The Experts below are selected from a list of 1920 Experts worldwide ranked by ideXlab platform
Philippe Gailloud - One of the best experts on this subject based on the ideXlab platform.
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safety of diagnostic Spinal Angiography in children
Journal of NeuroInterventional Surgery, 2021Co-Authors: Ayushi Gautam, Mina Motaghi, Philippe GailloudAbstract:Background Spinal Angiography (SA) is associated with low complications in adults but its safety in children has not been properly analyzed. The goal of our study is to assess the safety of pediatric SA. Methods This study is the retrospective analysis of a series of 36 consecutive SA procedures performed in 27 children over a 5-year period. Parameters including neurological complications, non-neurological complications requiring additional management, contrast volume, and radiation exposure were analyzed via univariate and bivariate methods. Results Our cohort included 24 diagnostic and 12 combined therapeutic cases in children with an average age of 11.1 years. No neurological or non-neurological complication requiring additional management was recorded. The average volume of contrast administered was 1.6 mL/kg in the diagnostic group and 0.9 mL/kg in the combined group. The average air kerma was 186.9mGy for an average of 36.8 exposures in the diagnostic group, and 264.5mGy for an average of 21 exposures in the combined group. Patients in the combined group had lower contrast load (45% lower on average) and higher air kerma (1.6 times higher on average). The difference in air kerma was due to a higher live fluoroscopy-related exposure. Conclusions This study reports the largest pediatric SA cohort analyzed to date and the only one including radiation dose and contrast load. It confirms that pediatric SA is a safe imaging modality with low risk of complications, and demonstrates that SA can be performed in children with low radiation exposure and contrast load.
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report of a Spinal extradural arteriovenous fistula with double radiculomedullary venous drainage therapeutic implications and role of intraoperative Spinal Angiography
Journal of Neurosurgery, 2021Co-Authors: Lydia Gregg, Philippe GailloudAbstract:Low-flow Spinal extradural arteriovenous fistulas (SEAVFs) are frequently misdiagnosed as Spinal dural arteriovenous fistulas (SDAVFs), and their true prevalence is unknown. The principal feature distinguishing low-flow SEAVFs from SDAVFs is the location of the shunt, which involves a pouch of epidural plexus in SEAVFs and a radiculomedullary vein (RMV) in SDAVFs. A venous hypertensive myelopathy comparable to the one observed with SDAVFs develops when the arterialized venous pouch of an SEAVF is connected to an RMV. Depending on the size of the epidural pouch, a low-flow SEAVF may uncommonly drain into multiple RMVs. The authors present an observation of a low-flow SEAVF whose double radiculomedullary drainage was revealed only after intraoperative digital subtraction Angiography, and they discuss the surgical implications of this anatomical configuration.
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Spinal vascular anatomy
Neuroimaging Clinics of North America, 2019Co-Authors: Philippe GailloudAbstract:This article reviews the arterial and venous anatomy of the spine and Spinal cord. Special emphasis is placed on vessels critical to the conduct and interpretation of Spinal Angiography, notably the intersegmental artery and its cranial and caudal derivatives: the vertebral, supreme intercostal, and sacral arteries.
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introduction to diagnostic and therapeutic Spinal Angiography
Neuroimaging Clinics of North America, 2019Co-Authors: Philippe GailloudAbstract:This article describes the basic principles of diagnostic and therapeutic Spinal Angiography as practiced by the author, including catheterization and radioprotection techniques, the selection of endovascular devices and embolization agents, and procedural complications.
