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Dimancea A, Mattioni S, Nouet A, Drir M, Santin A, Marrot B, Shotar E, Corcy C, Bottin L, Sourour NA, Premat K, Alamowitch S, Carpentier A, Degos V, Clarençon F, Lionnet F, Lenck S. Preventive treatment of unruptured intracranial aneurysms in adult patients with sickle cell anemia: A cohort study. J Neuroradiol 2023; 50:511-517. [PMID: 36781119 DOI: 10.1016/j.neurad.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms are frequent in patients with sickle cell anemia, while subarachnoid hemorrhage is a major cause of death and disability in young adult patients. Several characteristics, such as younger age and smaller size at rupture, may incline therapeutic decision towards exclusion treatments. Clinical guidelines on treatment of unruptured intracranial aneurysms in this population are still missing. We aimed to assess the safety and efficacy of the treatment of unruptured intracranial aneurysm in patients with sickle cell anemia, using an adapted hematological preparation regimen. PATIENTS AND METHODS Adult patients with sickle cell anemia and treated unruptured aneurysms by endovascular therapy or neurosurgery were included in this retrospective cohort study. Treatment decision was reached after multi-disciplinary assessment. A pre-operative blood transfusion protocol was undertaken targeting a HbS below 30%. Demographic data, hematological preparation parameters and clinical and radiological outcomes were documented. RESULTS AND CONCLUSIONS Twenty-five procedures were performed in 18 patients encompassing 19 aneurysms treated by embolization and 6 by surgery. Median age at treatment was 34 years-old and median aneurysm dome size was 4.4 mm. Immediate aneurysm exclusion rate was 85.7% after endovascular therapy and 100% after neurosurgery. Median follow-up was 6 months, with all patients being asymptomatic at last follow-up. Two transitory ischemic neurological deficits, as well as four cases of iodine-induced encephalopathy were identified after embolization. No complication occurred after surgery. Endovascular therapy by coiling and neurosurgical treatment of unruptured intracranial aneurysms appears to be safe in patients with sickle cell anemia and should be considered given the specific hemorrhagic risk observed in this population. A rigorous hematological preparation, associated with a dedicated peri‑operative protocol and an adequate therapeutic strategy are essential prerequisites.
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Affiliation(s)
- A Dimancea
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Mattioni
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - A Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - M Drir
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France
| | - A Santin
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - B Marrot
- Department of Radiology, Tenon University Hospital, Paris, France
| | - E Shotar
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - C Corcy
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - L Bottin
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France
| | - N A Sourour
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - K Premat
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Alamowitch
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - A Carpentier
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - V Degos
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - F Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; GRC BioFast. Paris VI University. Paris. France
| | - F Lionnet
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - S Lenck
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; Inserm UMR 1127, Paris Brain Institute, Paris, France.
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Alciato L, Simon F, Hervochon R, Trunet S, Nouet A, Tankéré F. Quality of life after hemifacial spasm surgery: French versions of the HFS-8 and HFS-30 questionnaires. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:425-430. [PMID: 33832863 DOI: 10.1016/j.anorl.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of the present study was to assess quality of life before and after surgery for hemifacial spasm, in order to validate two specific quality of life scales translated in French. Surgical results and complications were reported. MATERIAL AND METHODS Twenty-three patients with hemifacial spasm treated by microvascular decompression were retrospectively included. The HFS-8 and HFS-30 quality of life scales were translated from English into French using a forward-backward method and implemented on patients at least one year after surgery. RESULTS Median HFS-8 and HFS-30 values were respectively 16±12.5 (range: 8-20.5) and 38±38.5 (range: 23-61.5) before surgery and 0.5±4.5 (range: 0-4.5) and 5±17.5 (range: 1-18.5) after surgery, showing significant improvement in quality of life (P<0.001). The internal consistency of both scales was excellent (Cronbach's alpha>0.9), and they were significantly correlated (Pearson coefficient=0.95; 95% CI [0.91; 0.98]; P<0.0001). Success rates were 83% and 91%, respectively, after primary and revision surgeries. Complications were transient with minor consequences in 80% of cases, but could impact quality of life when lasting. CONCLUSIONS These results support the validity of the French versions of HFS-8 and HFS-30. Microvascular decompression is a safe and effective treatment for hemifacial spasm, and these scales are reliable tools to assess postoperative quality of life.
