ALMIR FERREIRA DE ANDRADE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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 Endovascular management of epidural hematomas Response(2018) PERES, Carlos Michel Albuquerque; CALDAS, Jose Guilherme Mendes Pereira; FIGUEIREDO, Eberval Gadelha; TEIXEIRA, Manoel Jacobsen; ANDRADE, Almir Ferreira deconferenceObject Factors Associated with Hemorrhagic Progression of Cerebral Contusion After Traumatic Brain Injury: A Multicenter Study(2022) LIMA, Leonardo R.; SOLLA, Davi; PASSOS, George; BRANDAO, Marcio; RAMOS, Camilla; ANDRADE, Mariana; ANDRADE, Almir; COSTA, Roberta; PAIVA, Wellingson; PIASON, Lucas; ROSSETI, Adroaldo- Endovascular management of acute epidural hematomas: clinical experience with 80 cases(2018) PERES, Carlos Michel A.; CALDAS, Jose Guilherme M. P.; PUGLIA JR., Paulo; ANDRADE, Almir F. de; SILVA, Igor A. F. da; TEIXEIRA, Manoel J.; FIGUEIREDO, Eberval G.OBJECTIVE Small acute epidural hematomas (EDHs) treated conservatively carry a nonmeasurable risk of late enlargement due to middle meningeal artery (MMA) lesions. Patients with EDHs need to stay hospitalized for several days, with neurological supervision and repeated CT scans. In this study, the authors analyzed the safety and efficacy of the embolization of the involved MMA and associated lesions. METHODS The study group consisted of 80 consecutive patients harboring small-to medium-sized EDHs treated by MMA embolization between January 2010 and December 2014. A literature review cohort was used as a control group. RESULTS The causes of head injury were falls, traffic-related accidents (including car, motorcycle, and pedestrian vs vehicle accidents), and assaults. The EDH topography was mainly temporal (lateral or pole). Active contrast leaking from the MMA was seen in 57.5%; arteriovenous fistulas between the MMA and diploic veins were seen in 10%; and MMA pseudoaneurysms were found in 13.6% of the cases. Embolizations were performed under local anesthesia in 80% of the cases, with N-butyl-2-cyanoacrylate, polyvinyl alcohol particles, or gelatin sponge (or a combination of these), obtaining MMA occlusion and complete resolution of the vascular lesions. All patients underwent follow-up CT scans between 1 and 7 days after the embolization. In the 80 cases in this series, no increase in size of the EDH was observed and the clinical evolution was uneventful, without Glasgow Coma Scale score modification after embolization and with no need for surgical evacuation. In contrast, the control cohort from the literature consisted of 471 patients, 82 (17.4%) of whom shifted from conservative treatment to surgical evacuation. CONCLUSIONS This study suggests that MMA embolization is a highly effective and safe method to achieve size stabilization in nonsurgically treated acute EDHs.
conferenceObject Decreased Cerebral Blood Flow in the Central Core of Malignant MCA Stroke in Patients Submitted to Decompressive Craniectomy is Associated with Late Recovery of Consciousness(2015) AMORIM, Robson; SHU, Edson; ANDRADE, Almir; GATTAS, Gabriel; PAIVA, Wellingson; TEIXEIRA, Manoel- Smartphone-assisted minimally invasive neurosurgery(2019) MANDEL, Mauricio; PETITO, Carlo Emanuel; TUTIHASHI, Rafael; PAIVA, Wellingson; MANDEL, Suzana Abramovicz; PINTO, Fernando Campos Gomes; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaOBJECTIVE Advances in video and fiber optics since the 1990s have led to the development of several commercially available high-definition neuroendoscopes. This technological improvement, however, has been surpassed by the smartphone revolution. With the increasing integration of smartphone technology into medical care, the introduction of these high-quality computerized communication devices with built-in digital cameras offers new possibilities in neuroendoscopy. The aim of this study was to investigate the usefulness of smartphone-endoscope integration in performing different types of minimally invasive neurosurgery. METHODS The authors present a new surgical tool that integrates a smartphone with an endoscope by use of a specially designed adapter, thus eliminating the need for the video system customarily used for endoscopy. The authors used this novel combined system to perform minimally invasive surgery on patients with various neuropathological disorders, including cavernomas, cerebral aneurysms, hydrocephalus, subdural hematomas, contusional hematomas, and spontaneous intracerebral hematomas. RESULTS The new endoscopic system featuring smartphone-endoscope integration was used by the authors in the minimally invasive surgical treatment of 42 patients. All procedures were successfully performed, and no complications related to the use of the new method were observed. The quality of the images obtained with the smartphone was high enough to provide adequate information to the neurosurgeons, as smartphone cameras can record images in high definition or 4K resolution. Moreover, because the smartphone screen moves along with the endoscope, surgical mobility was enhanced with the use of this method, facilitating more intuitive use. In fact, this increased mobility was identified as the greatest benefit of the use of the smartphone-endoscope system compared with the use of the neuroendoscope with the standard video set. CONCLUSIONS Minimally invasive approaches are the new frontier in neurosurgery, and technological innovation and integration are crucial to ongoing progress in the application of these techniques. The use of smartphones with endoscopes is a safe and efficient new method of performing endoscope-assisted neurosurgery that may increase surgeon mobility and reduce equipment costs.
- Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle(2017) ARAUJO, Joao Luiz Vitorino; VEIGA, Jose C. E.; WEN, Hung Tzu; ANDRADE, Almir F. de; TEIXEIRA, Manoel J.; OTOCH, Jose P.; RHOTON JR., Albert L.; PREUL, Mark C.; SPETZLER, Robert F.; FIGUEIREDO, Eberval G.OBJECTIVE Access to the third ventricle is a veritable challenge to neurosurgeons. In this context, anatomical and morphometric studies are useful for establishing the limitations and advantages of a particular surgical approach. The transchoroidal approach is versatile and provides adequate exposure of the middle and posterior regions of the third ventricle. However, the fornix column limits the exposure of the anterior region of the third ventricle. There is evidence that the unilateral section of the fornix column has little effect on cognitive function. This study compared the anatomical exposure afforded by the transforniceal-transchoroidal approach with that of the transchoroidal approach. In addition, a morphometric evaluation of structures that are relevant to and common in the 2 approaches was performed. METHODS The anatomical exposure provided by the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches was compared in 8 fresh cadavers, using a neuronavigation system. The working area, microsurgical exposure area, and angular exposure on the longitudinal and transversal planes of 2 anatomical targets (tuber cinereum and cerebral aqueduct) were compared. Additionally, the thickness of the right frontal lobe parenchyma, thickness of the corpus callosum trunk, and longitudinal diameter of the interventricular foramen were measured. The values obtained were submitted to statistical analysis using the Wilcoxon test. RESULTS In the quantitative evaluation, compared with the transchoroidal approach, the transforniceal-transchoroidal approach provided a greater mean working area (transforniceal-transchoroidal 150 +/- 11 mm(2); transchoroidal 121 8 mm(2); p < 0.05), larger mean microsurgical exposure area (transforniceal-transchoroidal 101 9 mm(2); transchoroidal 80 +/- 5 mm(2); p < 0.05), larger mean angular exposure area on the longitudinal plane for the tuber cinereum (transforniceal-transchoroidal 71 degrees +/- 7 degrees; transchoroidal 64 degrees +/- 6 degrees; p < 0.05), and larger mean angular exposure area on the longitudinal plane for the cerebral aqueduct (transforniceal-transchoroidal 62 degrees +/- 6 degrees; transchoroidal 55 degrees +/- 5 degrees; p < 0.05). No differences were observed in angular exposure along the transverse axis for either anatomical target (tuber cinereum and cerebral aqueduct; p > 0.05). The mean thickness of the right frontal lobe parenchyma was 35 +/- 3 mm, the mean thickness of the corpus callosum trunk was 10 +/- 1 mm, and the mean longitudinal diameter of the interventricular foramen was 4.6 +/- 0.4 mm. In the qualitative assessment, it was noted that the transforniceal-transchoroidal approach led to greater exposure of the third ventricle anterior region structures. There was no difference between approaches in the exposure of the structures of the middle and posterior region. CONCLUSIONS The transforniceal-transchoroidal approach provides greater surgical exposure of the third ventricle anterior region than that offered by the transchoroidal approach. In the population studied, morphometric analysis established mean values for anatomical structures common to both approaches.
conferenceObject Effects of cranioplasty in cerebral blood flow(2015) PAIVA, Wellingson Silva; OLIVEIRA, Arthur; AMORIM, Robson; BOR-SENG-SHU, Edson; ANGHINAH, Renato; ANDRADE, Almir; TEIXEIRA, Manoel