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Spinal dural arteriovenous fistula sdavf variant with dual perimedullary and epidural drainage
European Spine Journal, 2018Co-Authors: Philippe GailloudAbstract:A Spinal dural arteriovenous fistula (SDAVF) is an abnormal connection between a radiculomeningeal artery and a radiculomedullary vein (RMV) characteristically draining into the perimedullary venous system. We present an observation of SDAVF draining simultaneously into the perimedullary and epidural venous systems. A 67-year-old man presented with lower extremity weakness and sphincter dysfunction. MRI documented a longitudinally extensive myelopathy with parenchymal enhancement and flow-voids on T2-weighted images. Spinal Angiography revealed the presence of two SDAVFs, at left T9 and right L1. The right L1 SDAVF was treated endovascularly. Superselective Angiography of the main feeder, a right T12 radiculomeningeal branch, documented an unusual drainage pattern, with contrast flowing both retrogradely towards the perimedullary venous system and antegradely into the epidural plexus. The meningeal branch was embolized using a liquid embolic agent with adequate penetration of the embolic material into the proximal segment of the draining vein. The left T9 SDAVF was surgically resected, as the radicular artery supplying the fistula also provided the artery of Adamkiewicz. Dual drainage of the right L1 SDAVF into the perimedullary and epidural venous systems allowed to locate the site of the arteriovenous shunt at the point of transdural passage of the RMV, a narrowed segment also known to represent an anti-reflux mechanism. The potential role played by the topographical relationship between the shunt and the anti-reflux mechanism of the RMV in the formation and clinical expression of SDAVFs is discussed.
Rafael J Tamargo - One of the best experts on this subject based on the ideXlab platform.
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intraoperative indocyanine green Angiography for obliteration of a Spinal dural arteriovenous fistula case report
Journal of Neurosurgery, 2009Co-Authors: Geoffrey P Colby, Philippe Gailloud, Alexander L Coon, Daniel M Sciubba, Ali Bydon, Rafael J TamargoAbstract:Spinal dural arteriovenous fistulas (DAVFs) are the most common type of Spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent Angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine. The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 Spinal DAVF was diagnosed based on results of conventional Spinal Angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7-9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent Angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG Angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG Angiography in vascular neurosurgery of the spine.
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intraoperative indocyanine green Angiography for obliteration of a Spinal dural arteriovenous fistula
Journal of Neurosurgery, 2009Co-Authors: Geoffrey P Colby, Philippe Gailloud, Alexander L Coon, Daniel M Sciubba, Ali Bydon, Rafael J TamargoAbstract:Spinal dural arteriovenous fistulas (DAVFs) are the most common type of Spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent Angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine. The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 Spinal DAVF was diagnosed based on results of conventional Spinal Angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7-9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent Angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG Angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG Angiography in vascular neurosurgery of the spine.
Vibhash D Sharma - One of the best experts on this subject based on the ideXlab platform.
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delayed onset paraparesis complicating epidural steroid injection with underlying Spinal dural arteriovenous fistula
Pain management, 2016Co-Authors: Kartavya Sharma, Vibhash D SharmaAbstract:We report a case of a 48-year-old man with chronic back pain attributed to discogenic lumbar radiculopathy who underwent a fluoroscopy-guided L2–3 interlaminar epidural steroid injection. 4 h later, he developed acute paraparesis, sensory loss below T10 level and urinary retention. MRI of the thoracic spine revealed diffuse abnormal T2/FLAIR signal and extensive vascular flow voids. A Spinal dural arteriovenous fistula was confirmed on Spinal Angiography. Embolization of the Spinal dural arteriovenous fistula resulted in significant improvement of symptoms. We review previously reported cases and current understanding of the pathophysiology of this complication. All cases had symptom onset several hours after the procedure. There seems to be a trend toward better outcomes with earlier treatment.
Liang Chuansheng - One of the best experts on this subject based on the ideXlab platform.