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Affiliation(s)
- L Alciato
- Service d'oto-rhino-laryngologie, GHU Pitié-Salpêtrière, Sorbonne Université, AP-HP, DMU ChIR, GRC robotique et innovation chirurgicale, Paris, France.
| | - F Simon
- Service d'oto-rhino-laryngologie, Hôpital Necker-Enfants malades, Université de Paris, AP-HP, Paris, France
| | - R Hervochon
- Service d'oto-rhino-laryngologie, GHU Pitié-Salpêtrière, Sorbonne Université, AP-HP, DMU ChIR, GRC robotique et innovation chirurgicale, Paris, France
| | - S Trunet
- Service de neuroradiologie, GHU Pitié-Salpêtrière, AP-HP, Paris, France
| | - A Nouet
- Service de neurochirurgie, GHU Pitié-Salpêtrière, AP-HP, DMU ChIR, Paris, France
| | - F Tankéré
- Service d'oto-rhino-laryngologie, GHU Pitié-Salpêtrière, Sorbonne Université, AP-HP, DMU ChIR, GRC robotique et innovation chirurgicale, Paris, France
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Bernat AL, Gaberel T, Giammattei L, Rault F, Gakuba C, Magro E, Peltier C, Graillon T, Baussart B, Premat K, Clarençon F, Nouet A, Civelli V, Froelich S. Intracranial hemorrhage related to brain vascular disease and COVID-19 containment: Where are the patients? Neurochirurgie 2020; 66:400-401. [PMID: 32781087 PMCID: PMC7837176 DOI: 10.1016/j.neuchi.2020.06.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A-L Bernat
- Neurosurgical Department, Lariboisière University Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Universités de Paris, Paris, France.
| | - T Gaberel
- Neurosurgical Department, University Hospital, Caen, France
| | - L Giammattei
- Neurosurgical Department, Lariboisière University Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Universités de Paris, Paris, France
| | - F Rault
- Neurosurgical Department, University Hospital, Caen, France
| | - C Gakuba
- Anesthesiology Department, University Hospital, Caen, France
| | - E Magro
- Neurosurgical Department, University Hospital, Brest, UMR 1101 LaTIM, UBO, France
| | - C Peltier
- Neurosurgical Department, University Hospital, Brest, UMR 1101 LaTIM, UBO, France
| | - T Graillon
- Neurosurgical Department, APHM La Timone Hospital, Marseille, France
| | - B Baussart
- Neurosurgical Department, Foch Hospital, Suresnes, France
| | - K Premat
- Interventional Neuroradiology Department, La Pitié-Salpêtrière Hospital, Paris, France; Universités de Paris, Paris, France
| | - F Clarençon
- Interventional Neuroradiology Department, La Pitié-Salpêtrière Hospital, Paris, France; Universités de Paris, Paris, France
| | - A Nouet
- Neurosurgical Department, La Pitié-Salpêtrière Hospital, Paris, France; Universités de Paris, Paris, France
| | - V Civelli
- Interventional Neuroradiology Department, Lariboisière Hospital, Paris, France; Universités de Paris, Paris, France
| | - S Froelich
- Neurosurgical Department, Lariboisière University Hospital, 2, rue Ambroise-Paré, 75010 Paris, France; Universités de Paris, Paris, France
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Guédon A, Shotar E, Thepenier C, Gabrieli J, Rolla-Bigliani C, Nouet A, Degos V, Sourour N, Clarençon F. Facteurs prédictifs d’occlusion anévrismale après pose d’un stent à diversion de flux. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rolla-Bigliani C, Gabrieli J, Shotar E, Di Maria F, Al Raaisi A, Degos V, Nouet A, Sourour N, Clarençon F. Anévrismes disséquants rompus de l’artère cérébelleuse postéro-inférieure : incidence, stratégies thérapeutiques et évolution neurologique. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Clarençon F, Di Maria F, Gabrieli J, Shotar E, Degos V, Nouet A, Biondi A, Sourour NA. Clinical Impact of Flat Panel Volume CT Angiography in Evaluating the Accurate Intraoperative Deployment of Flow-Diverter Stents. AJNR Am J Neuroradiol 2017; 38:1966-1972. [PMID: 28818824 DOI: 10.3174/ajnr.a5343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The deployment of flow-diverter stents may be difficult to analyse on regular DSA. The purpose of our study was to investigate the clinical impact of stent-dedicated flat panel volume CT angiography to evaluate intraoperatively the satisfactory deployment of flow-diverter stents. MATERIALS AND METHODS From January 2009 to April 2015, 83 consecutive patients (mean age, 51 years; 62 women) were treated in our institution with flow-diverter stents. Eighty-seven aneurysms (82 unruptured, 5 ruptured; 77 anterior, 10 posterior circulation) were treated in these 83 patients (4 patients had 2 aneurysms, both treated by means of flow-diverter stents). One patient was treated for a traumatic carotid cavernous fistula. In 80% of the cases (68/85) a flat panel volume CT angiography was performed in the angiographic suite just after the flow-diverter stent deployment. Stent visualization was assessed by 2 independent reviewers. The clinical impact of stent malapposition was evaluated. RESULTS Flow-diverter stent visualization was satisfactory in 73.5% of the cases. In 2 cases (2.9%) the flat panel volume CT angiography prompted the operator to perform an additional intrastent angioplasty for a condition that was previously underestimated. Four patients (4.7%) experienced acute thromboembolic complications; 3 others had delayed thromboembolic complications. Only 1 of these patients had thromboembolic complications (acute or delayed) related to stent misdeployment, which was easily managed intraoperatively with no clinical consequence. CONCLUSIONS Flat panel volume CT angiography is an interesting tool to depict flow-diverter stent misdeployment and may encourage the operator to perform intrastent angioplasty (2.9% of the cases in our experience) to reduce the risks of thromboembolic complications.
