Biomedical subjects
Publications and source records attributed to J J Merland.
The authors report a case of aneurysm of the right posterior inferior cerebellar artery which was successfully treated by endovascular occlusion of the vertebral artery at C1 level. This treatment was justified by the failure of neurosurgery.
The authors define the "throbbing buttocks syndrome" which can in fact correspond to different pathological entities: aneurysm of the persistent sciatic artery and/or congenital or traumatic arteriovenous fistula of the hypogastric and gluteal vessels. Seven cases are reported: 1 case of aneurysm of the persistent sciatic artery complicated by truncal embolism and fissuring which was treated successfully by occlusive endoaneurysmorrhaphy; and 6 cases of arteriovenous fistulas (1 traumatic and 5 congenital). In all cases of arteriovenous fistula the technique used involved initial embolization which was complicated by anterior ligature of the hypogastric artery and then by excision of the malformation which was extremely hemorrhagic in some cases. Out of these 6 cases, results have been satisfactory for 5 and incomplete for the remaining one.
Explore the source record for details and available documents.
MRI appears to be a very valuable examination to study pathology of the vertebral artery. The examination must include T1 and T2 sequences and scans in three planes. The use of oblique scans allows the planes of section to be adjusted to the course of the artery. MRI can therefore demonstrate abnormalities of flow caused by intrinsic or compressive pathology.
A case of a post-traumatic carotid-cavernous fistula treated by endovascular approach through the vertebrobasilar system is reported. The 16 year old female patient was hurt in a car accident. The instantly-occurring carotid-cavernous fistula was treated with a Fogarty catheter, the internal carotid artery being occluded during this procedure. Ten years later the fistula recurred with a predominantly cortical venous drainage. The fistula was closed with two detachable balloons by an endovascular approach from the vertebrobasilar system via the posterior communicating artery. The small residual fistula, fed by the external artery was occluded by a venous approach via the internal jugular.
58 patients with a juvenile nasopharyngeal angiofibroma have been treated by a combined neuroradiological-surgical method. In the cases with smaller tumor extension, fed only by the external carotid arteries or with only slight participation of the internal carotid arteries, the external carotid arteries alone have been embolized using particles. In the cases with marked participation of the internal carotid arteries these vessels were also embolized. In the first group there have been no complications and no recurrences. In the latter (31 cases) there have been three temporary minor complications and 11 recurrences.
Direct arteriovenous fistulas originating from the terminal branches of the external carotid artery constitute a rare form of facial vascular disorders. They are usually well tolerated and do not grow. Surgical removal or ligation of the fistula may be hazardous to the facial nerve or lead to aesthetic insult. Based on our experience in five cases treated successfully with detachable balloons, we propose this technique as an alternative to surgery.
To reduce the intraoperative and postoperative complications in patients who suffer intracerebral arteriovenous malformations (AVM's), the slow reduction of the shunt flow to a brain perfusion flow has been tried by the use of several methods: microsurgical techniques, selective and superselective embolization, intraoperative embolization, staged operation. The risk of re-bleeding and intraoperative oedema increases in AVM's with two or more feeders. Our policy was to exclude such AVM's by primary superselective embolization. If there was only a small residual angioma, we tried to remove this by microsurgical techniques. The haemodynamics in AVM's could be examined by measuring the blood flow velocities in the feeding arteries and in the other parts of the circle of Willis by transcranial Doppler sonography (TCD). Signs of haemodynamic effective embolization could be measured by the reduction of flow velocities. After exclusion of an AVM the velocities in the brain and feeding arteries decreased to below normal values in the first days after the operation. In the feeding arteries this was due to the fact that the arteries were enlarged so that the velocity must be decreased when there was normal volume flow. The combination of superselective angiography and microsurgical resection of the residual angioma seemed to be the best way to treat AVM's which are fed by more than two arteries and which are 3 or more cm in diameter. TCD investigations were used to measure the haemodynamic changes before and after angioma superselective embolization and microsurgical operation.
Thirty-four patients with angiographically proved arteriovenous malformations of the spinal cord were studied between May 1986 and July 1987. Examinations were performed on a CGR 5000 Magniscan 0.5-T scanner with a surface coil in all cases, and multislices in both T1- and T2-weighted sequences were obtained in sagittal and axial planes. The results showed that MR can accurately diagnose all cases of intramedullary arteriovenous malformations, since transverse images were able to precisely locate the nidus within the spinal cord. Other types of spinal cord arteriovenous malformations were also studied (perimedullary fistulae and dural arteriovenous fistula), and the findings confirmed the value of MR in the characterization of these lesions as well.
We report two cases of multiple aneurysm complicating bacterial endocarditis and involving the hepatic, renal and superior mesenteric arteries. The aneurysms were treated by the superselective embolization technique hitherto restricted to cerebral arteries. The first patient had been operated upon for mitral valve endocarditis. Because of a persistent anicteric cholestasis, repeat ultrasonography and computerized tomographic scan were performed which revealed two intrahepatic aneurysms associated, at arteriography, with an aneurysm of the superior mesenteric artery. The patient underwent superselective embolization of one of the intrahepatic aneurysms, then of the superior mesenteric artery aneurysm. Angiographic cure was obtained and persists after a 17-month follow-up. In the second patient, persistent clinical and biochemical hepatic abnormalities after mitral and aortic valve replacements for endocarditis prompted us to perform an ultrasonography which showed a large hepatic aneurysm, and an abdominal arteriography which disclosed the presence of several aneurysms. Because of its size and suspected fissuration, the hepatic aneurysm was treated by superselective embolization, and this was followed by embolization of a renal artery. The immediate post-treatment period was uneventful, and complete angiographic cure was confirmed after 6 months. Superselective embolization seems to give good results at mid-term and should therefore be considered for fragile patients with multiple abdominal aneurysms.
Intra-mandibular arteriovenous malformations are very serious conditions, the treatment of which up to now has been extremely mutilating. This report concerns the first case, to the best of the author's knowledge, of conservative treatment involving elective polymerizing embolisation after prior dental devitalization, which even itself may not be necessary.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
We studied seven cases of Terson's syndrome, in association with bleeding in the subarachnoid space caused by rupture of vascular malformation or cranial traumatism. The association of rapid increase of intracranial pressure with subarachnoid hemorrhage could explain the development of a Terson's syndrome. The retinal hemorrhages associated with the vitreous hemorrhage are variable in morphology and topography. Pars plana vitrectomy has been performed in eight eyes with most often good results.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Forty-three patients with arterio-venous fistulae of the dura of the transverse sinus with a complaint of tinnitus are reviewed, with a follow-up of 12 months to 11 years. 34 patients were embolized, 2 treated surgically, and 7 were untreated. Embolization appears to have been beneficial. The frequently benign nature of this abnormality must be emphasized, and serious psychological study of the patient must be made before deciding on therapy.