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the clinical application studies of ct Spinal Angiography with 64 detector row spiral ct in diagnosing Spinal vascular malformations
European Journal of Radiology, 2009Co-Authors: Gao Sijia, Zhang Mengwei, Liu Xiping, Zhu Yushen, Liu Jinghong, Wang Zhonghui, Zang Peizhuo, Shi Qiang, Wang Qiang, Liang ChuanshengAbstract:Abstract Background and purpose To explore the value of CT Spinal Angiography with 64-detector row spiral CT in diagnosing Spinal vascular malformations. Methods Seventeen patients with initial MR and clinical findings suggestive of Spinal vascular diseases underwent CT Spinal Angiography. Among these, 14 patients took DSA examination within 1 week after CT scan, 7 patients underwent surgical treatment, and 6 patients underwent vascular intervention embolotheraphy. CT protocol: TOSHIBA Aquilion 64 Slice CT scanner, 0.5 mm thickness, 0.5 s/r, 120 kV and 350 mA, positioned at the aortic arch level, and applied with “sure start” technique with CT threshold of 180 Hu. Contrast agent Iohexol (370 mg I/ml) was injected at 6 ml/s velocity with total volume of 80 ml. The post-processing procedures included MPR, CPR, MIP, VR, etc. Among the 17 patients, four patients underwent fast dynamic contrast-enhanced 3D MR Angiography imaging. CT Spinal Angiography and three-dimensional contrast-enhanced MR Angiography (3D CE-MRA) images were compared and evaluated with DSA and operation results based on disease type, lesion range, feeding arteries, fistulas, draining veins of vascular malformation by three experienced neuroradiologists independently, using double blind method. The data were analyzed using SPSS analytic software with χ2-test. We compared the results with DSA and operation results. Results The statistical analysis of the diagnostic results by the three experienced neuroradiologists had no statistical difference (P > 0.05). All of the 17 patients showed clearly the abnormality of Spinal cord vessels and the range of lesions by CT Spinal Angiography. Among them, one patient was diagnosed as arteriovenous fistulas (AVF) by MRI and CT Spinal Angiography, which was verified by surgical operation. DSA of the same patient, however, did not visualize the lesion. One case was diagnosed as AVM complicated with AVF by DSA, but CT Spinal Angiography could only show AVM not AVF. The type differentiations of all the other 16 patients were consistent with DSA results. For 13 cases with positive CT Spinal Angiography results, DSA displayed 20 feeding vessels, among which 16 vessels were displayed correctly by CT Spinal Angiography, four could not be visualized, and two turned out to be false-positive. Fistulas were not displayed in six cases by CT Spinal Angiography. Draining veins were displayed clearly in all cases, which agreed with DSA results. Four cases who took CE-MRA obtained the same type diagnosis as that from CT Spinal Angiography. Feeding arteries were not displayed in CE-MRA of one case, but could be clearly visualized in other three cases, and the results agreed with CTA and DSA results. Fistulas could be seen in two cases. Draining veins and the disease range could be displayed distinctly by 3D CE-MRA. Conclusion CT Spinal Angiography is quite valuable for diagnosing vascular malformation of Spinal cord. It can be a screening exam before DSA, and has a guiding effect on DSA, reducing the amount of time required for DSA.
Geoffrey P Colby - One of the best experts on this subject based on the ideXlab platform.
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robotic assistant Spinal Angiography a case report and technical considerations
Case Reports, 2021Co-Authors: Satoshi Tateshima, Hamidreza Saber, Geoffrey P Colby, Dieter R Enzmann, Gary DuckwilerAbstract:Robotic-assisted technology has shown to be promising in coronary and peripheral vascular interventions. Early case reports have also demonstrated its efficacy in neuro-interventions. However, there is no prior report demonstrating use of the robotic-assisted platform for Spinal Angiography. We report the feasibility of the robotic-assisted thoracic and lumbar Spinal Angiography.
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intraoperative indocyanine green Angiography for obliteration of a Spinal dural arteriovenous fistula case report
Journal of Neurosurgery, 2009Co-Authors: Geoffrey P Colby, Philippe Gailloud, Alexander L Coon, Daniel M Sciubba, Ali Bydon, Rafael J TamargoAbstract:Spinal dural arteriovenous fistulas (DAVFs) are the most common type of Spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent Angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine. The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 Spinal DAVF was diagnosed based on results of conventional Spinal Angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7-9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent Angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG Angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG Angiography in vascular neurosurgery of the spine.
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intraoperative indocyanine green Angiography for obliteration of a Spinal dural arteriovenous fistula
Journal of Neurosurgery, 2009Co-Authors: Geoffrey P Colby, Philippe Gailloud, Alexander L Coon, Daniel M Sciubba, Ali Bydon, Rafael J TamargoAbstract:Spinal dural arteriovenous fistulas (DAVFs) are the most common type of Spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent Angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine. The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 Spinal DAVF was diagnosed based on results of conventional Spinal Angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7-9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent Angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG Angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG Angiography in vascular neurosurgery of the spine.