P Lasjaunias

Hôpital Bicêtre (Hôpitaux Universitaires Paris-Sud), Lutetia Parisorum, Île-de-France, France

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Publications (349)495.77 Total impact

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    ABSTRACT: Cerebral aneurysms arise at the bifurcation of blood vessels. They are primarily saccular in shape, but may have additional lobules or “nipples”. Far less commonly, fusiform dilatation or ectasia of intracranial vessels occurs and in some cases may be associated with connective tissue or atherosclerotic disease. Most saccular aneurysms occur in relation to the anterior cerebral artery (35%), followed by the internal carotid artery (30%), and the middle cerebral artery (25%). About 10% arise from the posterior circulation. The formation of cerebral aneurysms was originally attributed to the presence of developmental defects in the tunica media, but defects in this layer occur as frequently in extracranial vessels where saccular aneurysms are rare. Furthermore, cerebral aneurysms are rarely seen in children.
    No preview · Chapter · Dec 2009
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    S Geibprasert · T Krings · V Pereira · S Pongpech · R Piske · P Lasjaunias
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    ABSTRACT: Dural arteriovenous shunts (DAVSs) developing in either the ventral, dorsal or lateral epidural spaces (VE, DE and LE-shunts) predictably drain in either cranio/spino-fugal or -petal directions. Associated conditions like venous outflow restrictions (VOR) may be responsible for changes in this drainage pattern. The goal of this study was to compare demographic, angiographic and clinical characteristics of different types of DAVS in Europe, South America, and Asia to find out whether the same clinical profile is present in different ethnicities. Charts and angiographic films of 446 patients with DAVS from three hospitals in Europe, Asia and South America were retrospectively evaluated. Clinical symptoms were separated into benign and aggressive and the presence or absence of cortical venous reflux (CVR) and VOR was noted. LE-shunts were present in elderly men and were always associated with CVR resulting in aggressive symptoms. VE-shunts were present in females and almost always had benign symptoms. There were no differences among the three populations for these shunts. DE-shunts in the Asian population were more aggressive secondary to a higher rate of VOR with associated CVR. VE-shunts rarely lead to CVR even in the presence of VOR, whereas LE-shunts invariably lead to CVR, irrespective of the population investigated. CVR in DE-shunts is not related to the primary disease (i.e. the shunt itself) but to associated factors that led to VOR. Since the occurrence of these varied between different ethnicities, DE-shunts were aggressive in the Asian population and benign in the European and South American populations.
    Full-text · Article · Dec 2009 · Interventional Neuroradiology
  • G. Rodesch · M. Hurth · M. Tadie · P. David · S. Gaillard · P. Lasjaunias

    No preview · Article · Sep 2009
  • P Mercier · G Brassier · H-D Fournier · M Delion · X Papon · P Lasjaunias
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    ABSTRACT: One hundred brains (first injected in cerebral arteries and veins with latex neoprene or India ink and studied under optic magnification) illustrate this anatomic chapter concerning the microsurgical anatomy of the cisternal segment, the neurovascular relationships, and the blood supply of the IIIrd to the XIIth cranial nerves.
    No preview · Article · Apr 2009 · Neurochirurgie

