Olivier De Witte

Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms.

OBJECTIVE To report our preliminary experience with the Pipeline flow-diverter stent for the endovascular treatment (EVT) of intracranial aneurysms. METHODS Between September 2009 and October 2010, 20 patients with 27 fusiform or wide-necked unruptured aneurysms were included and treated by Pipeline stent placement alone. Technical issues, immediate findings, delayed complications, and clinical and imaging follow-up at three and six months were assessed. RESULTS EVT was successfully performed in all patients. Clinical outcome was excellent in all but one patient who died. This latter patient developed a massive infarct due to a delayed stent thrombosis. Other complications without permanent deficit included one perimesencephalic subarachnoid hemorrhage and one retroperitoneal hematoma. Minor technical issues without clinical consequence were encountered in nine patients and included stent migration, stent misplacement, unanticipated stent shortening, and the impossibility to recapture the distal coil tip of the supporting device. Angiographic follow-up in 19 patients with 25 aneurysms showed 21 complete occlusions, one neck remnant, and three incomplete occlusions. No significant parent artery stenosis was seen. CONCLUSION This study shows that the Pipeline stent is useful for EVT of fusiform and wide-necked intracranial aneurysms. Moreover, the stent is well tolerated with a low rate of intra-stent stenosis at short-term follow-up. However, technical improvements are needed to ensure safe and precise use of the device.

FDG-PET as a prognostic factor in high-grade astrocytoma

AbstractBackground: The prognostic value of the metabolic status of cerebral gliomas determined by positron emission tomography with [18F]-fluoro-deoxy-D-glucose (FDG-PET) has been established in populations with a mixture of grades 2, 3 and 4 gliomas, but remains uncertain when only malignant gliomas are considered (grade 3 and 4). Methods: FDG-PET performed in 30 patients with anaplastic astrocytoma (grade III) and 61 patients with glioblastoma (grade 4) were classified according to a metabolic grading. The uptake of FDG was lower in the tumor compared to white matter (WM) in grade 1 (4 glioblastoma, 4 anaplastic astrocytoma), it was intermediate between WM and cortex in grade 2 (20 glioblastoma, 22 anaplastic astrocytoma), and it was superior to cortex in grade 3 (38 glioblastoma, 4 anaplastic astrocytoma). Results: Kaplan–Meier survival curves were similar in patient with grades 1 and 2, but were significantly worse (p = 0.007) in grade 3. In multivariate analysis considering age, pathological grade (anaplastic astrocytoma versus glioblastoma), and metabolic grades, the metabolic grade did not appear to be an independent prognostic factor. When anaplastic astrocytomas and glioblastomas were considered separately, metabolic grade is of predictive value only in the group of glioblastomas. Conclusion: In malignant gliomas, metabolic grading determined by FDG-PET was not superior to the pathological grading for survival prediction. Still, it remains of predictive value when applied to malignant gliomas histologically classified as glioblastoma.

Traumatic epidural hematoma of the cervical spine: magnetic resonance imaging diagnosis and spontaneous resolution: case report.

OBJECTIVE AND IMPORTANCE Demonstration of interest of medical treatment of cervical epidural hematomas. CLINICAL PRESENTATION A young patient developed cervical pain after experiencing cervical trauma. Computed tomography and magnetic resonance imaging demonstrated an epidural cervical hematoma. A spontaneous resolution of the clinical symptoms and the radiological abnormalities was observed. CONCLUSION Although surgical decompression is generally regarded as mandatory in selected patients with incomplete and nonprogressing deficits, conservative management may be possible.

Balloon-assisted coiling of intracranial aneurysms is not associated with a higher complication rate

IntroductionWithin the neurosurgical literature on intracranial aneurysms, balloon-assisted coiling (BAC) remains controversial when compared to conventional coiling (CC). The aim of this study was to compare our results with BAC and CC over a 4-year period.MethodsDaily interventional neuroradiology has been available since March 2004 in our institution. Between March 2004 and February 2008, 275 patients with 357 aneurysms were treated by an endovascular approach, including 174 patients/204 aneurysms treated by CC (group I) and 80 patients/92 aneurysms treated by BAC (group II). The remaining patients were treated with other endovascular techniques. Indications of BAC were as follow: aneurysms with an unfavourable neck/sac ratio and/or a branch arising from the neck (90.2%), unstable coiling catheter (6.5%), and anticipated aneurysm rupture (3.3%). The clinical charts, procedural data, and angiographic results of groups I and II were compared.ResultsBAC was used in 25.8% (92/357) of all embolized aneurysms and it was successful in 83/92 aneurysms (90%). There was no significant difference in the procedure-related morbidity and mortality rates between group I (2.3% and 1.15%, respectively) and group II (2.5% and 1.25%, respectively). Although retreatment was more frequent in group II (13%) than in group I (11%), the difference was not statistically significant (P = 0.8125).ConclusionWhen BAC is used frequently, it is a safe and effective technique that is associated with complication rates comparable to those of CC. Although BAC is not associated with more stable anatomical results, it should be considered as an alternative therapeutic option for the treatment of broad-based intracranial aneurysms.

