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J C Marchal

Publications and source records attributed to J C Marchal.

At least 37 records · Page 2Linked to original sources
PubMed1996

Aneurysm clipping after endovascular treatment with coils: a report of eight patients.

Between January 1990 and December 1994, patients with subarachnoid hemorrhage related to ruptured aneurysms who were referred to our institution were treated by neurosurgical and neuroradiological teams. In each patient, the respective indications for neurosurgical or endovascular treatment were discussed, taking into consideration patients' age and the morphological and topographical aneurysm features. We report eight cases of patients with subarachnoid hemorrhage who underwent operations after primary endovascular procedures (Hunt and Hess scores III, IV, and V). The indications for surgical treatment were as follows. First, deliberate partial occlusion of the aneurysm (two aneurysms of the internal carotid artery and one aneurysm of the anterior communicating artery) was performed to obtain only partial clotting of the aneurysm sac by free coils. However, this procedure was discontinued in favor of the use of Guglielmi detachable coils. The second indication was partial occlusion after an endovascular procedure (two aneurysms of the middle cerebral artery and one internal carotid artery aneurysm). The third indication was re-expansion of the aneurysm 1 year after the endovascular treatment (one middle cerebral artery aneurysm). The final indication was secondary rupture of the aneurysm sac and false aneurysm around the migrating coil (one aneurysm of the pericallosal artery). During surgery, the aneurysm sac appeared translucent. The coils bulged out and stretched the aneurysm sac. One ruptured the membrane leading to a subarachnoid hemorrhage during the endovascular procedure. No hemorrhage occurred during the surgical clipping. Aneurysm obliteration was easily performed, especially when the packing was partial, but was very difficult when the complete aneurysm closure led to a stenosis of the parent vessel. A giant sylvian aneurysm rest, visible only with angiography, was left untreated. This series illustrates an original experience, which led us to conclude that aneurysm surgery with coils in place is not as difficult as is often thought.

Adult↗
PubMed1996

Arteriovenous malformations of the corpus callosum--radioanatomic study and effectiveness of intranidus embolization.

Forty-three patients with arteriovenous malformations (AVMs) of the corpus callosum treated by embolization were reviewed. The following clinical and radioanatomic characteristics were found: 84% (36 patients) presented with intracranial hemorrhage, 43% (20 nidi) of the lesions were located in the posterior half of the corpus callosum, multiple nidi were more frequent (21%) than expected, 27 nidi (59%) were fed by branches of both the anterior and posterior cerebral arteries, AVMs mainly drained into the internal cerebral vein and/or interhemispheric superficial veins, and 19 (41%) had both draining pathways, 10 patients (23%) had impaired drainage through the straight sinus due to dysplasia. Staged embolization was performed in 245 feeders. Curative occlusion (more than 95%) was obtained in 17 patients (40%) and considerable occlusion (more than 75%) in 33 patients (77%). Large and giant, diffuse-type, and multifocal AVMs were difficult to completely embolize. Complications associated with embolization occurred in six patients, mostly during the first 5 years. Only two patients had a permanent deficit related to a complication. Overall morbidity and mortality were 7% and 2%, respectively. Nine patients were referred for stereotactic radiosurgery, three of whom were completely cured and five patients have not been assessed. Most AVMs in the corpus callosum are supplied by multi-axial feeders, so multi-target intranidus embolization is very important to prevent the development of other feeders secondary to the hemodynamic shift. Combined therapy using maximum embolization and subsequent radiosurgery may be the most effective method to treat AVMs in the corpus callosum.

Adolescent↗
PubMed1996

[Spinal epidural cavernous angioma. Apropos of 2 cases. Review of the literature].

We report 2 cases of spinal epidural cavernous angiomas revealed by paraplegia, and present the main cases reported in the literature since 1895. The diagnosis of this uncommon affection seems to be difficult to establish only upon clinical and radiological features. In spite of recent advances in neuroradiological imaging, these kinds of angiomas still remain an operative and histopathological discovery. A laminectomy was performed revealing a vascular lesion which was totally extirpated. Functional recovery was achieved in both cases.

