotid artery occlusion. Trapping of the aneurysm by detachable balloons eliminates immediately the risk of hemorrhage, offers the possibility of test occlusion of the internal carotid artery with the patient awake prior to permanent occlusion, and should also reduce the risk of thromboembolism. It should be preceded by a bypass procedure when preliminary evaluation indicates that the patient will not tolerate internal carotid artery occlusion.

Adult↗
PubMed1986

Diagnosis and endovascular therapy of vascular lesions in the cavernous sinus.

One hundred and twenty-eight lesions of the cavernous sinus were diagnosed and treated by endovascular embolization alone or combined with postembolization surgery. All patients presented with acute or subacute cavernous sinus syndrome. A complete angiographic evaluation included bilateral internal and external carotid and vertebral angiography. A total of 88 carotid-cavernous (c-c) fistulae (68 traumatic and 20 spontaneous) and 40 giant aneurysms were demonstrated. A complete anatomic cure or satisfactory clinical improvement was seen in 67 of 68 traumatic fistulae, in 14 of 20 spontaneous c-c fistulae and in 38 of 40 giant intracavernous aneurysms. An overall 15 per cent immediate and 2.7 per cent long-term morbidity with one death was observed. The technical and clinical complications involving endovascular therapy of each specific intracavernous vascular lesion are analyzed.

Adult↗
PubMed1985

Reversible optic neuropathy due to carotid-cavernous fistula.

Optic nerve dysfunction occurred several weeks after traumatic carotid-cavernous fistula developed in a 21-year-old man. Vision was completely restored after the fistula was closed with an intra-arterial detachable balloon. By carefully monitoring visual function in patients with traumatic carotid-cavernous fistulas, delayed optic neuropathy can be recognized and treated successfully.

Adult↗
PubMed1983

Spinal cord size in syringomyelia: change with position on metrizamide myelography.

Change in the anteroposterior diameter of the cervical spinal cord was demonstrated on metrizamide myelography in 20 out of 40 cases of cervical syringomyelia. Twelve of these were normal-sized cords, four were small, and four enlarged. Comparable lateral cervical myelograms in the prone and supine positions were sufficient to show size change for normal-sized or small cords. Additional myelograms in the erect and Trendelenburg positions were necessary to show size change in enlarged cervical cords, especially with associated Chiari malformation. A localized change in cord size suggests syringomyelia. If the change in cord size is diffuse, then change less than 10% is not necessarily significant. In undiagnosed myelopathy, metrizamide myelography has the potential to detect unsuspected syringomyelia even when the cord is normal-sized or small. Myelographic study may also be useful as an adjunct to delayed computed tomographic studies.

Humans↗
PubMed1983

Balloon embolus.

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Carotid Artery Diseases↗
PubMed1982

Embolization of cerebral arteriovenous malformations with bucrylate.

Forty-six patients with cerebral arteriovenous malformations (AVM's) were selected for embolization with bucrylate. These patients were assigned to three different groups. Group I consisted of 22 patients with nonresectable AVM's who were selected for embolization with a Silastic calibrated-leak ballon. In 16 or these patients, embolization was achieved, with partial obliteration of the AVM in 14 and complete obliteration in two. Five patients had subarachnoid hemorrhage caused by the balloon bursting and concomitant dissection of the feeding vessel. Four of these patients recovered completely and one died of a brain-stem hemorrhage. A permanent field defect was noted in five cases, and two patients had a transient mild neurological deficit. Group II consisted of 13 patients treated by intraoperative embolization. Complete obliteration by embolization was obtained in four cases, and complete surgical resection after embolization in five. Partial embolization with no surgical resection was achieved in five cases. Three of these patients had a permanent mild neurological deficit and two had transient deficits. There was no mortality in this group. Group III consisted of 11 patients treated by embolization with bucrylate using a new latex calibrated-leak balloon. This balloon has a higher malleability, and takes on the exact configuration of the feeder, with no risk of dissection. This balloon also permits delivery of the faster and larger injection of bucrylate to the arterial feeders of the AVM. Two AVM's were completely obliterated, and embolization was only partially successful in the other cases. Neurological complications consisted of incomplete field defects in two cases, slight memory loss in one case, and transient clumsiness of the arm and face in one case. Two patients have a catheter permanently glued in the malformation, with no neurological complication. There was no mortality in this group.

Adolescent↗
PubMed1981

Treatment of 54 traumatic carotid-cavernous fistulas.