  • No preview · Article · Nov 2008 · Cancer/Radiothérapie
  • Source
    D.R. Rutgers · P Fillard · G Paradot · M Tadié · P Lasjaunias · D Ducreux
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    ABSTRACT: The corpus callosum is an important predilection site for traumatic axonal injury but may be unevenly affected in head trauma. We hypothesized that there were local differences in axonal injury within the corpus callosum as investigated with diffusion tensor imaging (DTI), varying among patients with differing severity of traumatic brain injury (TBI). Ethics committee approval and informed consent were obtained. Ten control subjects (7 men, 3 women; mean age, 37 +/- 9 years) and 39 patients with TBI (27 men, 12 women; 34 +/- 12 years) were investigated, of whom 24 had mild; 9, moderate; and 6, severe TBI. Regions of interest were selected in the callosal genu, body, and splenium to calculate fractional anisotropy (FA), apparent diffusion coefficient (ADC), and the number of fibers passing through. Statistical comparison was made through analysis of variance with the Scheffé post hoc analysis. Compared with controls, patients with mild TBI investigated <3 months posttrauma (n = 12) had reduced FA (P < .01) and increased ADC (P < .05) in the genu, whereas patients with mild TBI investigated > or =3 months posttrauma (n = 12) showed no significant differences. Patients with moderate and severe TBI, all investigated <3 months posttrauma, had reduced FA (P < .001) and increased ADC (P < .01) in the genu compared with controls and reduced FA in the splenium (P < .001) without significant ADC change. Mild TBI is associated with DTI abnormalities in the genu <3 months posttrauma. In more severe TBI, both the genu and splenium are affected. DTI suggests a larger contribution of vasogenic edema in the genu than in the splenium in TBI.
    Preview · Article · Jul 2008 · American Journal of Neuroradiology
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    T Aurboonyawat · V Pereira · T Krings · F Toulgoat · P Chiewvit · P Lasjaunias
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    ABSTRACT: Ontogenetically, the ventricular venous systemmay develop in order to drain the gray matter(cells of the mantle layer of the neural tube) which migrates dorsally. On primitive brain vesicles of submammals especially fish, amphibianand reptile, the ventricular venous system is the major venous collector located on the middorsal surface, in between the meningeal layers comparable to the subarachnoid space in mammals. The ventricular venous system functions as a major drainage system for the brain vesicles in these submammals but its role decreases when the other two venous systems develop. Concerning the route of venous exit from the brain vesicles, we found that it resembles the spinal cord but could not be found all the way along the brain vesicles.
    Full-text · Article · Jun 2008 · Interventional Neuroradiology
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    ABSTRACT: The cranio spinal epidural spaces were categorized into three different compartments - ventral, dorsal and lateral. Each compartment has its specific drainage role in relation to the embryologic development of the venous system of the central nervous system (CNS) and the surrounding bony structures. The ventral epidural space drains structures derived from the notochord and adjacent sclerotomes. The dorsal epidural group is related to the drainage of the spinous processes at the spinal level and to the vault and calvarium cranially. The lateral epidural group collects the emissary bridging veins of the pial venous system of the spinal cord and brain. The dural arteriovenous shunts (DAVS) developing in these spaces predictably drain either in the subarachnoid veins or in the epidural-paraspinal collectors according to the epidural compartment involved. Additional comorbidity, like epidural venous thrombosis or high flow characteristics of the DAVS, will be responsible for changes in the draining pattern of otherwise anticipated spinofugal or craniofugal drainage. This embryologically based classification establishes homologies between spinal and cranial epidural spaces, thus allowing epidemiological and clinical comparison including spinal and cranial DAVSs.
    No preview · Article · May 2008
  • L Hernandez · P Landrieu · F Toulgoat · P Lasjaunias
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    ABSTRACT: Primary stroke can be due to embolism or an obstructive process of the vascular wall. Embolism may come from a parietal lesion of a large artery in the neck (traumatic dissections), from a cryptic cardiopathy, from a venous thrombosis associated with a right-left shunt. Among pathologies of endocranial arteries, the most frequent is the acute, postviral arteriopathy of the sus-clinoïd carotid, which evolves toward stabilisation or regression. Insidious obstructive arteriopathies of the Willis circle, including development of a transparenchymal suppletive circulation (Moya-Moya disease), cumulate chronic circulatory insufficiency and repetitive strokes. Inflammatory multifocal cerebral arteriopathies mainly involve mean and small arteries. Most of them are secondary to a multisystemic disease, but some are primary. The basic investigation is anatomical and begins with MRI. Emergency conventional cerebral angiography is discussed when heparinotherapy is difficult to decide (evolutive thrombosis), or when an endovascular intervention appears possible (anoeuvrism). Secondarily, conventional angiography is indicated in any chronic situation where a precise anatomical follow-up is necessary. Investigations of the cardiovascular system, of the thrombophilic risk, of a dysimmune process are discussed according to the clinico-anatomical diagnosis.
