Papers by philippe gailloud
Poster: "SERAM 2012 / S-0251 / Fistulas Durales Medulares y empeoramiento clinico en relacio... more Poster: "SERAM 2012 / S-0251 / Fistulas Durales Medulares y empeoramiento clinico en relacion con tratamiento corticoideo" by: "J. Blasco Andaluz1, A. Lopez Rueda1, J. Macho Fernandez1, M. Radvany2, M. Pearl2, P. Gailloud2; 1Barcelona/ES, 2Baltimore, MD/US"
Neurosurgery, Jun 1, 2008
Anatomical Science International, 2007
Interventional Neuroradiology, Jul 29, 2020
The proximal segment of the vertebral artery most often consists of a persistent sixth cervical i... more The proximal segment of the vertebral artery most often consists of a persistent sixth cervical intersegmental artery that originates from the subclavian artery, but it may also derive from a fifth, fourth, or third cervical intersegmental artery (in decreasing order of frequency), or from a first thoracic intersegmental artery. The involvement of more cranial cervical branches is exceptional, with no known persistent first cervical intersegmental artery and possibly five cases of persistent second cervical intersegmental arteries reported so far. This report describes a patient with multiple arterial variations including right persistent second cervical intersegmental artery of common carotid origin, distal VA duplication, circumflex aortic arch, and segmental internal carotid agenesis in a context of possible PHACE syndrome.
Elsevier eBooks, 2021
Spinal vascular malformations (SVM) are classified based on their location (intramedullary, perim... more Spinal vascular malformations (SVM) are classified based on their location (intramedullary, perimedullary, radicular, extradural) and flow pattern (high-flow, low-flow, no arteriovenous shunt). High-flow SVMs are generally congenital lesions diagnosed in children and young patients without gender predominance. They present with hemodynamic disturbances, mass effect, or hemorrhages, but may also be discovered incidentally. Low-flow SVMs tend to be acquired lesions presenting in older men with progressive myelopathy caused by spinal venous hypertension. They are rarely associated with vascular syndromes but may accompany prothrombotic conditions. The sensitivity and specificity of conventional MRI are excellent for high-flow SVMs but poor for low-flow lesions, which are frequently diagnosed with extensive delays reducing the potential for favorable outcomes. The sensitivity of advanced MRI techniques remains unclear, notably for the detection of low-flow shunts without flow voids on conventional MRI. Catheter angiography remains the gold standard modality for the evaluation of the spinal vasculature and its disorders. SVMs can be treated by surgical or endovascular means. Initially plagued by high recurrence rates due to inadequate embolization material, endovascular techniques represent nowadays a valid alternative to surgery, thanks notably to the introduction of liquid embolic agents.
Neuroimaging Clinics of North America, Nov 1, 2019
This article reviews the arterial and venous anatomy of the spine and spinal cord. Special emphas... more 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.
Journal of NeuroInterventional Surgery, Aug 2, 2023
BackgroundNon-Hispanic Black (NHB) patients experience increased prevalence of stroke risk factor... more BackgroundNon-Hispanic Black (NHB) patients experience increased prevalence of stroke risk factors and stroke incidence compared with non-Hispanic White (NHW) patients. However, little is known about >90-day post-stroke functional outcomes following mechanical thrombectomy.ObjectiveTo describe patient characteristics, evaluate stroke risk factors, and analyze the adjusted impact of race on long-term functional outcomes to better identify and limit sources of disparity in post-stroke care.MethodsWe retrospectively reviewed 326 patients with ischemic stroke who underwent thrombectomy at two centers between 2019 and 2022. Race was self-reported as NHB, NHW, or non-Hispanic Other. Stroke risk factors, insurance status, procedural parameters, and post-stroke functional outcomes were collected. Good outcomes were defined as modified Rankin Scale score ≤2 and/or discharge disposition to home/self-care. To assess the impact of race on outcomes at 3-, 6-, and 12-months’ follow-up, we performed univariate and multivariate logistic regression.ResultsPatients self-identified as NHB (42%), NHW (53%), or Other (5%). 177 (54.3%) patients were female; the median (IQR) age was 67.5 (59–77) years. The median (IQR) National Institutes of Health Stroke Scale score was 15 (10–20). On univariate analysis, NHB patients were more likely to have poor short- and long-term functional outcomes, which persisted on multivariate analysis as significant at 3 and 6 months but not at 12 months (3 months: OR=2.115, P=0.04; 6 months: OR=2.423, P=0.048; 12 months: OR=2.187, P=0.15). NHB patients were also more likely to be discharged to rehabilitation or hospice/death than NHW patients after adjusting for confounders (OR=1.940, P=0.04).ConclusionsNHB patients undergoing thrombectomy for ischemic stroke experience worse 3- and 6-month functional outcomes than NHW patients after adjusting for confounders. Interestingly, this disparity was not detected at 12 months. Future research should focus on identifying social determinants in the short-term post-stroke recovery period to improve parity in stroke care.
