NICOLLAS NUNES RABELO
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- Postconcussion and Suicide: How Far Should Outpatients be Assessed?(2021) WELLING, Leonardo C.; RABELO, Nicollas Nunes; BARBOSA, Mateus Goncalves de Sena; FIGUEIREDO, Eberval Gadelha
- Brain death and management of the potential donor(2021) YOSHIKAWA, Marcia Harumy; RABELO, Nicollas Nunes; WELLING, Leonardo Christiaan; TELLES, Joao Paulo Mota; FIGUEIREDO, Eberval GadelhaOne of the first attempts to define brain death (BD) dates from 1963, and since then, the diagnosis criteria of that entity have evolved. In spite of the publication of practice parameters and evidence-based guidelines, BD is still causing concern and controversies in the society. The difficulties in determining brain death and making it understood by family members not only endorse futile therapies and increase health care costs, but also hinder the organ transplantation process. This review aims to give an overview about the definition of BD, causes, physiopathology, diagnosis criteria, and management of the potential brain-dead donor. It is important to note that the BD determination criteria detailed here follow the AAN's recommendations, but the standard practice for BD diagnosis varies from one country to another.
- Augmented reality and physical hybrid model simulation for preoperative planning of metopic craniosynostosis surgery(2020) COELHO, Giselle; RABELO, Nicollas Nunes; VIEIRA, Eduardo; MENDES, Kid; ZAGATTO, Gustavo; OLIVEIRA, Ricardo Santos de; RAPOSO-AMARAL, Cassio Eduardo; YOSHIDA, Mauricio; SOUZA, Matheus Rodrigues de; FAGUNDES, Caroline Ferreira; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaOBJECTIVE The main objective of neurosurgery is to establish safe and reliable surgical techniques. Medical technology has advanced during the 21st century, enabling the development of increasingly sophisticated tools for preoperative study that can be used by surgeons before performing surgery on an actual patient. Laser-printed models are a robust tool for improving surgical performance, planning an operative approach, and developing the skills and strategy to deal with uncommon and high-risk intraoperative difficulties. Practice with these models enhances the surgeon's understanding of 3D anatomy but has some limitations with regard to tactile perception. In this study, the authors aimed to develop a preoperative planning method that combines a hybrid model with augmented reality (AR) to enhance preparation for and planning of a specific surgical procedure, correction of metopic craniosynostosis, also known as trigonocephaly. METHODS With the use of imaging data of an actual case patient who underwent surgical correction of metopic craniosynostosis, a physical hybrid model (for hands-on applications) and an AR app for a mobile device were created. The hybrid customized model was developed by using analysis of diagnostic CT imaging of a case patient with metopic craniosynostosis. Created from many different types of silicone, the physical model simulates anatomical conditions, allowing a multidisciplinary team to deal with different situations and to precisely determine the appropriate surgical approach. A real-time AR interface with the physical model was developed by using an AR app that enhances the anatomic aspects of the patient's skull. This method was used by 38 experienced surgeons (craniofacial plastic surgeons and neurosurgeons), who then responded to a questionnaire that evaluated the realism and utility of the hybrid AR simulation used in this method as a beneficial educational tool for teaching and preoperative planning in performing surgical metopic craniosynostosis correction. RESULTS The authors developed a practice model for planning the surgical cranial remodeling used in the correction of metopic craniosynostosis. In the hybrid AR model, all aspects of the surgical procedure previously performed on the case patient were simulated: subcutaneous and subperiosteal dissection, skin incision, and skull remodeling with absorbable miniplates. The pre- and postoperative procedures were also carried out, which emphasizes the role of the AR app in the hybrid model. On the basis of the questionnaire, the hybrid AR tool was approved by the senior surgery team and considered adequate for educational purposes. Statistical analysis of the questionnaire responses also highlighted the potential for the use of the hybrid model in future applications. CONCLUSIONS This new preoperative platform that combines physical and virtual models may represent an important method to improve multidisciplinary discussion in addition to being a powerful teaching tool. The hybrid model associated with the AR app provided an effective training environment, and it enhanced the teaching of surgical anatomy and operative strategies in a challenging neurosurgical procedure.