Adult↗
PubMed1995

[Spontaneous spinal epidural hematoma. Apropos of 2 new cases].

The authors report on two cases of spontaneous spinal epidural hematomas. The clinical and radiological (CT, MRI) features as well as the pathogenesis of this rare disease are discussed in comparison with the literature. The authors emphasize the necessity for early diagnosis and treatment as the condition can compromise the functional and even vital prognosis of the patient.

Adult↗
PubMed1994

[Papilloma of the choroid plexus. Apropos of 11 cases].

The authors report 11 cases of choroid plexus papillomas in children operated on from 1979 until 1993. The age ranges from 2 months to 14 years old. The most frequent location occurred in the lateral ventricles (7 cases) followed by the locations in the third ventricle (3 cases) and the fourth ventricle (1 case). A complete resection was performed in all the cases. Hydrocephalus induced by the tumors was always present. An internal and permanent shunting procedure was carried out in the pre-operative period in 5 cases, in the post-operative course in 1 case. 3 cases underwent an external CSF shunting before surgery. This external CSF drainage has been taken out a few days after the surgical resection and no further permanent internal shunting was required in the long-term outcome. In 2 cases, no CSF drainage was performed either before or after surgery. Choroid plexus papillomas (CPP) require surgical management. The hypervascularisation of these tumors can give rise to important bleeding and generate surgical difficulties particularly in children under one year. The best way to remove these tumors would be to reach the arterial feeder(s) in first place, but it is not always possible. It's also difficult to forecast wether or nor the hydrocephalus will require further permanent CSF drainage, so we have chosen to carry on an external and transient CSF shunting.

Adolescent↗
PubMed1994

Dissection of intracranial vertebral arteries revealed by subarachnoidal haemorrhage. Report of seven cases.

Between April 1986 and April 1991, seven cases of meningeal haemorrhage consecutive to dissection of the 4th segment of a vertebral artery were observed at the Neuroradiology Department of the Nancy University Hospital. Four of the 7 patients were men, and 3 were women; mean age varied from 45 to 61 years. The clinical presentation was not suggestive, except in one case where the haemorrhagic episode was associated with Wallenberg's syndrome, pointing to the aetiological diagnosis. The outcome was variable. Two patients died of early complications of the haemorrhage which occurred before treatment could be given. In 2 others patients treated with antiplatelet agents the outcome was favourable; however, at angiography the lesions regressed in one of these two patients, but they progressed in the other with formation of a false aneurysm. The remaining 3 patients were treated by endovascular occlusion of the lesion-bearing vessel: one died of complications of a haemorrhage-induced vasospasm; the other two are symptomless after a 2 to 6 months follow-up.

Aortic Dissection↗
PubMed1994

[Pericranial sinus].

This study concerns four cases of sinus pericranii observed at the Neurological Department of Nancy. Sinus pericranii is a direct communication between the outer surface of the skull and the intracranial venous sinuses. It may be congenital, acquired or traumatic. This abnormality, usually located in the midline and often in the frontal region, is usually symptomless, but some patients complain of headache, nausea and vertigo. Sinus pericranii shows as a fluctuating non pulsatile mass of reddish or bluish colour, expanding when the patient bends his head down. Radiography usually shows one or several bone defects opposite the lesion found at CT bone window. On soft tissue window the mass is not calcified and usually enhanced by contrast injection. It is sometimes possible to visualize the vascular communication between the extracranial region and the underlying dural sinus. When visualization is blurred, or CT shows intracerebral abnormalities, MRI examination is required. Angiography with subtraction in venous phase (40 to 60 seconds after the injection), sometimes aided by films taken in head down position. It is of interest only in cases where CT and MRI have shown associated vascular abnormalities. Otherwise, direct injection of contrast medium into the malformation makes it possible to assert the diagnosis of sinus pericranii and to determine the flow rate within the malformation, which to some extent commands the the therapeutic technique. In patients with small and asymptomatic sinus pericranii absention is the rule. When the sinus is of moderate size, and the flow rate not rapid and when there is no significant communication with the cerebral veins, endovascular sclerosis may be advocated. In all other cases, surgical removal is recommended and is usually easy.

