Xavier Buy

Institut Bergonié, Burdeos, Aquitaine, France

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Publications (80)79.85 Total impact

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    ABSTRACT: To review our 10-year experience with percutaneous long bone cementoplasty (PLBC) in poor surgical patients.
    European radiology. 08/2014;
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    ABSTRACT: To evaluate diaphragmatic hernias (DH) after percutaneous radiofrequency ablation (PRFA) for basal lung nodules and to detect risk factors. Between January 2009 and December 2012, the presence of DH was retrospectively recorded in all of the patients who underwent PRFA with multitine expandable electrodes for ablation of nodules in the lower lobe. All nodules were classified into three groups according to the location of the tines after deployment relative to the diaphragm: In group 1, the tines were at a distance of >1 cm from the diaphragm; in group 2, at least one tine was in contact with the diaphragm without perforation; and in group 3, at least one tine was perforating the diaphragm. We recorded 4 cases of DH (3 on the left side, 1 on the right side) in 156 patients (2.3 % of procedures). The delay of onset was 7.8 months. DH occurred in groups 2 (n = 1) and 3 (n = 3). Only the 3 cases that occurred on the left side were symptomatic (2 intussusceptions and 1 gastroesophageal reflux) and were surgically repaired. The electrode was positioned in the center of the diaphragm in all cases. The central position of the electrode and the contact of at least one tine with the diaphragm after deployment seem to be a risk factor to develop DH.
    CardioVascular and Interventional Radiology 02/2014; · 2.09 Impact Factor
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    ABSTRACT: La tuberculose est une maladie qui concerne un tiers de la population mondiale. Depuis 2011, on note un premier recul à l’échelle globale malgré la disparité interrégionale et l’augmentation des résistances aux traitements médicamenteux. L’atteinte rachidienne, le mal de Pott, représente la moitié des tuberculoses ostéo-articulaires. Le traitement médical s’accompagne d’un temps chirurgical devant un tableau de compression médullaire ou radiculaire, devant un abcès volumineux et devant une ostéolyse importante de la colonne antérieure entraînant une cyphose et une instabilité. L’abord antérieur permet un meilleur débridement et la réalisation d’une bonne fusion osseuse. L’ostéosynthèse postérieure quant à elle est la plus adaptée pour réduire et maintenir à long terme l’équilibre sagittal. De nouvelles possibilités combinent les techniques chirurgicales classiques, le drainage et la décompression médullaire à foyer fermé en radiologie interventionnelle ou utilisent l’ostéosynthèse percutanée.
    Revue de Chirurgie Orthopédique et Traumatologique 01/2014; 100(2):187–193.
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    ABSTRACT: One-third of the world's population is infected with Mycobacterium tuberculosis. Data reported in 2011 indicate, for the first time, a decline in cases of tuberculosis, despite persistent inequalities across geographic areas and increasing rates of drug resistance. Osteo-articular tuberculosis affects the spine in half the cases. Pharmacotherapy must be combined with surgery in patients with spinal cord or nerve root compression, large abscesses, or marked anterior column osteolysis with kyphosis and instability. The quality of debridement and bony fusion is optimal when the anterior approach is used. Posterior fixation is the best means of achieving reduction followed by stable sagittal alignment over time. New treatment strategies combine conventional surgical methods, closed interventional radiology procedures for drainage and spinal cord decompression, and percutaneous fixation.
    Orthopaedics & Traumatology Surgery & Research 01/2014; · 1.06 Impact Factor
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    ABSTRACT: Background context Pseudomeningoceles are most commonly the result of dural tear during spine surgery. They may sometimes slowly enlarge but they generally develop inside the spinal canal, towards the foramina, or towards the surgical incision. Purpose To describe a late and exceptional complication of a surgical discectomy. Study design Case report. Methods We report a unique case of a large asymptomatic pseudomeningocele strictly developed into the L5 vertebra, discovered incidentally in a 38-year-old woman. CT and MRI showed a large cystic lesion involving the vertebral body and the left pedicle of L5 without contrast enhancement. There was neither extension of the cyst towards the vertebral lamina nor towards the spinal canal. Consent to publish the data was obtained from our patient. This work has no disclosure of funding and was approved by the Institutional Review Board of our institution. Results Diagnoses was performed during transpedicular image-guided puncture when opacification of the cyst revealed dural communication. Biochemical analysis and cytology confirmed presence of cerebrospinal fluid and absence of tumoral cells Conclusions Dural tear was considered as a neglected complication following surgical discectomy at the same level performed 18 years ago. Differential diagnoses of cystic spinal lesions are discussed.