    No preview · Article · Apr 2008 · Archives de Pédiatrie
  • Source
    D.R. Rutgers · F Toulgoat · J Cazejust · P Fillard · P Lasjaunias · D Ducreux
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    ABSTRACT: Traumatic axonal injury is a primary brain abnormality in head trauma and is characterized by reduction of fractional anisotropy (FA) on diffusion tensor imaging (DTI). Our hypothesis was that patients with mild traumatic brain injury (TBI) have widespread brain white matter regions of reduced FA involving a variety of fiber bundles and show fiber disruption on fiber tracking in a minority of these regions. Ethics committee approval and informed consent were obtained. Twenty-one patients with mild TBI were investigated (men:women, 12:9; mean age +/- SD, 32 +/- 9 years). In a voxel-based comparison with 11 control subjects (men:women, 8:3; mean age, 37 +/- 9 years) using z score analysis, patient regions with abnormally reduced FA were defined in brain white matter. MR imaging, DTI, and fiber tracking characteristics of these regions were described and analyzed using Pearson correlation, linear regression analysis, or the chi(2) test when appropriate. Patients had on average 9.1 regions with reduced FA, with a mean region volume of 525 mm(3), predominantly found in cerebral lobar white matter, cingulum, and corpus callosum. These regions mainly involved supratentorial projection fiber bundles, callosal fibers, and fronto-temporo-occipital association fiber bundles. Internal capsules and infratentorial white matter were relatively infrequently affected. Of all of the involved fiber bundles, 19.3% showed discontinuity on fiber tracking. Patients with mild TBI have multiple regions with reduced FA in various white matter locations and involving various fiber bundles. A minority of these fiber bundles show discontinuity on fiber tracking.
    Full-text · Article · Apr 2008 · American Journal of Neuroradiology
  • Source
    P H Mercier · G Brassier · H D Fournier · J Picquet · X Papon · P Lasjaunias
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    ABSTRACT: This study of 25 brains at the pontomedullary junction defined the different possible origins of the perforating arteries and lateral spinal arteries in relation to the posterior inferior cerebellar arteries (PICAs). - If the PICA emerges from the common trunk of the AICA-PICA coming from the basilar artery, it never gives perforating arteries or a lateral spinal artery on the lateral surface of the brain stem but supplies blood to a part of the ipsilateral cerebellar hemisphere. - If the PICA arises extradurally at C1, it never gives perforating arteries for the lateral surface of the brain stem, but it gives pial branches for the posterior surface of the medulla oblongata and is always the origin of the lateral spinal artery. - If the PICA emerges in the intradural vertebral artery, it is the source of the perforating arteries for the lateral surface of the brain stem and of the blood supply of the ipsilateral cerebellum.
    Preview · Article · Mar 2008 · Interventional Neuroradiology
  • Source
    T Aurboonyawat · V Pereira · T Kring · F Toulgoat · A Churojana · P Lasjaunias
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    ABSTRACT: Comparing the adult submammalian brain with the human embryonic brain, some patterns of venous drainage are quite similar. The veins lying on the lateral surface of the brain in submammals resemble those of the human embryo. In addition, the new longitudinal venous anastomosis ventral to the brain vesicles occurring late in human embryonic development seems to be similar to the late appearance of the basal vein and the ventral brain stem venous plexus found in adult mammals including man. The evolution of the new structures of the brain vesicles throughout the vertebrate series may have an induction role on the appearance of the cranial venous system. This part of the article series focuses on the evolution of the lateral-ventral venous system of the five brain vesicles. Nevertheless, the limitation of this article is due in part to the paucity of circumstantial papers and different names used for the veins.
    Full-text · Article · Mar 2008 · Interventional Neuroradiology
  • L. Hernandez · P. Landrieu · F. Toulgoat · P. Lasjaunias
    [Show abstract] [Hide abstract]
    ABSTRACT: Primary stroke can be due to embolism or an obstructive process of the vascular wall. Embolism may come from a parietal lesion of a large artery in the neck (traumatic dissections), from a cryptic cardiopathy, from a venous thrombosis associated with a right-left shunt. Among pathologies of endocranial arteries, the most frequent is the acute, postviral arteriopathy of the sus-clinoïd carotid, which evolves toward stabilisation or regression. Insidious obstructive arteriopathies of the Willis circle, including development of a transparenchymal suppletive circulation (Moya-Moya disease), cumulate chronic circulatory insufficiency and repetitive strokes. Inflammatory multifocal cerebral arteriopathies mainly involve mean and small arteries. Most of them are secondary to a multisystemic disease, but some are primary. The basic investigation is anatomical and begins with MRI. Emergency conventional cerebral angiography is discussed when heparinotherapy is difficult to decide (evolutive thrombosis), or when an endovascular intervention appears possible (anoeuvrism). Secondarily, conventional angiography is indicated in any chronic situation where a precise anatomical follow-up is necessary. Investigations of the cardiovascular system, of the thrombophilic risk, of a dysimmune process are discussed according to the clinico-anatomical diagnosis.
    No preview · Article · Mar 2008 · Archives de Pédiatrie
  • B. Husson · P. Lasjaunias†

