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Biomedical subjects

Philippe Gailloud

Publications and source records attributed to Philippe Gailloud.

At least 55 records · Page 3Linked to original sources
PubMed2003

Developmental venous anomalies and sinus pericranii in the blue rubber-bleb nevus syndrome. Case report.

Blue rubber-bleb nevus syndrome (BRBNS) is a developmental disorder that originally was identified by the presence of distinctive cutaneous and gastrointestinal hemangiomas. More recently it has been recognized that the number of affected organs is larger and that BRBNS includes central nervous system vascular malformations. A 52-year-old woman in whom intracranial vascular malformations had been diagnosed earlier presented for evaluation. At birth, several blue nevi had been noted on her tongue, lips, and neck. Cerebral angiography demonstrated an extensive network of developmental venous anomalies and a left anterior sinus pericranii. The literature on BRBNS and developmental venous anomalies is reviewed.

Cerebral Angiography↗
PubMed2003

Bilateral aberrant internal carotid arteries with bilateral persistent stapedial arteries and bilateral duplicated internal carotid arteries.

A 5-year-old boy was evaluated for a left retrotympanic mass found at otoscopy. Subsequent petrous bone CT and MR angiographic examinations demonstrated bilateral aberrant internal carotid, bilateral stapedial artery persistence, and bilateral duplicated internal carotid arteries. Imaging findings and their clinical relevance are discussed. A second case of unilateral aberrant internal carotid artery with a persistent stapedial artery is included for comparison.

Carotid Artery, Internal↗
PubMed2003

De novo aneurysm formation 6 and 22 months after initial presentation in two patients.

Two cases of angiographically and surgically documented de novo intracranial aneurysm formation are reported. The first patient, a 32-year-old woman, developed two new aneurysms within a 6-month period, and the second patient, a 27-year-old woman, developed two new aneurysms within a 22-month period. In both patients, the new aneurysms were symptomatic, causing stroke and subarachnoid hemorrhage, respectively. The development of aneurysms de novo over such a short period of time has important implications for periodic imaging in patients considered to be at high risk for intracranial aneurysm formation.

Adult↗
PubMed2003

Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke.

BACKGROUND AND PURPOSE: Acute vertebrobasilar ischemic stroke is often associated with high morbidity and mortality with limited therapeutic options. Endovascular treatment with thrombolysis has offered some hope for affected patients; however, overall outcomes have been less than satisfactory. In this report, we present the results of our approach in six consecutive cases of acute vertebrobasilar ischemic stroke by combined proximal vessel stent placement and thrombolysis. METHODS: Six consecutive cases were retrospectively reviewed for the clinical outcome of patients presenting to our institution with acute posterior circulation stroke who underwent cerebral revascularization including proximal arterial stent placement by using balloon-expandable coronary stents and intraarterial thrombolysis. All of these patients were initially evaluated by stroke team neurologists and imaged with MR, including diffusion-weighted imaging documenting acute posterior circulation stroke. MR angiography of the circle of Willis was also obtained. Short-term follow-up was conducted to assess National Institutes of Health stroke scores (NIHSS) and modified Rankin scores. RESULTS: In these six cases, a combined approach of proximal arterial stent placement (five cases of vertebral artery origin and one case of carotid and subclavian stent placement plus vertebral artery revascularization) and thrombolysis was performed at variable times after stroke onset (range, 30 hours to 5 days). Four of the six patients had good basilar artery recanalization (Thrombolysis in Myocardial Infarction [TIMI] grade 0-1 before tissue plasminogen activator thrombolysis and TIMI grade 2 after procedure). Four of six patients had excellent immediate recovery and were discharged to an acute rehabilitation unit or their homes with improved neurologic symptoms and functional status. Two patients died: one patient presented with coma at outset with an NIHSS of 38, and the other patient probably had reocclusion of the basilar artery within 24 hours despite initial postprocedural improvement. CONCLUSION: We demonstrate that, in the setting of acute stroke, stent placement in combination with revascularization and thrombolysis is practical and allows quick access to a clot and simultaneously increases perfusion through collaterals during the thrombolytic process. In particular, basilar thrombolysis may be facilitated by proximal vertebral stent placement as concomitant atheromatous vertebrobasilar stenosis is common.

Acute Disease↗
PubMed2002

Percutaneous pediculoplasty: polymethylmethacrylate injection into lytic vertebral pedicle lesions.

Two patients with painful lytic lesions of the vertebral pedicle were treated with percutaneous pediculoplasty. This technique, similar to vertebroplasty but with increased procedural risks because of the immediate vicinity of neural structures, was performed under high-quality biplane fluoroscopic guidance. For lesions involving both the pedicle and the vertebral body, a double-needle unipedicular technique is advocated.

Adolescent↗
PubMed2002

Superior bronchial artery arising from the left common carotid artery: embryology and clinical considerations.

A bronchial artery arising from the left common carotid artery was incidentally documented during cerebral angiography in a 64-year-old patient. This variant can be understood as the adult persistence of a primitive bronchial branch arising from the third branchial arch. It represents a potential pitfall for the identification and treatment of the bleeding source in patients with hemoptysis.

Angiography, Digital Subtraction↗
PubMed2002

Vertebral hemangiomas associated with familial cerebral cavernous malformation: segmental disease expression. Case report.

Recently, several groups of authors have described mutations in the Krev interaction-trapped 1 [corrected] (KRIT1) gene in families in whom cerebral cavernous malformations (CCMs) are present. In a number of French kindreds harboring familial CCMs, cutaneous as well as cerebral manifestations of this autosomal-dominant disorder were demonstrated. Involvement of other tissues has been poorly described. The authors present the proband, in an affected family with a previously reported KRIT1 mutation, in whom vertebral hemangiomas in addition to cerebral and cutaneous lesions were found. One of the vertebral lesions was associated with a large cutaneous lesion. This combination of vertebral and overlying cutaneous lesions suggests segmental disease expression as the result of a second hit during development, implying loss of function as the relevant molecular pathogenic mechanism. This case illustrates that tissue involvement outside the nervous system must be considered when treating patients with familial CCMs.

