L. Picard

Embolisations et occlusions par ballonnets dans les processus tumoraux@@@Embolization and balloon occlusions in tumoral processes: Seven years' experience: Sept annes d'exprience

The authors report 169 therapeutic embolizations in cases of tumoral lesions in the craniocerebral, ENT, and vertebrospinal territories. Most endovascular occlusions performed for tumoral processes are presurgical indications, with the aim of reducing hemorrhage at operation. Embolization becomes practically mandatory for nasopharyngeal angiofibromas, considerably reducing the peroperative bleeding. Indications of embolization for meningiomas must be discussed according to the size and location of the tumors: embolization is especially useful in large tumors or those inserted on the base of the skull, mainly in the middle fossa. In chemodectomas, embolization can be used presurgically or on its own when surgery becomes impossible; angiographic follow-up shows that secondary repermeabilization is frequent in spite of clinical improvement. In malignant tumors of the craniofacial region, indications of embolization must be considered with care because failure of vascularization tends to make radiotherapy less efficient; in these cases, embolization can be useful in reducing pain or to contend with cataclysmal hemorrhages.SummaryThe authors report 169 therapeutic embolizations in cases of tumoral lesions in the craniocerebral, ENT, and vertebrospinal territories. Most endovascular occlusions performed for tumoral processes are presurgical indications, with the aim of reducing hemorrhage at operation. Embolization becomes practically mandatory for nasopharyngeal angiofibromas, considerably reducing the peroperative bleeding. Indications of embolization for meningiomas must be discussed according to the size and location of the tumors: embolization is especially useful in large tumors or those inserted on the base of the skull, mainly in the middle fossa. In chemodectomas, embolization can be used presurgically or on its own when surgery becomes impossible; angiographic follow-up shows that secondary repermeabilization is frequent in spite of clinical improvement. In malignant tumors of the craniofacial region, indications of embolization must be considered with care because failure of vascularization tends to make radiotherapy less efficient; in these cases, embolization can be useful in reducing pain or to contend with cataclysmal hemorrhages.

Embolisations et Occlusions par Ballonnets dans les Lésions Vasculaires Cranio-Faciales

We review 258 cases of craniofacial vascular lesion treated by endovascular occlusion in the past 7 years in the Neuroradiology Departments of Nancy, Nantes, and Toulouse. Dural fistulas very often need both embolization and surgery. Craniofacial angiomas are not straightforward indications for therapy: the age of the patient, the unpredictability of evolution, and possible sequelae have to be taken into account; embolization is very successful in counteracting hemorrhage. Angiomatoses such as Rendu-Osler disease can respond well to repeated embolizations over several years. Lesions such as hemolymphangiomas are also excellent indications for embolization, either alone or with surgery. Occlusion by detachable balloon is ideally the most elegant method, but it is not always technically feasible, nor free from complications.

Embolisations et Occlusions par Ballonnets dans les Processus Tumoraux

The authors report 169 therapeutic embolizations in cases of tumoral lesions in the craniocerebral, ENT, and vertebrospinal territories. Most endovascular occlusions performed for tumoral processes are pre-surgical indications, with the aim of reducing hemorrhage at operation. Embolization becomes practically mandatory for nasopharyngeal angiofibromas, considerably reducing the peroperative bleeding. Indications of embolization for meningiomas must be discussed according to the size and location of the tumors: embolization is especially useful in large tumors or those inserted on the base of the skull, mainly in the middle fossa. In chemodectomas, embolization can be used presurgically or on its own when surgery becomes impossible; angiographic follow-up shows that secondary repermeabilization is frequent in spite of clinical improvement. In malignant tumors of the craniofacial region, indications of embolization must be considered with care because failure of vascularization tends to make radiotherapy less efficient; in these cases, embolization can be useful in reducing pain or to contend with cataclysmal hemorrhages.

First Panel Discussion Embolization Material

In this round table discussion, we plan to discuss some of the indications, contraindications, complications, and results of the various interventional therapeutic techniques. We are fortunate this morning to have a panel represented not only by neuroradiologists from South America and North America, including Canada, but also from Europe. Our panelists include Dr. William Bank from Pittsburgh, Pennsylvania: Dr. Alex Berenstein from New York; Dr. Allen Fox from London, Ontario, Canada; Dr. Bartolome Grillo from Montevideo, Uruguay; Dr. Sadek Hilal from New York; Dr. Charles Kerberfrom Pittsburgh, Pennsylvania; Dr. Claude Manelfe from Toulouse, France; and Dr. Luc Picard from Nancy, France.

Dveloppement de la neuroradiologie thrapeutique@@@Development of therapeutic neuroradiology

SummaryWhile therapeutic endovascular occlusions date from as early as 1904, it is in the last 20 years that therapeutic neuroradiology has come into its own. Progress has been made in four directions. (1) Embolization has developed from the original technique involving arteriotomy, through percutaneous methods, to presentday superselective catheterization. Concurrently, the materials used have been improved: from nonmalleable muscle and Silastic balls, to malleable Spongel and dura mater, and most recently to polymerizable fluid plastic substances. The possibility of obstructing very narrow vessels extends the range of indications of embolization. (2) Balloon catheters have been developed, first with nondetachable balloons (1971), more recently with detachable ones (1974). (3) Other techniques may be used to produce a therapeutic thrombosis, e.g., endovascular electrocoagulation and thermocoagulation. (4) Foreign bodies may be extracted safely by catheterization.Further development of techniques should ensure a growing importance for therapeutic neuroradiology in the future.While therapeutic endovascular occlusions date from as early as 1904, it is in the last 20 years that therapeutic neutroradiology has come into its own. Progress has been made in four directions. (1) Embolization has developed from the original technique involving arteriotomy, through percutaneous methods, to present-day superselective catheterization. Concurrently, the materials used have been improved: from nonmalleable muscle and Silastic balls, to malleable Spongel and dura mater, and most recently to polymerizable fluid plastic substances. The possibility of obstructing very narrow vessels extends the range of indications of embolization. (2) Balloon catheters have been developed, first with nondetachable balloons (1971), more recently with detachable ones (1974). (3) Other techniques may be used to produce a therapeutic thrombosis, e.g., endovascular electrocoagulation and thermocoagulation. (4) Foreign bodies may be extracted safely by catheterization. Further development of techniques should ensure a growing importance for therapeutic neuroradiology in the future.

Narrow Lumbar Canal by Postoperative Epidural Lesions

When the postoperative follow-up of a patient who underwent a surgical procedure in the lumbosacral area is disturbed either by persistance or aggravation of the symptoms, or even by the appearance of another clinical symptomatology, the etiologic diagnosis becomes difficult.