HELDER PICARELLI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
conferenceObject Using color flow image to identify brain vessels during metastasis approach(2014) PASCHOAL JR., F. Mendes; OLIVEIRA, M. L. de; PICARELLI, H.; AZEVEDO, M. K.; LIMA, S. B.; BASTOS, M. F.; RIBAS, E. S. C.; TEIXEIRA, M. J.; BOR-SENG-SHU, E.- A Diffuse Leptomeningeal Glioneural Tumor Case Producing Hydrocephalus and Polyradiculopathy(2020) PICARELLI, Helder; NEPOMUCENO, Thales Bhering; RIBEIRO, Renan Ribeiro; YAMAKI, Vitor Nagai; FIGUEIREDO, Eberval GadelhaThe present report describes the case of a male 17-year-old patient who progressively developed a hydrocephalus and polyradiculopathy due to involvement of central nervous system (CNS) by a diffuse leptomeningeal glioneuronal tumor ( DLGNT). The tumor had partial remission in response to the treatment with radiotherapy plus procarbazine, lomustine, and vincristine (PCV) chemotherapy, and the patient had improvement in function and pain levels. The current knowledge about DLGNT, including its clinical manifestations, imaging findings, histological characteristics, and treatment are revised and discussed in the present paper.
bookPart Síndrome Complexa de Dor Regional(2019) YENG, Lin Tchia; TEIXEIRA, Manoel Jacobsen; ROCHA, Roberto de Oliveira; PICARELLI, Helder; KOBAYASHI, Ricardo; FARIA, Viviane G.bookPart Metástases Cerebrais(2015) PICARELLI, Helder- Mortality, Morbidity, and Prognostic Factors in the Surgical Resection of Brain Metastases: A Contemporary Cohort Study(2020) PICARELLI, Helder; OLIVEIRA, Marcelo de Lima; MARTA, Gustavo Nader; SOLLA, Davi J. Fontoura; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaObjective Despite advances in systemic therapy and radiotherapy (RT), neurosurgical resection (NSR) remains a mainstay of the treatment of brain metastases (BMs). Although it is unequivocal in instances of diagnostic doubt, radioresistance, and risk of death due to neurologic causes, NSR may be controversial in other situations. Many aspects related to NSR have not yet been well established, and the primary prognostic indices were proposed only in the last decade. This study evaluates the survival and the morbidity, causes of death, prognostic factors, and the impact of RT in patients with BMs treated by NSR in the current era. Methods A total of 200 patients with BMs who were treated by NSR were evaluated sequentially and followed prospectively. We used logistic regression and Cox regression models to identify independent factors associated with mortality at 4 weeks and at 1 year, respectively. Clinical features, morbidity, recurrence, and causes of death were also studied. Results Lung cancer was the most prevalent cancer (36.5%); the median Karnofsky Performance Status (KPS) score was 60. Total resection was achieved in 89%, and adjuvant RT was applied in 63% of the cases. The rates of surgical mortality, morbidity, and mortality at 4 weeks were 1.5%, 17%, and 7.5%, respectively. Systemic infections were the leading cause of death in 62.5% of the cases. The median survival was 5 months, and 34.5% of patients lived > 1 year. The postoperative KPS (KPSpo) score remained unchanged or improved in 94.5% of the cases. In the multivariate analysis, a KPSpo score >= 80 and the application of adjuvant RT were associated with a lower risk of death at 12 weeks and at 1 year. Interestingly, the variables of primary tumor site, number of BMs, and presence of carcinomatous meningitis were not significant. Conclusion Morbidity and mortality were high, a third of the patients lived > 1 year, and the KPS score improved or remained unchanged in most cases. Prognostic indices and health conditions were important predictive factors, but the KPSpo score and adjuvant RT were independent variables for survival at 12 weeks and at 1 year. Therefore, new studies are needed to assess the influence of new therapies and specific molecular profiles.