    The Spine Journal 01/2014; · 3.36 Impact Factor
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    ABSTRACT: OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of percutaneous renal cryoablation. SUBJECTS AND METHODS. A prospective nonrandomized evaluation of 120 renal tumors in 95 patients treated with percutaneous cryoablation because their condition did not allow surgery focused on tumor characteristics, complications, hospital course, treatment success based on MRI follow-up, and effect on renal function. RESULTS. The mean follow-up period was 28 months (range, 6-63 months). The mean tumor size was 26 mm (range, 10-68 mm), including 20 tumors larger than 40 mm. Ninety-one tumors were treated with CT and 29 with MRI guidance. Fifty-six tumors were anterior, and thermal protection of adjacent organs with carbodissection or hydrodissection was used in 55 cases. According to the Clavien-Dindo classification, five grade II complications and four grade III-V complications occurred. The technical success rate was 94%. Two tumors required a second session of cryoablation because of recurrence or residual tumor. Twelve months after treatment the overall survival was 96.7%, and the disease-free survival rate was 96.4%, including patients with recurrent genetic tumors. Renal function remained unchanged even in the subgroup of patients with a single kidney. CONCLUSION. Midterm follow-up shows that percutaneous renal cryoablation is an effective and safe alternative technique for patients whose condition does not allow surgery and that renal function is preserved. Cryoablation combined with percutaneous thermal protection techniques allows treatment of more complex tumors (large central tumors and tumors close to vulnerable structures). However, T1b and central tumors are associated with higher risk of incomplete treatment.
    American Journal of Roentgenology 12/2013; 201(6):1353-1361. · 2.90 Impact Factor
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    ABSTRACT: PURPOSE: We present our experience of utilizing peripheral nerve electrostimulation as a complementary monitoring technique during percutaneous thermal ablation procedures; and we highlight its utility and feasibility in the prevention of iatrogenic neurologic thermal injury. METHODS: Peripheral motor nerve electrostimulation was performed in 12 patients undergoing percutaneous image-guided thermal ablations of spinal/pelvic lesions in close proximity to the spinal cord and nerve roots. Electrostimulation was used in addition to existing insulation (active warming/cooling with hydrodissection, passive insulation with CO2 insufflation) and temperature monitoring (thermocouples) techniques. Impending neurologic deficit was defined as a visual reduction of muscle response or need for a stronger electric current to evoke muscle contraction, compared with baseline. RESULTS: Significant reduction of the muscle response to electrostimulation was observed in three patients during the ablation, necessitating temporary interruption, followed by injection of warm/cool saline. This resulted in complete recovery of the muscle response in two cases, while for the third patient the response did not improve and the procedure was terminated. No patient experienced postoperative motor deficit. CONCLUSION: Peripheral motor nerve electrostimulation is a simple, easily accessible technique allowing early detection of impending neurologic injury during percutaneous image-guided thermal ablation. It complements existing monitoring techniques and provides a functional assessment along the whole length of the nerve.
    CardioVascular and Interventional Radiology 05/2013; · 2.09 Impact Factor
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    ABSTRACT: When a metastatic disease is localized and slowly evolving either spontaneously or after a general treatment, a local treatment may be proposed. For about 15 years, image-guided percutaneous ablation has been developed which allows to treat tumors with temperature modifications. These mini-invasive techniques may be repeated in patients whose disease may be chronic. Ablation techniques are also used in a more palliative manner on bone metastases to obtain pain relief.