Angiography, Digital Subtraction↗
PubMed1992

[Surgery for lumbar disk hernia after chemonucleolysis. Results and analysis. Apropos of 100 cases].

We studied the clinical results of 100 patients operated after failure of chemonucleolytic treatment with chemopapain for lumbosciatica caused by disk herniation. Secondary surgical procedures were performed because of persistence of sciatic pain and disk herniation visible on CT scan. Post-operative follow-up was done at a minimum of one year. Clinical results were analyzed according to the criteria of Mac-Naff. Out of 100 patients who were re-operated, there were: 14% excellent results, 38% good results, 26 mediocre results, and lastly 22% failures or worsening of the condition. Thus 52% satisfactory compared to 75-95% when surgery is done immediately; 48% of the results were unsatisfactory or worse than before. We analyzed the mechanism of action of papain and suggested a pathophysiological explanation for these results. We concluded that chemonucleolysis with chemopapain cannot be an intermediary step between systematic medical treatment and surgical treatment.

Adult↗
PubMed1992

[Transluminal angioplasty in the treatment of vasospasm. Value of transcranial Doppler in the diagnosis and follow-up].

Vasospasm (V.S.) transluminal angiographic treatment (T.L.A.) is recommended in case of symptomatic V.S. before or after surgery. V.S. diagnosis and follow up after T.L.A. rely on clinical and transcranial doppler (T.C.D.) data. Before T.L.A. angiography (A degrees) demonstrates V.S. degree and location. T.L.A. technic is described. The authors report 14 cases of T.L.A. (7 before and 7 after surgery). Before surgery in 4 cases patients exhibited ischemic symptoms from V.S.: 2 died (one from reanimation problems the other from a new hemorrhage). After surgery of 7 patients one died from artery rupture, one from extra-neurologic complication. T.C.D. capacity to follow up V.S. is emphasized. As soon as T.L.A. is performed the mean cerebral blood flow (C.B.F.) decreases (< 100 cm/s) and does not increase anymore. At the level of non dilated arterial segments V.S. may increase after T.L.A.: it is then recommended to dilate all the spastic arteries, as far as it is possible. After T.L.A. C.B.F. may decrease in arteries far from the dilated ones probably because arterial supplies are no more necessary.

Angioplasty, Balloon↗
PubMed1992

[Neurinoma of the oculomotor nerves. Apropos of 2 cases].

The authors report two cases of neurinomas of the oculomotor nerves: one neurinoma of the oculomotor nerve and one of the abducens nerve. The study of 30 cases in the previous literature points out the major striking features of these tumors. Both headaches and oculo-motor palsies are the most regular clinical features. They are not typically suggestive. Therefore the diagnosis is difficult among all the tumors of cavernous sinus and surrounding structures. C.T. scan and M.R.I. with the clinical history should readily allow pre-operative diagnosis. These data are insufficient to distinguish the affected nerve. The surgical treatment is not always complete due to the tumor infiltration into the cavernous sinus.

Adult↗
PubMed1991

[Surgical problems arising from ethmoid adenocarcinomas].

Adenocarcinomas are the most frequent ethmoid tumors. The only curative treatment at present is surgery. Potential extensions of these tumors require a wide exeresis. This is best ensured with an approach that is cranial and of the Cairns type at first, then in some cases facial and patterned on the Moure-Sebileau course of approach. This procedure demands the immediate reconstruction of the 3 levels involved: the dura mater, the bone and the mucosa of the nasal fossae. We reconstruct the dura mater with a pericranial flap, the bone with bone grafts, and the mucosa with a flap from the galea.

Adenocarcinoma↗
PubMed1991

[A case of cellular blue nevus with bone and meningeal invasion].

The blue naevus is an essentially benign tumour. However, the cellular variety may rarely undergo malignant transformation. The authors report an unusual case of blue naevus in terms of size and evolution. This tumour which involved the occipitovertebral and parotid regions infiltrated underlying tissues and organs, in particular, the occipital bone, the dura mater and the parotid gland. The clinical, histological and histogenic problems associated with the blue naevus are discussed. There are only scattered reports of tumours of a similar nature in the literature and for this reason we felt that this case merited being reported.