- Ultrasonography During Surgery to Approach Cerebral Metastases: Effect on Karnofsky Index Scores and Tumor Volume(2017) OLIVEIRA, Marcelo de Lima; PICARELLI, Helder; MENEZES, Marcos Roberto; AMORIM, Robson Luis; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, EdsonBACKGROUND: The goals of treating a cerebral metastasis (CM) are to achieve local control of the disease and to improve patient quality of life. The aim of this study was to analyze the effect of conventional surgery supported by intraoperative ultrasound (IOUS) to approach a CM. To perform this analysis, we determined the postoperative Karnofsky Performance Status Scale (KPS) scores and tumor resection grades. METHODS: Patients with a CM diagnosis were included in this study. Surgical treatment was either supported or not by IOUS. Pre-and postoperative KPS scores were determined by the oncology team, and cerebral tumor volume was estimated through pre-and postoperative magnetic resonance imaging. The surgical team determined whether it was possible to perform a total CM resection. RESULTS: There were 78 patients treated using surgical management (35 with and 43 without IOUS). In the IOUS group, the postoperative KPS scores were higher (80 vs. 70, respectively; P = 0.045) and the KPS evolution was superior (P = 0.036), especially in the following subgroups: difficulty of tumor resection ranking score < 4 (P = 0.037), tumor in an eloquent area (P = 0.043), tumor not associated with vessels or nerves (P = 0.007), and solitary lesions (P = 0.038). The residual tumor volume was lower in the IOUS group (9.5% and 1.6 mm(3) vs. 30.8% and 9 mm(3), respectively; P = 0.05). In patients with a KPS score >= 70, 62% of them had <10% residual tumors (76% in the IOUS group and 45% in the non-IOUS group; P = 0.032; odds ratio, 3.8). CONCLUSIONS: IOUS may improve postoperative KPS scores and decrease residual tumor volumes in CM surgeries. These findings should be confirmed in future studies.
conferenceObject (TC)-T-99M-MIBI SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY-COMPUTED TOMOGRAPHY (SPECT-CT) TO DETECT TUMOR PROGRESSION IN GLIOBLASTOMAS (GB)(2017) VICTOR, Carolina; LOPEZ, Rossana; NUNES, Rafael; MARTA, Gustavo; PICARELLI, Helder; BUCHPIGUEL, Carlos Alberto; FEHER, Olavo- Atypical Virchow-Robin Spaces Mimicking Cystic Primary Brain Tumor - Clinical Report and Literature Review(2020) PICARELLI, Helder; NEPOMUCENO, Thales Bhering; CASAL, Yuri; YAMAKI, Vitor Nagai; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaThe Virchow-Robin spaces (VRSs), which are often incidentally observed in modern structural neuroimaging examinations, are small cystic cavities that usually surround the small arteries and arterioles at the level of basal ganglia, the anterior perforated substance and the thalamic-mesencephalic junction. Typically, they have similar physicochemical characteristics to cerebral spinal fluid (CSF) and there is no contrast enhancement on brain CT and MRI images. Its real meaning is unknown, although some contemporary studies have suggested that it might be related to certain traumatic brain injury or several other central nervous system (CNS) disorders, as degenerative diseases. Occasionally, some wide and atypical VRS may be mistaken for primary cystic brain tumors, especially in the context of large and symptomatic lesions, multiple clustered cysts, cortical lesions and if there is adjacent reactive gliosis. The present paper reports four patients who were affected by atypical VRS mimicking brain tumors that required imaging follow-up or even a biopsy to confirm the diagnosis or to indicate the correct approach. Although it is not so unusual, one of them occurred concomitantly and adjacent to a diffuse glioma (co-deleted 1p19q, WHO-GII).
conferenceObject Intraoperative ultrasonography for presumed brain metastases: a case series study(2013) PICARELLI, H.; OLIVEIRA, M. L.; BOR-SENG-SHU, E.; LIMA, S. P. B.; NOGUEIRA, R. C.; RIBAS, E. S.; SANTOS, A. M.; TEIXEIRA, M. J.