Biomedical subjects
Publications and source records attributed to R Houdart.
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.
Five cases of subarachnoid hemorrhage arising from an intraspinal tumor are presented, Three of these were ependymomas in the region of the cauda equina. One was a neurofibroma at L1. The fifth was a hemangioblastoma in the upper lumbar region. The literature dealing with subarachnoid hemorrhage due to intraspinal lesions is reviewed. The majority of cases of spinal subarachnoid hemorrhage are due to arteriovenous malformations, but 50 cases in which the bleeding developed from a neoplasm have been reported.
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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The case reported was a 69-year-old patient with a myxoma of the left atrium presenting as multiple emboli: acute ischaemia of the lower limbs preceded, three months before, by a spontaneously regressive right hemiplegia which, in view of the patient's age, was considered to be a simple manifestation of atherosclerosis. The diagnostic value of the echocardiogram in cases of systemic emboli of undetermined origin is stressed.
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.
Physiology teaches that in addition ot be basic areas of C.S.F. resorption in the region of the cerebrum, supplementary zones exist situated in particular at the coverings of the spinal nerves. The aim of this study was a quantitative and dynamic analysis of spinal flow in 74 subjects, 64 of whom had clinical signs of communicating hydrocephalus. In certain of them, classical examinations provided no precise indications as to the appropriate neurosurgical procedure. Study of the dynamics and resorption of the C.S.F. in the spine would appear to provide new elements in assessment prior to the decision to insert a ventriculo-atrial valve.
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The lumbar epidural veins are opacified by injection of the lateral sacral and ascending lumbar veins with abdominal compression. This technique provides a good opacification of the entire lumbar epidural venous system. Some anatomical points are discussed and clarified. The interest of the technique in the diagnosis of discal herniations is emphasized.
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