Adolescent↗
PubMed1990

Role of angioplasty in the treatment of symptomatic vascular spasm occurring in the post-operative course of intracranial ruptured aneurysms.

Angioplasty of vascular spasm (VS), related to subarachnoid hemorrhage (SAH) has been recently introduced to the medical field. The authors report 5 cases treated by this mean in the postoperative period. These patients were all symptomatic from their VS inspite of early surgery and of the preventive treatment by Nimodipine. In all cases, obtained increase in the caliber of the spastic vessels was followed by a rapid clinical improvement coupled with a significant decline of the flow rates as confirmed by transcranial Doppler (TCD). No recurrence of VS has been observed. This technique appears quite effective provided that it is performed as early as the clinical symptoms come out in correlation with important acceleration of flow rates on TCD.

Adult↗
PubMed1990

Mucoceles of the sphenoidal sinus. Report of six cases and review of the literature.

Six personal cases of mucocele of the sphenoidal sinus are reported, and 124 cases from the literature are reviewed. Sphenoidal sinus mucocele is a benign and rare lesion which has long been unrecognized. Clinical features include fronto-orbital pain, oculomotor palsies, loss of visual acuity, exophthalmos and anosmia. Our series is of particular interest since four of our six patients presented with endocrine disorders. Recent advances in neuroradiological methods should rapidly lead to the correct diagnosis. Treatment consists of aspiration and drainage of the mucocele via a trans-sphenoidal approach. The results are good, and ophthalmoplegia usually subsides. In our experience, endocrine disorders do not always respond to treatment. The prognosis of sphenoidal sinus mucocele depends on the preoperative duration of the loss of visual acuity.

Adult↗
PubMed1990

[Extradural intracavernous epidermoid cyst. Apropos of 2 cases].

The authors report two cases of intracranial, extradural, intracavernous epidermoid cyst. In one case the cyst was ruptured into the subarachnoid space and in the substance of the temporal lobe. The two cysts had to be subtotally resected because of dense adherences with the internal carotid artery. In both cases the post-operative periods were uneventful.

Adult↗
PubMed1990

Dural fistulae of the tentorium cerebelli. Radioanatomical, clinical and therapeutic considerations.

Among the 84 intracranial dural fistulae treated in the Neuroradiology department of the University Hospital Centre of Nancy between August 1983 and April 1990, 10 (11.9%) were located on the tentorium cerebelli. The patients were 7 men and 3 women aged from 41 to 61 years at the time of diagnosis. All tentorial dural fistulae showed an exclusively cortical drainage, and only one of them was associated with probable thrombosis of a major sinus. Nine patients presented with at least one episode of neurological deficit (including 2 with progressive ascending myelopathy) associated with a cerebro-meningeal haemorrhage in 6 cases. In all patients the initial treatment was an endovascular one, subsequently reinforced by surgery in 2 patients. In every case the clinical condition was improved or stabilized and no recurrent haemorrhage was observed, but radioanatomical cure was obtained in only 3 patients: 1 treated by the endovascular route and 2 by embolization combined with surgery. The anatomical, physiopathological and clinical aspects of these particular fistulae and the different possible therapeutic approaches are discussed.

Adult↗
PubMed1989

[Value of transcranial Doppler in the monitoring of aneurysmal subarachnoid hemorrhage treated with calcium inhibitors].

Fifty four patients (33 male and 21 female, mean age 47) with spontaneous aneurysmal subarachnoid hemorrhages have been tested by repeated TCD: 25 of them were systematically administered intravenous Nimodipine when admitted at hospital, the 29 others constituted a reference group. There was no statistically significant difference between the two groups of patients for age, sex, initial clinical status, importance of bleeding at CT scan, localization of aneurysm or existence of an angiospasm, whether clinically symptomatic or not. In 72% of the cases, TCD allowed to prove the existence of an angiospasm when higher flow velocity was registered in cranial basal arteries. There was no significant difference between the two groups. The final clinical status of the patients seemed to be more favourable in the treated group. Yet it did not appear to be directly linked to the existence of a spasm or not. This argued in favour of a non-univocal mechanism of action of Nimodipine.

Brain↗