- Long-term Dysphagia following Acoustic Neuroma Surgery: Prevalence, Severity and Predictive Factors(2021) ABBAS-KAYANO, Raiene Telassin; SOLLA, Davi Jorge Fontoura; RABELO, Nicollas Nunes; GOMES, Marcos de Queiroz Teles; CABRERA, Hector Tomas Navarro; TEIXEIRA, Manoel J.; FIGUEIREDO, Eberval GadelhaBackground Acoustic neuroma (AN) may compress the cerebellum and brainstem and may cause dysfunction of bulbar cranial nerves. Objective To describe swallowing function outcomes in the late postoperative period after AN surgery. Methods This cohort study included patients operated on between 1999-2014, with a mean follow up of 6.4 4.5 years. The swallowing function was assessed through the functional oral intake scale (FOIS). The primary outcome was defined by scores 5 to 1, which implied oral feeding restriction or adaptation. Risks factors were identified through multivariate logistic regression. Results 101 patients were evaluated. As many as 46 (45.5%) presented dysphagia on the late postoperative period. Women comprised 77.2%, and the mean age was 47.1 +/- 16.0 years (range 19-80). Dysphagic patients presented more type II neurofibromatosis (NF II) (32.6% vs. 10.9%, p = 0.007), larger tumors (3.8 +/- 1.1 vs. 3.1 +/- 1.0 cm, p < 0.001), partial resection (50.0% vs. 85.5%, p < 0.001) and needed more surgeries (>= 2, 39.1% vs. 18.2%, p = 0.019). Important peripheral facial palsy (PFP) (House-Brackmann [HB] grade >= 3) was present before the surgery on 47.5% and worsened on 55.4%. Postoperative PFP (p < 0.001), but not preoperative PFP, was predictive of postoperative dysphagia. On multivariate analysis, the following factors were risk factors for dysphagia: NF II (OR 5.54, p = 0.034), tumor size (each 1 cm, OR 2.13, p = 0.009), partial resection (OR 5.23, p = 0.022) and postoperative HB grade >= 3 (OR 12.99, p = 0.002). Conclusions Dysphagia after AN surgery is highly correlated to postoperative facial motor function. NF II, tumor size, and extent of resection were also predictive of this morbidity in the late postoperative period.
- Management of Giant Thrombosed MCA Aneurysm: Double STA-MCA Revascularization(2021) MURA, Jorge; ALVAREZ, Victor Hernandez; OBERMAN, Dan Zimelewicz; CARDENAS, Aladino Rojas; RABELO, Nicollas Nunes; FIGUEIREDO, Eberval GadelhaGiant middle cerebral artery (MCA) aneurysms are rare complex cerebrovascular lesions to treat.(1) The management of those aneurysms may be very challenging, despite the introduction of refined microsurgical techniques and the rapid progress in endovascular methods, which often require bypass surgery as part of the strategy.(2-4) This approach is particularly relevant to giant, dolichoectatic, and thrombotic aneurysms.(5,6) This video shows the surgical strategy and stepwise depiction of the surgical treatment of a complex giant thrombosed aneurysm using a double-barrel superficial temporal artery (STA) to MCA bypass (Video 1). Informed written consent was obtained from the patient and his family. The patient was a 50-year-old man, previously healthy, who presented with headache, memory difficulty, and left-sided involuntary movements for 2 months. Computed tomography scan showed a giant round calcified and heterogeneous lesion compatible with a thrombosed MCA aneurysm. Brain magnetic resonance imaging showed the same lesion with a flow void signal inside in a serpentine fashion and a complete hemosiderin halo. Conventional angiography showed the false lumen and the filling of the distal MCA branches with a certain degree of arterial delay. The lesion was located between M1 and M3 segments of MCA. Extracranial-intracranial STA-MCA bypass was performed. Then we opened the aneurysm sac for decompression and observed the lenticulostriate artery branches arising away from the aneurysm sac. The complete clipping and patency of the anastomosis was validated during surgery by indocyanine green angiography. Postoperative cerebral computed tomography angiography revealed good patency from the STA to the MCA. The patient was neurologically intact without complains.
- Preoperative Planning Modalities for Meningoencephalocele: New Proof of Concept(2021) COELHO, Giselle; VIEIRA, Eduardo Varjao; RABELO, Nicollas Nunes; MARIE, Thailane; BRITO, Daniella; MASSA, Emilio C. Del; MENDES, Kid; ZAGATTO, Gustavo; MASCHIETTO, Ana Carolina; PEIXOTO, Rian; SOUZA, Julio Sergio de; CALIL, Zacharias; YOSHIDA, MauricioOBJECTIVE: Late surgical correction of meningoencephalocele is a rare scenario that remains challenging for surgeons. Three-dimensional models can mimic the correct anatomical relationships, and technological systems have brought advances to medicine. This study aims to present a novel preoperative planning modality that combines augmented reality with a hybrid model for complex malformation associated with late correction. METHODS: The present report describes a case of frontoethmoidal encephalocele of a 10-year-old girl. Two different methods for planning the approach were developed: 1) a hybrid hands-on model and 2) augmented reality, using a cell phone app and headset display. The customized hybrid model was created based on patient's imaging. The augmented reality app was developed with a real-time interface. RESULTS: The hybrid model recreated anatomic alterations, thereby allowing a multidisciplinary team to determine an appropriate surgical approach. All aspects of the surgical procedure were simulated. A pre- to postoperative comparison was made, which emphasized benefit of tridimensional anatomical relationships using augmented reality tool and its role in preoperative planning. CONCLUSIONS: The authors believe this new multi-modality preoperative platform could be a useful method to improve multidisciplinary discussion as well as a powerful tool for teaching and planning.
