WAGNER MALAGO TAVARES
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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article 0 Citação(ões) na Scopus Cerebellopontine angle empyema after lumbar disc herniation surgery(2015) NASCIMENTO, Clarissa Gambara; BROCK, Roger Schmidt; MORAIS, Barbara Albuquerque; TAVARES, Wagner Malago; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground: Lumbar discectomy is still one of the most common spinal surgeries performed today. Nevertheless, there are few publications considering severe complications. Case Description: We report a case with severe complication, without any previous report, a brain empyema after cerebrospinal fluid leak with good outcome afterword. A 45 years old man, returned six days after surgery, presenting cerebrospinal fluid leak, which after clinical and laboratory deterioration was reoperated. In the 14th postoperative facing worsening level of consciousness was diagnosed empyema in cerebellopontine angle and hydrocephalus underwent emergency surgery. Evolved with hemiplegia in the first postoperative attributed to vasculitis, completely recovered after 5 days. Conclusions: Although infrequent, lumbar discectomy is subject to severe complications, which as the case presented, can be dramatic. In surgeries must be careful to avoid cerebrospinal fluid leak e infectious complications.- Clinically nonfunctioning pituitary adenoma growth after radiosurgery(2012) BATISTA, Rafael Loch; TOSCANINI, Andrea Cecilia; GLEZER, Andrea; SIQUEIRA, Mario Gilberto; BENABOU, Salomon; FONOFF, Erick Talamoni; TAVARES, Wagner Malago; TEIXEIRA, Manoel Jacobsen; CUNHA NETO, Malebranche Berardo Carneiro da
article 10 Citação(ões) na Scopus Hemodynamic stroke caused by strangulation(2014) NETO, Hugo Sterman; NEVILLE, Iuri Santana; BEER-FURLAN, Andre; TAVARES, Wagner Malago; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaWe report a case of watershed ischemic stroke in a 36-year-old male secondary to manual strangulation. The patient presented with a right hemiparesis with grade IV motor deficit and an expressive aphasia. Radiological investigation revealed an ischemic stroke on the left distal middle cerebral artery territory and in watershed areas of the left anterior and posterior cerebral arteries. There was no evidence of injury of cervical vessels. The hemodynamic mechanism and associated brain injury secondary to manual strangulation is described and discussed based on a literature review.bookPart Tumefação Cerebral Difusa(2015) TAVARES, Wagner Malagó- Early Tracheostomy in Severe Traumatic Brain Injury Patients: A Meta-Analysis and Comparison With Late Tracheostomy(2020) FRANCA, Sabrina Araujo de; TAVARES, Wagner M.; SALINET, Angela S. M.; PAIVA, Wellingson S.; TEIXEIRA, Manoel J.Objectives: To elucidate the impact of early tracheostomy on hospitalization outcomes in patients with traumatic brain injury. Data Sources: Lilacs, PubMed, and Cochrane databases were searched. The close-out date was August 8, 2018. Study Selection: Studies written in English, French, Spanish, or Portuguese with traumatic brain injury as the base trauma, clearly formulated question, patient's admission assessment, minimum follow-up during hospital stay, and minimum of two in-hospital outcomes were selected. Retrospective studies, prospective analyses, and case series were included. Studies without full reports or abstract, commentaries, editorials, and reviews were excluded. Data Extraction: The study design, year, patient's demographics, mean time between admission and tracheostomy, neurologic assessment at admission, confirmed ventilator-assisted pneumonia, median ICU stay, median hospital stay, mortality rates, and ICU and hospital costs were extracted. Data Synthesis: A total of 4,219 studies were retrieved and screened. Eight studies were selected for the systematic review; of these, seven were eligible for the meta-analysis. Comparative analyses were performed between the early tracheostomy and late tracheostomy groups. Mean time for early tracheostomy and late tracheostomy procedures was 5.59 days (sd, 0.34 d) and 11.8 days (sd, 0.81 d), respectively. Meta-analysis revealed that early tracheostomy was associated with shorter mechanical ventilation duration (-4.15 [95% CI, -6.30 to -1.99]) as well as ICU (-5.87 d [95% CI, -8.74 to -3.00 d]) and hospital (-6.68 d [95% CI, -8.03 to -5.32 d]) stay durations when compared with late tracheostomy. Early tracheostomy presented less risk difference for ventilator-associated pneumonia (risk difference, 0.78; 95% CI, 0.70-0.88). No statistical difference in mortality was found between the groups. Conclusions: The findings from this meta-analysis suggest that early tracheostomy in severe traumatic brain injury patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient's early rehabilitation and discharge.
- Early tracheostomy in stroke patients: A meta-analysis and comparison with late tracheostomy(2021) FRANCA, Sabrina Araujo de; TAVARES, Wagner M.; SALINET, Angela S. M.; PAIVA, Wellingson S.; TEIXEIRA, Manoel J.Tracheostomy (TQT) timing and its benefits is a current discussion in medical society. We aimed to compare the outcomes of early (ET) versus late tracheostomy (LT) in stroke patients with systematic review and metaanalysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Five hundred and nineteen studies were retrieved, whereas three were selected for the systematic review and meta-analysis. There were 5636 patients in the ET group (3151 male, 2470 female, 15 not reported - NR) and 7637 patients in the LT group (4098 male, 3542 female, and 33 NR). ET was significantly associated with fewer days in the hospital (weighted mean difference: -7.73 [95 % CI -8.59-6.86], p < 0.001) and reduced cases of ventilator-associated pneumonia (VAP) (risk difference: 0.71 [95 % CI 0.62-0.81], p < 0.001). There were no between-group statistical differences in intensive care unit stay duration, mechanical ventilation duration, or mortality. The findings from this meta-analysis cannot state that ET in severe stroke patients contributes to better outcomes when compared with LT. Scandalized assessments and randomized trials are encourage for better assessment.