Neurosurgery, Feb 24, 2023
BACKGROUND: Intraosseous dural arteriovenous fistulas (IODAVFs) are rare DAVFs that communicate w... more BACKGROUND: Intraosseous dural arteriovenous fistulas (IODAVFs) are rare DAVFs that communicate with marrow. Given their infrequency, common nomenclature is nonexistent. Patients may present with benign symptoms, such as tinnitus, or venous hypertension symptoms including hemorrhage depending on the venous outflow pattern. OBJECTIVE: To describe all available cases of IODAVF in the literature, in addition to our cases, to better define presentation, and treatment outcomes. To advance a classification system to develop common language for these lesions for clinicians and researchers. METHODS: Neurointerventional procedure logs at 2 high-volume neurovascular centers were reviewed for all cases of IODAVFs, as was the English-based literature available in PubMed. The angioarchitecture, symptoms, management, and demographics were reviewed and summarized. RESULTS: Four institutional cases were identified, 2 of which had shunting within the marrow (clival or petrous), with venous drainage toward the heart. One case involved the dorsum sella with drainage into the superior petrosal sinus with reflux into the anterior and posterior spinal venous plexuses, and one involved the left petroclival junction, resulting in communication with the cavernous sinus with retrograde drainage into the superior ophthalmic veins. Two patients were managed by observation, one was treated with radiosurgery and one with microsurgical skeletonization. Twenty additional cases from the literature are summarized. CONCLUSION: IODAVFs of the cerebrocranial vasculature may present incidentally, with tinnitus, or with symptoms related to mass effect or venous hypertension. We propose a classification which accounts for drainage patterns. Further study is needed for these rare lesions.
Surgical and Radiologic Anatomy, Mar 23, 2022
This report describes a series of angiographic observations of tracheobronchial arterial variants... more This report describes a series of angiographic observations of tracheobronchial arterial variants and discusses their clinical implications. The angiographic features of eleven aberrant tracheal or bronchial arteries are reported, including four variants originating from the vertebral artery and two cases of bronchovertebral anastomosis. An additional observation of thyrothymic artery illustrates the discussion of the mechanisms involved in the development of these variants. Tracheobronchial arterial variants are predominantly left-sided variants (9 out of 11). They are linked to dominant paratracheal arterial connections, particularly the lateral longitudinal anastomosis. Unusual bronchial arteries of vertebral origin show a strong association with aberrant left vertebral arteries of aortic or proximal subclavian origin. This report presents a spectrum of tracheo-broncho-vertebral variations and emphasizes the role of previously described paratracheal arterial anastomoses in their formation. These variants can play a critical role during hemoptysis embolotherapy, either as an occult source of hemorrhage or as a risk factor for devastating complications.
Elsevier eBooks, 2020
Abstract Cerebral blood flow is provided by the paired internal carotid arteries (ICAs) and verte... more Abstract Cerebral blood flow is provided by the paired internal carotid arteries (ICAs) and vertebral arteries. The intradural branches of the ICA supply the anterior cerebral circulation (i.e., cerebral hemispheres, including basal ganglia) and the orbit; these branches include the ophthalmic artery, posterior communicating artery, anterior choroidal artery, and anterior and middle cerebral arteries. The vertebrobasilar system, formed by fusion of the vertebral arteries into the basilar artery, supplies the posterior cerebral circulation, including the brainstem, cerebellum, and posterior aspect of the cerebral hemispheres via the posterior cerebral arteries. Connections between the anterior and posterior circulations occur through the circle of Willis and its branches or through occasionally persistent embryologic carotid-vertebral and carotid-basilar connections (i.e., persistent trigeminal, hypoglossal, and proatlantal arteries). Cortical (or leptomeningeal) anastomoses also exist over the surface of the cerebral convexity and connect the anterior, middle, and posterior cerebral arteries. These anastomoses may provide important collateral pathways in patients with stenoocclusive disorders such as atheromatous disease or moyamoya syndrome. Finally, so-called watershed areas exist between the terminal vascular territories of the principal cerebral arteries. Watershed areas represent zones at risk for ischemic injury in patients with hemodynamically significant stenosis of the ICA, low cardiac output, or severe prolonged hypotension.