Endovascular treatment of posterior circulation fusiform aneurysms: single-center experience in 31 patients.

BACKGROUND:Posterior circulation fusiform aneurysms are rare but difficult to treat. OBJECTIVE:To report our experience with endovascular treatment of posterior circulation fusiform aneurysms. METHODS:A retrospective review of our prospectively maintained database identified all posterior circulation fusiform aneurysms treated by endovascular approach over a 6-year period. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS:From March 2004 to March 2010, 31 patients were identified: 11 asymptomatic patients, 9 who presented with a subarachnoid hemorrhage, 6 with a stroke, and 5 with a mass effect. All but 1 patient (97%), who died before being treated, were successfully treated by parent artery occlusion (n = 10), stenting plus coiling (n = 10), or stenting alone with conventional or flow-diverting stents (n = 10). Twenty-two patients showed a good or an excellent outcome (73%); 3 had a fair or a poor outcome (10%); and 5 patients died (17%). These 8 patients initially presented with severe subarachnoid hemorrhage or mass effect. Procedure-related morbidity includes only one patient who kept a worsening of cranial nerve palsies. There was no definitive procedure-related morbidity or mortality. Immediate aneurysm occlusion was incomplete in 20 cases (67%) and complete in 10 cases (33%). Mean follow-up of 20 months in 23 patients showed 12 further thromboses, 9 stable results, and 2 flow reductions. Final results included 19 complete occlusions (83%) and 4 incomplete occlusions (17%). CONCLUSION:Posterior circulation fusiform aneurysms may be treated by different endovascular approaches with satisfying clinical and anatomical results in most cases. However, patients who present with severe subarachnoid hemorrhage or mass effect still have a poor prognosis.

Prevention of epidural fibrosis in a prospective series of 100 primary lumbo-sacral discectomy patients: Follow-up and assessment at re-operation

An implantable device (ADCON-L), which acts as a resorbable barrier to epidural fibrosis following lumbar discectomy, has been shown to minimize the formation of peridural fibrotic scar and to improve the post-operative outcome, in two large controlled and multi-center clinical trials. In this prospective study, 100 patients were treated with the device during their first-time lumbo-sacral discectomy surgeries and monitored for 12 months. During this time interval, four of these patients required re-operation. In these cases, epidural scar and ease of dissection were systematically evaluated and recorded. At the time of re-operation, in all four patients, absent or minimal soft scar tissue was found where ADCON-L had been placed, no adhesions to the involved root were observed, and the dissection was easier than expected; the healing of the surgical wound was excellent , and no residual implant material was found. These observations indicate that the use of ADCON-L at the time of the first lumbar disc surgery minimizes the hazards and difficulty that can be encountered in a subsequent revision surgery due to the presence of epidural fibrosis, and may therefore improve the chances of satisfactory outcome following re-operation.

PoleStar N-10 low-field compact intraoperative magnetic resonance imaging system with mobile radiofrequency shielding.

The PoleStar N-10 intraoperative magnetic resonance imaging system is manufactured by Odin Medical Technologies, Yokneam, Israel, and is marketed by Medtronic Surgical Navigation Technologies, 826 Coal Creek Circle, Coal Creek Corporate Center One, Louisville, CO 80027; telephone: 720/890-3200. The cost of the PoleStar N-10 ranges from

High levels of cellular proliferation predict pseudoprogression in glioblastoma patients

900,000 to

Semi-quantification of methionine uptake and flair signal for the evaluation of chemotherapy in low-grade oligodendroglioma.

1,050,000, depending on options. The price of the mobile radiofrequency shielding option is

Arnold Chiari Type I malformation presenting as a trigeminal neuralgia: case report.

80,000.