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Affiliation(s)
- F Clarençon
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.) .,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - F Di Maria
- Department of Interventional Neuroradiology (F.D.M.), Foch Hospital, Suresnes, France
| | - J Gabrieli
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.).,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - E Shotar
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.).,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - V Degos
- Anesthesiology (V.D.).,Paris VI University (F.C., J.G., E.S., V.D.), Pierre et Marie Curie, Paris. France
| | - A Nouet
- Neurosurgery (A.N.), Pitié-Salpêtrière Hospital. Paris France
| | - A Biondi
- Department of Neuroradiology and Endovascular Therapy (A.B.), Besançon University Hospital, Besançon, France
| | - N-A Sourour
- From the Departments of Interventional Neuroradiology (F.C., J.G., E.S., N.-A.S.)
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Clarençon F, Di Maria F, Gabrieli J, Shotar E, Zeghal C, Nouet A, Chiras J, Sourour NA. Flow Diverter Stents for the Treatment of Anterior Cerebral Artery Aneurysms: Safety and Effectiveness. Clin Neuroradiol 2015; 27:51-56. [PMID: 26250557 DOI: 10.1007/s00062-015-0441-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
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Sourour N, Hallout S, Di Maria F, Nouet A, Gabrieli J, Cornu P, Chiras J, Clarençon F. O-029 safety and effectiveness of middle cerebral artery aneurysms treatment (endovascular and surgical): retrospective analysis of a single center series with 362 consecutive patients. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011917.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zanello M, Peyre M, Mokhtari K, Boch A, Capelle L, Carpentier A, Clemenceau S, Karachi C, Navarro S, Nouet A, Reina V, Sanson M, Cornu P, Kalamarides M. Méningiomes multi-récidivants : établissement de critères de réponse thérapeutiques après analyse des cinétiques de croissance et des types de récidive. Neurochirurgie 2014. [DOI: 10.1016/j.neuchi.2014.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shotar E, Clarençon F, Sourour N, Di Maria F, Debare M, Degos V, Nouet A, Zeghal C, Chiras J. Facteurs prédictifs de l’évolution neurologique des patients présentant un hématome intra-cérébral secondaire à une rupture de malformation artério-veineuse intracrânienne. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mathon B, Gallas S, Tuillier T, Bekaert O, Decq P, Brugieres P, Nouet A, Gaston A. [Intracranial dural arteriovenous fistula with perimedullary venous drainage: Anatomical, clinical and therapeutic considerations about one case, and review of the literature]. Neurochirurgie 2013; 59:133-7. [PMID: 23806764 DOI: 10.1016/j.neuchi.2013.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 03/05/2013] [Accepted: 04/26/2013] [Indexed: 11/15/2022]
Abstract
Intracranial dural arteriovenous fistulae with perimedullary venous drainage are unusual type of vascular brain malformations. Patients may present with a rapidly progressive ascending myelopathy associated with autonomic dysfunction, which can cause a misdiagnosis and delay the therapeutic management. These clinical signs must be quickly recognized to avoid a poor outcome. The authors report the case of a 60-year-old woman presenting with a progressive myelopathy due to a dural arteriovenous fistula with perimedullary venous drainage. The diagnosis was suspected on brain-spinal MRI and confirmed by brain arteriography visualizing the arteriovenous shunt in the middle segment of the superior petrous sinus. MRI showed edema in the medulla oblongata. The treatment was performed early by endovascular glue embolization of the arteriovenous shunt and of the origin of the vein. Brain arteriography and clinical follow-up, one month later, showed complete disappearance of the dural fistula and regression of clinical symptoms. MRI control showed the reduction of the brain stem edema. Because of the early pejorative prognosis of these kinds of fistulae, early diagnosis and treatment are needed.
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Affiliation(s)
- B Mathon
- Service de neurochirurgie, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
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