- Efficacy and Safety of Intraoperative Radiotherapy for High-Grade Gliomas: A Systematic Review and Meta-Analysis(2024) PALAVANI, Lucca B.; OLIVEIRA, Leonardo de Barros; REIS, Pedro Abrahao; BATISTA, Savio; SANTANA, Lais Silva; MARTINS, Lucas Piason de Freitas; RABELO, Nicollas Nunes; BERTANI, Raphael; WELLING, Leonardo Christiaan; FIGUEIREDO, Eberval Gadelha; PAIVA, Wellingson S.; NEVILLE, Iuri SantanaBackground and ObjectivesHigh-grade gliomas (HGGs) are aggressive tumors of the central nervous system that cause significant morbidity and mortality. Despite advances in surgery and radiation therapy (RT), HGG still has a high incidence of recurrence and treatment failure. Intraoperative radiotherapy (IORT) has emerged as a promising therapeutic approach to achieve local tumor control while sparing normal brain tissue from radiation-induced damage.MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the use of IORT for HGG. Eligible studies were included based on specific criteria, and data were independently extracted. Outcomes of interest included complications, IORT failure, survival rates at 12 and 24 months, and mortality.ResultsSixteen studies comprising 436 patients were included. The overall complication rate after IORT was 17%, with significant heterogeneity observed. The IORT failure rate was 77%, while the survival rates at 12 and 24 months were 74% and 24%, respectively. The mortality rate was 62%.ConclusionThis meta-analysis suggests that IORT may be a promising adjuvant treatment for selected patients with HGG. Despite the high rate of complications and treatment failures, the survival outcomes were comparable or even superior to conventional methods. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation through prospective randomized controlled trials to better understand the specific patient populations that may benefit most from IORT. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation. Notably, the ongoing RP3 trial (NCT02685605) is currently underway, with the aim of providing a more comprehensive understanding of IORT. Moreover, future research should focus on managing complications associated with IORT to improve its safety and efficacy in treating HGG.
- Vascularization of the uncus – Anatomical study and clinical implications(2021) ISOLAN, G. R.; MARRONE, A. C. Huf; MARRONE, L. C. Porcellos; STEFANI, M. A.; COSTA, J. C. da; TELLES, J. P. Mota; CHOI, G. G.; SILVA, S. A. da; RABELO, N. N.; FIGUEIREDO, E. G.Background: The objective of this paper was to describe the arterial supply of the uncus and quantify the branches directed to the anteromedial aspect of the human temporal cortex. Methods: We studied 150 human cerebral hemispheres identifying main afferent arteries supplying the anteromedial temporal cortex with particular attention to the uncus, determining the territory supplied by each artery through either cortical or perforating branches. Results: The uncus was supplied by 419 branches of the anterior choroidal artery (AChA), 210 branches of the internal carotid artery (ICA), 353 branches of the middle cerebral artery (MCA), and 122 branches of the posterior cerebral artery (PCA). The total of supplying vessels was 1104 among the 150 hemispheres studied, which corresponds to 7.36 arteries per uncus. The average of branches per hemisphere was as follows: 2.79 from AChA, 1.40 from ICA, 2.35 from MCA, and 0.81 from PCA. The relative contribution of each artery for the total of specimens studied was as follows: 38% from AChA, 19% from ICA, 32% from the MCA, and 11% from the PCA. We identified cortical anastomoses mostly between the MCA and PCA (27 cases). Conclusion: We described and quantified the uncus’ vascularization, including anatomical variations. This updated, detailed description of the mesial temporal vascularization is paramount to improve the treatment of neurosurgical conditions. © 2021 Published by Scientific Scholar on behalf of Surgical Neurology International.
- The historic evolution of intracranial pressure and cerebrospinal fluid pulse pressure concepts: Two centuries of challenges(2021) RABELO, N. N.; BRITO, J. D. S.; SILVA, J. S. da; SOUZA, N. B. de; COELHO, G.; BRASIL, S.; FRIGERI, G.Background: There is a consensus on the importance of monitoring intracranial pressure (ICP) during neurosurgery, and this monitoring reduces mortality during procedures. Current knowledge of ICP and cerebrospinal fluid pulse pressure has been built thanks to more than two centuries of research on brain dynamics. Methods: Articles and books were selected using the descriptors “ICP,” “cerebrospinal fluid pulse,” “monitoring,” “Monro-Kellie doctrine,” and “ICP waveform” in electronic databases PubMed, Lilacs, Science Direct, and EMBASE. Results: Several anatomists and physiologists have helped clarify the patterns of intracranial volumes under normal and pathological conditions. Monro-Kellie doctrine was an important step in a story that is reconstructed in this article. Through documentary research, we report the contribution of important medical figures, such as Monro, Kellie, Abercrombie, Burrows, Cushing, Langfitt, Marmarou, and other physiologists and anatomists who left their marks on the history of Medicine. Conclusion: Understanding intracranial dynamics is an unfinished historical construction. Current knowledge is the result of two centuries of research that began with the investigations of Alexander Monro secundus. © 2021 Published by Scientific Scholar on behalf of Surgical Neurology International
- Glasgow Coma Scale-Pupils Score: opening the eyes to new ways of predicting outcomes in TBI(2019) RABELO, Nicollas Nunes; COSTA, Bruno Braga Sisnando da; SAKAYA, Gabriel Reis; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval Gadelha