Biopsy↗
PubMed2002

CT findings in the infantile form of citrullinemia.

Citrullinemia is a rare autosomal recessive inborn error of the urea cycle due to a deficiency in argininosuccinic acid synthetase. We present two cases of the infantile form of citrullinemia in which CT revealed bilateral and symmetric corticosubcortical hypoattenuating areas, ulegyric changes, and atrophy in the frontal lobes, as well as atrophy in the gyrus cinguli, insulae, and temporal lobes.

Atrophy↗
PubMed2002

Tailored cognitive testing with provocative amobarbital injection preceding AVM embolization.

BACKGROUND AND PURPOSE: Transarterial embolization of cerebral arteriovenous malformations (AVMs) has been associated with postprocedural neurologic complications in 7-39% of patients. We sought to determine whether a method of targeted neurologic and cognitive testing during AVM embolization reduces the incidence of focal cognitive and other neurologic deficits associated with the procedure. METHODS: A cognitive neurologist extensively examined 12 patients prior to AVM embolization. In each patient, a battery of tests tailored to their specific abilities was developed by using stimuli selected from standard and experimental cognitive tests to probe specific brain regions related to the location of the AVM. In each feeder vessel to be embolized, a 50-mg bolus of sodium amobarbital was superselectively administered through a microcatheter; this was followed immediately by neurologic and cognitive testing with the tailored battery. After testing, the position of the microcatheter tip was checked with fluoroscopy. If the provocative test results were negative, the evaluated feeder was embolized with N-butyl cyanoacrylate glue. RESULTS: Although results with 27 of 29 provocative amobarbital injections were negative, results with two injections in two different individuals revealed cognitive deficits during tailored provocative testing. In both, the evoked deficits resolved with dissipation of the amobarbital effect; the feeder vessels were not embolized. Neurologic and cognitive evaluation after each of 27 embolizations revealed no major or minor deficits. CONCLUSION: In our experience, provocative amobarbital testing prior to AVM embolization was helpful in identifying vascular territories where embolization may lead to neurologic and cognitive deficits.

Adult↗
PubMed2002

Bilateral arch origin of the vertebral arteries.

A case of bilateral anomalous origins of the vertebral arteries (VAs) is reported. Both VAs arose directly from the aortic arch between the left common carotid artery and the left subclavian artery. The possible embryologic mechanism and clinical importance of this previously unreported variant are reviewed.

Angiography, Digital Subtraction↗
PubMed2002

Angiographic and embryologic considerations in five cases of middle cerebral artery fenestration.

Five cases of unilateral middle cerebral artery fenestration were observed during the prospective evaluation of 1466 consecutive cerebral angiograms (0.43% of 1170 patients) between January 1999 and July 2001. In each case, an early branching temporopolar artery was seen to arise from the inferior limb of the fenestrated segment. This finding suggests that early branching temporopolar arteries may participate in the formation of middle cerebral artery fenestration by interfering with the normal fetal development of the middle cerebral artery.

Adult↗
PubMed2002

The craniocervical venous system in relation to cerebral venous drainage.

BACKGROUND AND PURPOSE: Passing from the supine to the upright position favors cerebral venous outflow into vertebral venous systems rather than into the internal jugular veins. We sought to determine venous connections between dural venous sinuses of the posterior cranial fossa and craniocervical vertebral venous systems. METHODS: Corrosion casts of the cranial and cervical venous system were obtained from 12 fresh human cadavers, and anatomic confirmation was made by dissection of three previously injected fresh human specimens. MR venography was performed to provide radiologic correlation. RESULTS: The lateral, posterior, and anterior condylar veins and the mastoid and occipital emissary veins were found to represent the venous connections between the dural venous sinuses of the posterior cranial fossa and the vertebral venous systems. This study revealed the nearly constant presence of the anterior condylar confluent (ACC) located on the external orifice of the canal of the hypoglossal nerve. The ACC offered multiple connections with the dural venous sinuses of the posterior cranial fossa, the internal jugular vein, and the vertebral venous system. All these structures were shown by MR venography. CONCLUSION: The lateral, posterior, and anterior condylar veins and the mastoid and occipital emissary veins connect the dural venous sinuses of the posterior cranial fossa with the vertebral venous systems. These connections are clinically relevant, because encephalic drainage occurs preferentially through the vertebral venous system in the upright position. The ACC is a constant anatomic structure that may play an important role in the redirection of cerebral blood in the craniocervical region.

Aged↗
PubMed2002

Training and pretreatment planning of interventional neuroradiology procedures--initial clinical validation.

A PC based system for simulating image-guided interventional neuroradiological procedures for physician training and patient specific pretreatment planning is described. The system allows physicians to manipulate and interface interventional devices such as catheters, guidewires, stents and coils within 2-D and hybrid surface and volume rendered 3-D patient vascular images in real time. A finite element method is employed to model the interaction of the catheters and guidewires with the vascular system. Fluoroscopic, roadmapping and volume rendered 3-D presentations of the vasculature are provided. System software libraries allow for the use of commonly employed catheters, guidewires, stents and occluding coils of various shapes and sizes. The results of an initial clinical validation suggest that the experience gained from our simulator is comparable with that of using a vascular phantom. We are conducting further validation with the aim of providing patient specific pretreatment planning.

Angioplasty, Balloon↗