Interventional Neuroradiology, Jul 7, 2019
Book chapters and journal articles dealing with spinal cord vascular malformations often referenc... more Book chapters and journal articles dealing with spinal cord vascular malformations often reference Otto Hebold and Julius Gaupp, but frequently misrepresent the observations published by the two German authors in the late 19th century. The purpose of this paper is to provide a better appreciation of these important contributions based on abridged translations of original documents set in their historical context, notably regarding the landmark works of Brasch, Raymond and Cestan, and Lindenmann. It is concluded that Gaupp offered the first reliable description of a perimedullary arteriovenous fistula while the lesion reported by Hebold was not a spinal vascular malformation.
Journal of neurological surgery, May 23, 2018
European journal of anatomy, 2017
A bilateral intersegmental trunk is formed when a pair of left and right thoracic or lumbar inter... more A bilateral intersegmental trunk is formed when a pair of left and right thoracic or lumbar intersegmental arteries share a common aortic origin. This rare variant – most frequently found at the low lumbar level – is exceptional in the thoracic region. We describe five angiographic observations of multiple thoracic bilateral intersegmental trunks (average 4.6 per patient, range 2 to 8, with a predominance between T6 and T8). The angiographic, comparative and developmental anatomy of thoracic BITs is discussed, as well as their clinical importance for angiographers and surgeons performing procedures that involve
Objective: To characterize possible risk factors for Vascular Myelopathies (VM) in order to poten... more Objective: To characterize possible risk factors for Vascular Myelopathies (VM) in order to potentially increase their recognition and distinction from inflammatory myelopathies. Background: Although the diagnosis of “Transverse Myelitis” (TM) is widely used in the clinical setting, the recognition of VM, which can mimic cases of TM, is critical for establishing the proper treatment. Risk factors for VM have been suggested from case studies but are not well established in large groups of patients. Methods: Eighty patients with clinical and radiological (MRI and/or angiography) profiles consistent with VM were identified among patients previously referred to a specialized center for evaluation of TM during the period between 2010 and 2014. Forty-two possible risk factors, which included past medical and family history at the time of presentation, were assessed by retrospective review of the clinical records. Another group of 80 patients with diagnosis of inflammatory myelopathies were used as disease-control group. Risk factors were evaluated using single variable and multivariate statistical analysis. Results: Risk factors associated with VM included male sex (p 0.0379), history of arterial hypertension (p 0.0336), dyslipidemia (p 0.0182) and smoking (p 0.0361). A recent history of extraneous exercise, especially weight lifting, was also associated with VM (p 0.0136). A weighted score of combined risk factors for vascular disease that were not significant in the initial analysis (i.e., history of cancer, severe hypotension, Valsalva maneuvers, coronary artery disease and diabetes) showed a strong statistically significant distinction between VM and TM. Conclusions: A thorough clinical history with emphasis on past medical, personal and family history, and activities prior to the onset of the symptoms is critical to identify potential risk factors for VM in patients who present with a myelopathic syndrome. Study Supported by: The Bart McLean Fund for Neuroimmunology Research and Johns Hopkins Project Restore. Disclosure: Dr. Barreras has nothing to disclose. Dr. Quiroga has nothing to disclose. Dr. Gailloud has received personal compensation for activities with Codman Neurovascular as a consultant. Dr. Gailloud holds stock and or stock options in Artventive Medical as a co-founder. Dr. Gailloud has received research support from Siemens Medical Dr. Pardo-Villamizar has nothing to disclose.
