Biomedical subjects
Publications and source records attributed to M Djindjian.
A Group of 38 medullary arterio-venous malformations have been embolized with solid emboli: 12 retromedullary, 22 intramedullary and four mixed AVM. Indications, contraindications, and long-term results are described.
Meningeal hemorrhages in 5 patients with tumors of the cauda equina are reported. In each case there were signs from the brain area which led to a false diagnosis of ruptured intracranial aneurism, before attention was drawn to the cauda equina by a relapse with hemorrhage or other signs. The value of medullary arteriography for positively diagnosing cauda equina tumors, and their differential diagnosis from medullary arteriovenous malformations--principal cause of spinal meningeal hemorrhages--is discussed, as well as the necessity for systematically evoking this topography in children and young adults when arteriographic exploration is negative.
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Five cases in which the Klippel-Trenaunay-Weber syndrome was associated with a spinal cord arteriovenous malformation are reported: they formed part of a series of 150 spinal arteriovenous malformations. Hypertrophic lesions, dilated arteries and varicose veins were present in every case, but cutaneous angiomatosis was found in only two. In each case, there was an intramedullary AVM. The relationship of the Klippel-Trenaunay-Weber syndrome to the regional angiomatous phacomatoses is discussed.
5 cases of an association of Klippel-Trenaunay-Weber syndrome and of spinal cord angiomas are reported amongst a series of 150 cases of malformation of the cord. The hypertrophic element, arterial dilatations and varices were found to be constant, in constant to cutaneous angiomatosis which was found in only 2 cases. There were intraspinal angiomas in all cases. The relationship between Klippel-Trenaunay-Weber syndrome and regional angiomatous phacomatoses are discussed.
Eleven cases of spinal ependymomas were studied by angiography. In four cases there was a tumoral blush, and in five cases, indirect signs of a spinal tumor. Although direct opacification of some caudal ependymomas is of great value, the main interest of spinal angiography is in the differential diagnosis with arterio-venous malformations, when there is a spinal S.A.H. or when there are abnormal vascular markings on the myelogram.
For a long time surgical removal of intra-medullary angiomas was considered as impossible. Accurate localization of the lesion by spinal angiography, microsurgical techniques allow to overcome this surgical challenge. 15 cases of spinal arteriovenous malformations fed by the anterior spinal artery have been operated. Criterias for surgery and post-operative results are mainly dependant upon the neurological states and the anatomical type of the malformations (type I, II, III, IV), Total removal of the malformations was performed in 12 cases with post-operative control angiography in seven instances.
There is a small group of spinal arteriovenous malformations which differ from all of the others. They receive their blood supply from the anterior spinal artery but are located outside of the spinal cord and its pia mater. Six such malformations from our series of 150 spinal arteriovenous malformations 1,4 are reported. They differ in their clinical manifestations from the others. They can be extirpated with improvement in the patient's clinical manifestations.
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Intermittent claudication of neurogenic origin can be traced to three basic causes: --either a chronic circulatory deficiency in the arteries leading to the spinal cord, whether these arteries be the site of an atheroma of the ostia, an inflammation or a loco-regional compression. In such cases, the claudication is painless which differentiates it from the arteritis claudication of the lower limbs. --or to a compression of the roots of the cauda equina and to a lesser degree of the spinal cord, through a narrow rachidian canal that is hereditary or acquired, and relative or absolute. --or finally to a sheathing peripheral neuropathy of the lower limbs. The two latter causes are accompanied by pain, and make it necessary to widen the classical notion of the intermittent claudication (Dejerine's non painful intermittent claudication of the spinal cord).