A series of 54 traumatic carotid-cavernous fistulas has been treated with detachable balloon catheters. The balloon was introduced through one of three different approaches: the endarterial route; the venous route through the jugular vein, the inferior petrosal sinus, and the cavernous sinus; or surgical exposure of the cavernous sinus; with occlusion of the fistula by a detachable balloon directly positioned in the cavernous sinus. Full follow-up review demonstrated that the carotid blood flow was preserved in 59% of cases. The most frequent complication was a transient oculomotor nerve palsy, which occurred in 20% of cases. In three cases where both the fistula and the carotid artery were originally occluded by the balloon, the superior portion of the fistula was later found not to be completely occluded, and these patients had intracranial ligation of the supraclinoid portion of the carotid artery. Three patients had hemiparesis, transient in two cases and permanent in the other. The results show that the fistula was totally occluded in 53 cases; in the one exception the patient became asymptomatic but had a minimal angiographic leak.

Adolescent↗
PubMed1981

Pathology of arteriovenous malformations embolized with isobutyl-2-cyanoacrylate (bucrylate). Report of two cases.

There is controversy as to the possible toxic effects of isobutyl-2-cyanoacrylate (bucrylate) when this substance is used for purposes of therapeutic embolization. Two cases are presented in which cerebral arteriovenous malformations were resected, one 42 days and the other a year after bucrylate embolization. In both, pathological examination revealed a brisk intimal foreign-body giant-cell reaction wherever bucrylate was present in a vessel, along with chronic inflammation in the vessel walls and adjacent brain parenchyma. The findings are discussed in the light of other observations on the histotoxicity of bucrylate.

Adult↗
PubMed1979

Intrathecal metrizamide enhancement of the optic nerve sheath.

The subarachnoid space continues into the orbit as part of the optic nerve sheath. This space varies in size but is usually tiny. Occasionally, prominent (one case in our experience) enhancement of the optic nerve as part of metrizamide computed tomography (CT) cisternography is seen on transverse and coronal scans presumably because of a patulous optic subarachnoid space. In five cases, we have appreciated minimal enhancement of optic nerves with metrizamide only by close comparison of CT numbers with base-line scans. One of these patients had a tiny meningioma removed successfully from the optic sheath, with return to normal vision of a previously blind eye.

Adult↗
PubMed1978

Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions.

Of the cerebral vascular lesions that can be treated with intravascular detachable balloon techniques, carotid-cavernous sinus fistulas and vertebro-vertebral fistulas have the best results. The great advantage of this technique is that the cerebral blood flow can usually be preserved after the occlusion of the fistula. The authors report 17 postraumatic carotid-cavernous sinus fistulas successfully treated with preservation of the carotid blood flow in 12 cases. None of the patients died, and the morbidity was limited to one case of third nerve palsy. The treatment of aneurysms by this method is, however, much more difficult and dangerous. Of 14 cases treated, seven good results were obtained. Two patients died and two had a poor outcome. The embolization of certain brain angiomas with calibrated-leak balloons using bucrylate promises to be important in the future.

Adult↗
PubMed1976

[Technic for an inflatable and releasable balloon in neurology. Experimental study. Application in man].

We consider our method with an inflatable and releasable balloon to be trustworthy and now applicable to the treatment of carotido-cavernous fistulas; it may not be possible in all cases to pass the ballon on through the fistula and inflate it in the cavernous sinus, but it seems to us so very important to preserve the carotid flow that we think that this should be achieved whenever possible. Certain arterial aneurysms could profit from this technique. We have purposely omitted all diagnostic application of the method which serbinenko has described in his article: selective opacifcation of certain branches of the internal carotid, deliberate temporary occlusion of certain branches to enable the amount of tolerance to be assessed. All these exploratory methods which we are beginning to carry out will form the subject of a later paper.

Adult↗
PubMed1975

[Treatment of arteriovenous fistulas and of aneurysms using an inflatable and releasable balloon. Experimental principles. Application to man].

The authors have perfected a technique making possible the percutaneous introduction of a balloon filled with hydrosoluble iodine and releasable, either in an arteriovenous fistula or in an aneurysm. Experimental jugulo-carotid fistulae and experimental aneurysms in the dog were treated in this way. The technique has been used in two human patients - one with a traumatic caverno-carotid fistula and the other with a complicated vertebral fistula.

Adult↗
PubMed1975

Inflatable and released balloon technique experimentation in dog -- application in man.

Experimental carotid jugular fistulas have been created in dogs and at a later time obstructed with an inflatable and released balloon. Experimental carotid aneurysms in dogs have also been obstructed with the same procedure. This new technique allows the inflation and release of a balloon in an arteriovenous fistula or in an aneurysm. The present case concerns a human vertebral fistula treated by this technique.

Animals↗