Neurology, Feb 12, 2013
OBJECTIVE: To develop a set of clinical criteria that distinguishes inflammatory and vascular mye... more OBJECTIVE: To develop a set of clinical criteria that distinguishes inflammatory and vascular myelopathies. BACKGROUND: Inflammatory and vascular myelopathies can be difficult to distinguish as they often present with similar clinical and neuroimaging features. After reviewing 400 cases referred to the Johns Hopkins Transverse Myelitis Center (JHTMC) from 2010 to 2012, we excluded those with identifiable myelopathies to focus on the presentation of idiopathic inflammatory and vascular myelopathies. DESIGN/METHODS: We developed a set of criteria that calculated vascular and inflammatory scores based on MRI and cerebrospinal fluid (CSF) data, vascular risk factors, clinical profile, and response to acute treatment in a set of patients previously diagnosed with idiopathic TM. Patients were included if they had MRI, CSF, and clinical data for review. Patients were excluded if their diagnosis was less likely an idiopathic inflammatory myelopathy or vascular myelopathy. The above criteria were used to produce five versions of a weighted scale, which were applied to 50 patients who fulfilled inclusion/exclusion criteria. Three independent neuroimmunologists from the JHTMC evaluated records of patients to determine if they came to a consensus regarding the diagnosis. Disagreements in diagnoses between raters were discussed by the entire clinical faculty of the JHTMC, where consensus diagnoses were established. The consensus diagnoses were compared to the inflammatory and vascular scores to refine the most accurate scoring system. RESULTS: The scoring criteria that most accurately captured the expert opinions have been refined for best fit to distinguish the diagnosis of inflammatory versus vascular myelopathy. Preliminary data indicates high inter-rater reliability. CONCLUSIONS: A classification scale that includes clinical as well as MRI and CSF data may provide a better clinical tool to determine the likelihood of a diagnosis of inflammatory vs. vascular myelopathies. These criteria will be tested prospectively to confirm validity on a larger number of patients. Disclosure: Dr. Mealy has nothing to disclose. Dr. Jimenez has nothing to disclose. Dr. Gailloud has received personall compensation for activities with Codman Neurovascular as a consultant. Dr. Gailloud has received research support from Siemens Medical. Dr. Becker has nothing to disclose. Dr. Newsome has received personal compensation for activities with Biogen Idec, Novartis, and Teva Neuroscience. Dr. Levy has received personal compensation for activities with ApoPharma Inc. Dr. Levy has received research support from ApoPharma Inc. Dr. Pardo-Villamizar has nothing to disclose.
Interventional Neuroradiology, Dec 6, 2021
The course of the vertebral artery from its subclavian artery origin up to its termination at the... more The course of the vertebral artery from its subclavian artery origin up to its termination at the vertebrobasilar junction is divided into four segments (V1–V4). This segmentation, based on schemes that have evolved since the late nineteenth century, should be a consistent and reproducible anatomical concept. However, the current literature offers conflicting definitions of that scheme, not infrequently within a single article or monograph. The principal inconsistency found in modern publications concerns the termination of the V2 segment, which is either set at the C2 or C1 transverse foramen depending on the scheme considered. Consequently, the portion of the vertebral artery extending between C2 and C1—a frequent site of pathological involvement—either belongs to the V2 or V3 segment. This discrepancy can affect the validity of studies evaluating the diagnosis and management of vertebral artery disorders. A V3 segment extending from the transverse foramen of C2 to the posterior atlanto-occipital membrane and subdivided into vertical, horizontal, and oblique subsegments—a pattern suggested by Barbieri in 1867 and adopted in some modern publications—would provide a simple, precise, and reliable solution without significantly altering the widely accepted division of the vertebral artery into four segments (V1–V4).
Surgical and Radiologic Anatomy, Oct 16, 2019
Purpose To report a case of unilateral segmental agenesis of the vertebral artery (VA). Methods W... more Purpose To report a case of unilateral segmental agenesis of the vertebral artery (VA). Methods We describe the angiographic and MRI features of a segmental VA agenesis (C2 segment). Results VA agenesis is caused by the absence of the anastomotic connection normally linking two adjacent intersegmental arteries; in the reported observation, a paravertebral extraforaminal anastomosis replaced the C2 segment normally joining the 1st and 2nd cervical intersegmental arteries through the C2 transverse foramen. Conclusion We present an observation of segmental VA agenesis. This variant is consistent with the developmental history of the VA. It appears exceptional but is more likely underappreciated.
Journal of neurological surgery, May 23, 2018
PubMed, 2016
An isolated right colic artery originating directly from the abdominal aorta was incidentally obs... more An isolated right colic artery originating directly from the abdominal aorta was incidentally observed during diagnostic spinal angiography. Variations in origin of the right colic artery are reviewed, and their embryology and potential clinical implications discussed.
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Papers by philippe gailloud