    Bulletin du cancer 04/2013; · 0.61 Impact Factor
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    ABSTRACT: Les fractures sur spondylarthrite ankylosante peuvent survenir suite à un traumatisme mineur. Le diagnostic de fracture non déplacée est basé sur la symptomatologie couplée à l’imagerie. L’interprétation radiologique reste cependant difficile et explique un taux de diagnostics tardifs considérable. Nous rapportons ici le cas d’un patient présentant une fracture occulte de L2 sur les radiographies lombaires et décrivons le cheminement radiologique suivi. La séquence T2 STIR sur l’imagerie à résonance magnétique (IRM) permet de déterminer le siège et l’ancienneté de la fracture. La séquence IRM T1 et la tomodensitométrie (TDM) servent ensuite à analyser le trait de fracture. Le traitement est souvent chirurgical en raison de l’instabilité de la fracture. Le taux de complications septiques et de descellement d’implants est non négligeable en chirurgie ouverte. L’utilisation de l’ostéosynthèse percutanée n’a pas encore été étudiée dans l’indication de fracture sur spondylarthrite ankylosante. Cette technique chirurgicale minimale invasive permet de réaliser une fixation interne multi-étagée et pourrait représenter une alternative à la chirurgie ouverte.
    Revue de Chirurgie Orthopédique et Traumatologique 02/2013; 99(1):87–91.
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    ABSTRACT: Patients with ankylosing spondylitis may experience spinal fractures even after minor injuries. The diagnosis of non-dislocated spinal fracture is based on clinical symptoms and radiological findings. Difficulties in interpreting the imaging studies can result in considerable diagnostic delays. We describe the steps of the radiological diagnosis in a patient with a fracture of L2 that was not visible on standard lumbar spine radiographs. Magnetic resonance imaging (MRI) T2 STIR sequences allowed determining the location and showed signs of a recent fracture. Then, MRI T1 images and computed tomography provided a detailed evaluation of the fracture line. In patients with ankylosing spondylitis, fracture instability is common, making surgical treatment mandatory. Open surgery is associated with substantial rates of infection and implant loosening. Percutaneous instrumentation has not yet been evaluated for the treatment of spinal fractures in patients with ankylosing spondylitis. This minimally invasive surgical technique enables multilevel internal fixation and may constitute an interesting alternative to open surgery.
    Orthopaedics & Traumatology Surgery & Research 12/2012; · 1.06 Impact Factor
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    ABSTRACT: We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance. Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI. Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1-25). Mean PSA nadir was 0.33 ng/ml (range: 0.02-0.94 ng/ml). Mean hospitalisation was 5 days (range: 3-13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain. MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy. • Magnetic resonance allows precise positioning of cryoprobes with real-time imaging. • High-resolution MRI allows excellent monitoring of the developing ice ball. • Cryoablation of prostate cancer under MR guidance is technically feasible. • Further work will refine the procedure and make it even safer.
    European Radiology 08/2012; 22(8):1829-35. · 4.34 Impact Factor
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    ABSTRACT: PURPOSE: To describe the technique and clinical outcome of percutaneous injection of bone cement in the treatment of symptomatic para-articular intraosseous cysts. MATERIALS AND METHODS: Five patients (three men, two women; mean age 35 years) with painful para-articular intraosseous cysts were treated by percutaneous injection of bone cement under combined fluoroscopic and computed tomography (CT) guidance. The lesions were all located in weight-bearing bones, involving the acetabulum, proximal tibia, distal tibia, talus, and calcaneus, respectively. RESULTS: The average amount of bone cement injected was 2.1 ml (range, 0.6-3.5 ml). Calcium phosphate cement was used in four cases and acrylic cement in one case. There were no immediate or delayed complications. Full pain relief was obtained between 1 and 4 weeks after treatment. All patients made a complete recovery and were pain-free at their last visit. CONCLUSIONS: Percutaneous injection of bone cement was a safe and efficient technique in the management of symptomatic para-articular intraosseous cysts in our population.