    No preview · Article · Jan 2008
  • Source
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    ABSTRACT: Many classifications of the cerebral venous system are found in the literature but they are seldom based on phylogenic study. Among vertebrates, venous drainage of the brain vesicles differs depending on the species. Due to the variability, poorly descriptive articles, and many different names used for the veins, the comparative study of the cranial venous system can hardly be performed in detail. The cranial venous system in vertebrates can be divided into three systems based on the evolution of the meninges and structures of the brain vesicles: the dorsal, lateral-ventral and ventricular systems. This study proposes a new classification of the venous drainage of brain vesicles using knowledge from a comparative study of vertebrates and focusing on the dorsal venous system. We found that the venous drainage of the neopallium and neocerebellum is involved with this system which may be a recent acquisition of cranial venous evolution.
    Full-text · Article · Dec 2007 · Interventional Neuroradiology
  • ME Schaaf · C Gandolfo · T Krings · CE Baccin · P Lasjaunias

    No preview · Article · Dec 2007 · Neuropediatrics
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    ABSTRACT: Souligner les principaux éléments IRM jouant un role dans les choix thérapeutiques.Matériels et méthodesSoixante quatre IRM réalisées chez 30 enfants entre 1990 et 2007 ont été revues. Tous les enfants ont eu une IRM en début de prise en charge.RésultatsDeux populations se différencient selon l’âge et le mode de révélation : soit une insuffisance cardiaque avant l’âge de 1 mois soit une macrocrânie au delà. L’engagement des amygdales cérébelleuses et la dilatation ventriculaire parfois inquiétante ne signent pas une HTIC et ne doivent pas conduire à une dérivation ventriculaire d’emblée. L’évaluation du parenchyme cérébral est primordiale. Chez le tout petit, la diffusion est indispensable pour ce bilan. La suspicion de calcifications peut nécessiter une étude TDM. Les hypersignaux T2 périventriculaires ne signifient pas une résorption transépendymaire si les espaces péricérébraux restent visibles. Les afférences artérielles de la MAVG viennent constamment de la circulation postérieure. Une contribution plus rare du territoire carotidien doit être signalée. Le sinus de drainage habituellement large peut comporter des sténoses. Au delà il peut exister des sinus occipitaux et/ou marginaux. Enfin la perméabilité des jugulaires qui peut être compromise, est fondamentale à préciser.ConclusionL’IRM est fondamentale pour l’étude du parenchyma cérébral, l’artériographie restant l’examen de référence pour l’étude de l’architecture de la MAVG.
    No preview · Article · Oct 2007 · Journal de Radiologie
  • Source
    A Ozanne · T Krings · D Facon · P Fillard · J.L. Dumas · H Alvarez · D Ducreux · P Lasjaunias
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    ABSTRACT: Diffusion tensor imaging (DTI) of the spinal cord in patients harboring spinal arteriovenous malformations (AVMs) was carried out to evaluate the feasibility of this new technique to determine the displacement of the spinal cord tracts and to correlate morphologic and functional DTI data (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) with the clinical symptoms. Nine patients with spinal cord AVMs were investigated at 1.5T using a sagittal spin-echo single-shot echo-planar generalized autocalibrating partially parallel acquisition diffusion-weighted imaging sequence. ADC and FA maps were computed in different regions of interest (both above and below the nidus), and tractography was used to visualize the course of the tracts. The data were correlated with the clinical symptoms and compared with 12 healthy control subjects. At the level of the nidus, tracts were normal, shifted, separated, or interrupted but not intermingled with the nidus. Interruption of the tracts was coherent with the clinical symptoms. In patients with severe neurologic deficits, FA values caudal to the nidus showed a reduced anisotropy consistent with loss of white matter tracts. We demonstrate that AVMs may interrupt, displace, or separate the fiber tracts and that clinical symptoms may be reflected by the quantitative FA results and the morphologic loss of fibers distant to the lesion. DTI with fiber tracking offers a novel approach to image spinal cord AVMs and may open a window to understand the complex pathophysiology of these lesions.
    Full-text · Article · Sep 2007 · American Journal of Neuroradiology
  • P Lasjaunias · A Ozanne · F Toulgoat · D Ducreux