- The authors reply(2021) FRANCA, Sabrina Araujo de; TAVARES, Wagner M.; SALINET, Angela S. M.; PAIVA, Wellingson S.; TEIXEIRA, Manoel J.
- Distortion Correction Protocol for 3T Stereotactic Magnetic Resonance Imaging: A Clinical Study(2019) TAVARES, Wagner Malago; TUSTUMI, Francisco; LEITE, Claudia da Costa; GAMARRA, Lionel Fernel; AMARO JUNIOR, Edson; TEXEIRA, Manoel Jacobsen; FRANCA, Sabrina Araujo de; FONOFF, Erich TalamoniBACKGROUND: With application of 3T magnetic resonance imaging (MRI) to functional neurosurgery procedures and given the inherent requirement of millimetric precision, the need to develop a method for correction of geometric image distortion emerged. The aim of this study was to demonstrate clinical safety and practical viability of a correction protocol in patients scheduled to undergo stereotactic procedures using 3T MRI. METHODS: This prospective study comprised 20 patients scheduled to undergo computed tomography (CT) stereotactic functional procedures or encephalic brain lesion biopsies. The CT images were references for MRI geometric accuracy calculations. For each scan, 2 images were obtained: normal and reversed images. Eight distinct points on CT and MRI were selected summing 152 points that were based on a power analysis calculation value >0.999. One patient was excluded because of the inability to find reliable common landmark points on CT and MRI. RESULTS: The distortion range was 0-5.6 mm and increased proportionally with stereotactic isocenter distance, meaning the distortion was greater in the periphery. After correction, the minimum and maximum distortion found was 0 mm and 3.5 mm, respectively. There was no significant difference between CT and MRI corrected x-coordinates (P > 0.05). CONCLUSIONS: The proposed method can satisfactorily correct geometric distortions in clinical 3T MRI studies. Clinical use of the technique can be practical and efficient after software automation of the process. The method can be applied to all spin-echo MRI sequences.
article 10 Citação(ões) na Scopus Brown-Sequard syndrome associated with unusual spinal cord injury by a screwdriver stab wound(2014) BEER-FURLAN, Andre Luiz; PAIVA, Wellingson Silva; TAVARES, Wagner Malago; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel JacobsenIntroduction: Stab wounds resulting in spinal cord injuries are very rare. In direct central back stabbings, the layers of muscles and the spinal column tends to deflect blades, rarely causing injuries to the spinal cord. We report an unusual case of traumatic spinal cord injury by a screwdriver stab, presented as Brown-Sequard syndrome and discuss possible pitfalls on the surgical treatment. Case report: A 34 year-old man was brought to the emergency department after a group assault with a single screwdriver stab wound on the back. Neurological examination revealed an incomplete Brown-Sequard syndrome, with grade IV motor deficit on the left leg and contralateral hemihypoalgesia below T9 level. Radiological evaluation showed a retained 9 cm screwdriver that entered and trespassed the spinal canal at T6 level, reaching the posterior mediastinum with close relation to the thoracic aorta. Vascular injury could not be excluded. The joint decision between the neurosurgery and the vascular surgery teams was the surgical removal of the screwdriver under direct visualization. A left mini-thoracotomy was performed. Simultaneously, a careful dissection was done and screwdriver was firmly pulled back on the opposite path of entry under direct visualization of the aorta. The neurological deficit was maintained immediately after the surgical procedure. Follow-up visit after 1 year showed minor motor deficit and good healing. Conclusions: It is important to consider all aspects of secondary injury on the surgical planning of penetrating spinal cord injury. The secondary injury can be minimized with multidisciplinary planning of the surgical procedure.- Serum sodium disorders in patients with traumatic brain injury(2011) PAIVA, Wellingson Silva; BEZERRA, Douglas Alexandre Franca; AMORIM, Robson Luis Oliveira; FIGUEIREDO, Eberval Gadelha; TAVARES, Wagner Malago; ANDRADE, Almir Ferreira De; TEIXEIRA, Manoel JacobsenSodium disorders are the most common and most poorly understood electrolyte disorders in neurological patients. The aim of this study was to determine the incidence of sodium disorders and its association with different traumatic brain injuries. This prospective study was conducted in 80 patients diagnosed with moderate and severe traumatic brain injuries. All patients underwent cerebral computed tomography. Incidence of sodium disorders, presence of injuries in the first computed tomography after traumatic brain injury, and level of consciousness were analyzed. Patients that presented other potential causes of sodium disorders and systemic trauma were excluded from the study. The incidence of sodium disturbances was 45%: 20 patients presented hypernatremia and 16 hyponatremia. Refers to all patients with sodium disturbances 53% were detected in the first sample. We recorded at least one measurement <125 mEq/L in 50% of the patients with hyponatremia. A greater incidence of sodium disorders was found in patients with subdural, intracerebral hematoma and with diffuse axonal injury. The incidence of sodium disorders among the patients with diffuse lesions was greater than in the group of patients with brain contusion (P = 0.022). The incidence of sodium disorders is higher in patients with diffuse traumatic brain injuries. No association was found between focal lesions and proportion of sodium disorders. Keywords: brain trauma, hypernatremia, hyponatremia