    Skeletal Radiology 04/2012; · 1.74 Impact Factor
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    ABSTRACT: To retrospectively evaluate the midterm outcome of patients treated for primary renal cell carcinomas arising in kidney transplants with minimally invasive techniques. The institutional review board of each participating institution approved this retrospective study and waived informed consent. This study was HIPAA compliant. A request for cases through the European Society of Urogenital Radiology network was made to institutions for patients who fit the requirements outlined by the authors, and a prospective follow-up of recipients was performed. Twenty-four tumors were identified that developed in the renal allograft of 20 patients from 11 institutions who were treated with radiofrequency ablation (n = 19) or cryoablation (n = 5) between 2003 and 2010. Maximal diameter of masses was 6-40 mm (median, 19.5 mm). Twenty masses were solid, and four were type 4 cystic masses. Preablation biopsy was performed for solid tumors only. All images and biologic and biopsy reports were retrospectively reviewed. Significant differences were determined by using a paired t test before and after ablation. Mean follow-up was 27.9 months (range, 7-71 months). Histopathologic examination revealed papillary carcinoma in 17 patients and clear cell carcinoma in three. Tumors were successfully treated with ultrasonographic guidance in six patients, with computed tomographic guidance in 10 patients, and with both in four patients. One case of infection of the tumor site and one case of transitory genitofemoral nerve injury were the only reported complications. No significant change of renal function was noted. Subsequent imaging follow-up did not reveal any case of recurrence in the ablative site. Percutaneous thermal ablation of renal tumors occurring in renal grafts is effective, with low morbidity. .
    Radiology 09/2011; 260(3):900-7. · 6.34 Impact Factor
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    ABSTRACT: Percutaneous ablation of renal tumors, including radiofrequency ablation and cryoablation, are increasingly being used for small tumors as an alternative to surgery for poor surgical candidates. Compared to radiofrequency ablation, cryoablation has several advantages: improved volume control and preservation of adjacent structures due to the excellent depiction of the ice ball on CT and MRI; better protection of the collecting system for central tumor with reduced risk of postprocedural urinary fistula. The main pitfall of cryoablation is the higher cost. Therefore, cryoablation should be reserved for the treatment of complex tumors. In this article, we will review the different steps of percutaneous renal tumor ablation procedures including patient selection, technical considerations, and follow-up imaging.
    Journal de Radiologie 09/2011; 92(9):774-88. · 0.35 Impact Factor
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    ABSTRACT: Several interventional radiology procedures are available for the management of cancer pain. In this article, we will briefly review the different procedures and their value in the setting of cancer pain management under two main categories: indirect action (regional anesthesia from neurolysis) and direct action on the tumor. Percutaneous ablation of bone tumors: alcohol, laser, radiofrequency, microwaves, ultrasound, and cryoablation. Several indications have previously been validated, including thermal ablation of bone metastases with results superior to conventional therapies. Additional applications should be validated over the next few years.
    Journal de Radiologie 09/2011; 92(9):801-13. · 0.35 Impact Factor
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    ABSTRACT: A variety of thermal ablation techniques have been advocated for percutaneous tumor management. Although the above techniques are considered safe, they can be complicated with unintended thermal injury to the surrounding structures, with disastrous results. In the present article we report a number of different insulation techniques (hydrodissection, gas dissection and balloon interposition, warming/cooling systems) that can be applied. Emphasis is given to the procedure-related details, and we present the advantages and drawbacks of the insulation techniques. We also provide tips on avoiding painful skin burns when treating superficial lesions. Finally, we point out the interest of temperature monitoring and how it can be achieved (use of thermocouples, fiberoptic thermosensors, or direct magnetic resonance imaging temperature mapping). The above thermal insulation and temperature monitoring techniques can be applied alone or in combination. Familiarity with these techniques is essential to avoid major complications and to increase the indications of thermal ablation procedures.
    Techniques in vascular and interventional radiology 09/2011; 14(3):170-6.