    No preview · Article · Aug 2007
  • A Ozanne · H Alvarez · T Krings · P Lasjaunias
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    ABSTRACT: The purpose of this article is to give an overview of the cerebral and spinal cord pediatric malformations; we particularly describe three of them: Vein of Galen arteriovenous Malformation, Pial Arteriovenous Malformation, and Dural Sinus Malformation. We report the experience of Bicêtre since 1981 to 2003, with 317 VGAM, 302 Pial AVM and 30 DSM. We describe natural history, clinical and imaging features, endovascular management and the clinical and morphologic results. The clinical consequences of the VGAM and Pial AVM are systemic or cerebral. When they are cerebral they are mainly from hydrovenous type, as melting brain, or chronic hydrocephalus with calcifications and seizures. Depending of their angioarchitecture and amount of arteriovenous shunt, their gravity and the time of revealing are variable. Pial AVM, they carry the risk of hemorrhage, unlike VGAM. The presence of a fistula type should lead to suspect hereditary hemorrhagic telangiectasia. The main risk of DSM is hemorrhage due to thrombosis of the malformation, more than hydrovenous disorders. In VGAM, we obtain the complete cure of the shunt in 55% of case, and reduction of more than half of the shunt in 93.8%. Seventy-four percent of treated cases had a normal neurologic examination. DSM have a worse prognostic, and mortality is 38% despite treatment.
    No preview · Article · Aug 2007 · Journal of Neuroradiology

Publication Stats

4k Citations
495.77 Total Impact Points

Institutions

  • 1991-2009
    • Hôpital Bicêtre (Hôpitaux Universitaires Paris-Sud)
      Lutetia Parisorum, Île-de-France, France
  • 2002-2005
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Leiden University
      Leyden, South Holland, Netherlands
  • 2004
    • Hôpital Foch
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 2001
    • University of Ulsan
      • Department of Radiology
      Urusan, Ulsan, South Korea
    • Kwong Wah Hospital
      Hong Kong, Hong Kong
  • 1991-2001
    • Université Paris-Sud 11
      Orsay, Île-de-France, France
  • 1996
    • University of Paris-Est
      Centre, France
  • 1986-1991
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 1989
    • SickKids
      Toronto, Ontario, Canada
  • 1979
    • Loma Linda University
      لوما ليندا، كاليفورنيا, California, United States
  • 1975-1977
    • Fondation Rothschild
      Lutetia Parisorum, Île-de-France, France