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    ABSTRACT: Cervical discogenic pain is an important cause of suffering and disability in the adult population. Pain management in cervical disc herniation relies initially on conservative care (rest, physiotherapy, and oral medications). Once conservative treatment has failed, different percutaneous minimally invasive radiological procedures can be applied to relief pain. This article offers a systematic review on the percutaneous minimally invasive techniques that can be advocated for the treatment of cervical pain of discal origin. Periradicular steroid injection under image guidance (computed tomography or magnetic resonance imaging) is the first technique to be considered. The steroid injection aims at reducing the periradicular inflammation and thus relieves the radicular pain. The steroid injections present satisfying short-term results, but pain can recur in the long term. Whenever the steroid injections fail to relieve pain from a contained cervical disc herniation, the more invasive percutaneous disc decompression techniques should be proposed. Percutaneous radiofrequency nucleoplasty is the most often applied technique on the cervical level with a low risk of thermal damage. When the indications and instructions are respected, radiofrequency nucleoplasty presents accepted safety and efficacy levels.
    Seminars in Musculoskeletal Radiology 04/2011; 15(2):172-80. · 1.40 Impact Factor
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    ABSTRACT: Several interventional radiology procedures are available for the management of cancer pain. In this article, we will briefly review the different procedures and their value in the setting of cancer pain management under two main categories: indirect action (regional anesthesia from neurolysis) and direct action on the tumor. Percutaneous ablation of bone tumors: alcohol, laser, radiofrequency, microwaves, ultrasound, and cryoablation. Several indications have previously been validated, including thermal ablation of bone metastases with results superior to conventional therapies. Additional applications should be validated over the next few years.
    Journal De Radiologie - J RADIOL. 01/2011; 92(9):801-813.
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    ABSTRACT: Percutaneous ablation of renal tumors, including radiofrequency ablation and cryoablation, are increasingly being used for small tumors as an alternative to surgery for poor surgical candidates. Compared to radiofrequency ablation, cryoablation has several advantages: improved volume control and preservation of adjacent structures due to the excellent depiction of the ice ball on CT and MRI; better protection of the collecting system for central tumor with reduced risk of postprocedural urinary fistula. The main pitfall of cryoablation is the higher cost. Therefore, cryoablation should be reserved for the treatment of complex tumors. In this article, we will review the different steps of percutaneous renal tumor ablation procedures including patient selection, technical considerations, and follow-up imaging.
    Journal De Radiologie - J RADIOL. 01/2011; 92(9):774-788.
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    ABSTRACT: The purpose of this study was to evaluate experience with and determine the efficacy and safety of thermal ablation in the management of spinal osteoid osteomas close to neural elements. The records of all patients with osteoid osteomas of the spine managed with thermal ablation at two academic centers from 1993 to 2008 were reviewed. Seventeen patients (13 male patients, four female patients; mean age, 25.9 years) had lesions in the lumbar (seven patients), thoracic (six patients), cervical (three patients), and sacral (one patient) regions of the spine. Two lesions were in the vertebral body, one was within the dens, and the others were in the posterior elements. The mean lesion diameter was 8.8 mm, and the mean distance between the lesion and the closest neural element was 4.3 mm. The lesions were managed with laser (13 lesions) or radiofrequency (four lesions) ablation. Special thermal protection techniques involving the epidural injection of gas or cooled fluid were used. Pain levels were assessed immediately before the procedure and on the day after the procedure. Long-term follow-up findings were available for 11 patients. No complications were encountered, and all patients reported relief of pain. The 11 patients who participated in long-term follow-up reported continued relief of pain. Percutaneous thermal ablation can be used to manage spinal osteoid osteomas close to the neural elements. Special thermal protection techniques may add a margin of safety.
    American Journal of Roentgenology 10/2010; 195(4):W293-8. · 2.90 Impact Factor

Publication Stats

461 Citations
79.85 Total Impact Points

Institutions

  • 2009–2014
    • Institut Bergonié
      Burdeos, Aquitaine, France
    • Nottinghamshire Healthcare NHS Trust
      Nottigham, England, United Kingdom
  • 1970–2013
    • University of Strasbourg
      Strasburg, Alsace, France
  • 2007–2012
    • CHRU de Strasbourg
      Strasburg, Alsace, France