HAMILTON MATUSHITA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
18 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 18
- Brain abnormalities in myelomeningocele patients(2020) MORAIS, Barbara Albuquerque; SOLLA, Davi Jorge Fontoura; YAMAKI, Vitor Nagai; FERRACIOLLI, Suely Fazio; ALVES, Cesar Augusto P. F.; CARDEAL, Daniel Dante; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenBackground Myelomeningocele (MMC) is often related to hydrocephalus and Chiari malformation (CM) type 2; however, other brain abnormalities have been reported in this population. In order to better understand and quantify other forebrain abnormalities, we analyzed magnetic resonance imaging (MRI) of MMC patients treated in utero or postnatal. Methods Between January 2014 and March 2017, 59 MMC were treated in our hospital. Thirty-seven patients (32 postnatal and 5 intrautero repair) had brain MRI and were enrolled at the study. MRI was analyzed by two experienced neuroradiologists to identify the supra and infratentorial brain abnormalities. Results A wide range of brain abnormalities was consistently identified in MMC patients. As expected, the most common were hydrocephalus (94.5%) and CM type II (89.1%). Of note, we found high incidence of corpus callosum abnormalities (86.4%), mostly represented by dysplasia (46%). Conclusions The data are consistent with the concept that brain abnormalities related to MMC can be both infratentorial and supratentorial, cortical, and subcortical. More studies are needed to correlate these forebrain abnormalities to long-term functional outcome and their prognostic value for these patients.
- High Intra-Abdominal Pressure Secondary to Obesity as a Determining Factor for Ventriculoperitoneal Shunt Malfunction(2018) MORAIS, Barbara Albuquerque; YAMAKI, Vitor Nagai; CARDEAL, Daniel Dante; ANDRADE, Fernanda Goncalves; PAIVA, Wellingson Silva; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenThe ventriculoperitoneal shunt (VPS) is an established treatment for hydrocephalus. The functioning of the system requires a pressure difference between the cranial and abdominal cavities. The VPS can be particularly problematic in patients with increased intra-abdominal pressure (IAP). We report the case of a 16-year-old girl with VPS since she was 2 months old due to hydrocephalus secondary to myelomeningocele. The patient had been asymptomatic ever since, but she sought the emergency service with intermittent headache and vomiting. A non-enhanced brain tomography, a shunt trajectory X-ray and an abdominal ultrasound revealed no cause of system malfunction. In view of the persistent clinical picture, a revision of the shunt was performed, which revealed adequate intraoperative functioning. She returned with the same symptoms two weeks after surgery. The patient was obese (body mass index [BMI]: 48). We hypothesized intermittent valve malfunction due to increased intra-abdominal pressure. She underwent a ventriculoatrial shunt, without intercurrences. In the postoperative period, the patient presented transient tachycardia and was asymptomatic at the 6-month follow-up. Obesity should be considered an important variable for the inadequate functioning of the VPS due to increased IAP and catheter dystocia to the extraperitoneal cavity. Studies have already correlated the IAP with the BMI, which reaches between 8mm Hg and 12mm Hg in obese individuals. Therefore, the BMI can be considered during the selection of valve pressure in systems with non-adjustable valves to prevent insufficient drainage. The recognition of obesity as a cause of VPS malfunction is fundamental to avoid unnecessary surgeries and intermittent malfunction of the system. Resumo A derivacAo ventriculoperitoneal (DVP) e um tratamento estabelecido para a hidrocefalia; contudo, algumas variaveis podem influenciar na eficacia desta modalidade. O funcionamento do sistema requer uma diferenca de pressAo entre as cavidades craniana e abdominal. A DVP pode ser particularmente problematica em pacientes com aumento da pressAo intra-abdominal (PIA). Neste artigo, relatamos o caso de uma paciente do sexo feminino, de 16 anos, portadora de DVP desde os 2 meses de idade por hidrocefalia secundaria a mielomeningocele. Desde entAo assintomatica, procurou o pronto-socorro com queixa de cefaleia e vomitos intermitentes. Uma tomografia de cranio sem contraste, um raio X (RX) do trajeto do cateter distal, e uma ultrassonografia (USG) abdominal nAo evidenciaram a causa do mau funcionamento do sistema. Diante do quadro persistente, realizou-se uma revisAo da derivacAo, que mostrou funcionamento adequado no periodo intraoperatorio. A paciente retornou com os mesmos sintomas duas semanas apos a cirurgia. A paciente era obesa (indice de massa corporal [IMC]: 48). Aventou-se possivel funcionamento intermitente da valvula pelo aumento da PIA. A paciente foi submetida a uma derivacAo ventriculo-atrial, que foi realizada sem intercorrencias. No pos-operatorio, ela apresentou quadro transitorio de taquicardia, e nAo apresentou sintomas no acompanhamento feito depois de 6 meses. A obesidade deve ser considerada uma variavel importante para o funcionamento inadequado da DVP, pelo aumento da PIA e pela associacAo com distocia do cateter para a cavidade extraperitoneal. Estudos ja correlacionaram a PIA com o IMC, que pode atingir entre8mm Hg e 12mm Hg em obesos. Logo, o IMC pode ser considerado na selecAo da pressAo da valvula em sistemas com valvulas nAo ajustaveis, para prevenir a drenagem insuficiente. O reconhecimento da obesidade de risco para o mau funcionamento da DVP e fundamental para evitar cirurgias desnecessarias e o mau funcionamento intermitente do sistema.
- Surgical technique of retrograde ventricle-sinus shunt is an option for the treatment of hydrocephalus in infants after surgical repair of myelomeningocele(2015) OLIVEIRA, Matheus Fernandes de; TEIXEIRA, Manoel Jacobsen; NORREMOSE, Karen Andrade; MATUSHITA, Hamilton; OLIVEIRA, Marcelo de Lima; SHU, Edson Bor Seng; PINTO, Fernando Campos GomesIntroduction: Treatment of hydrocephalus is accomplished primarily through a ventricular-peritoneal shunt (VPS). This study aims to describe the application of retrograde ventricle-sinus shunt (RVSS) in patients with hydrocephalus after surgical treatment of myelomeningocele. Method: A prospective, randomized and controlled pilot study. We consecutively enrolled 9 patients with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012. These patients underwent elective RVSS or VPS. Five underwent RVSS and 4 underwent VPS. Patients were followed for one year with quarterly evaluations and application of transcranial Doppler. Results: RVSS group showed outcomes similar to those of VPS group. Doppler revealed significant improvement when comparing preoperative to postoperative period. RVSS group had significantly higher cephalic perimeter than VPS group. Neuropsychomotor development, complications and subjective outcomes did not differ between groups. Conclusion: RVSS shunt is viable; it is an alternative option for the treatment of hydrocephalus.
article Shunt dysfunction and constipation Response(2019) MORAIS, Barbara Albuquerque; CARDEAL, Daniel Dante; ANDRADE, Fernanda Goncalves; PAIVA, Wellingson Silva; MATUSHITA, Hamilton; TEIXEIRA, Manoel Jacobsen- Apert syndrome without craniosynostosis(2019) RAMOS, Diego de Angelis; MATUSHITA, Hamilton; CARDEAL, Daniel Dante; NASCIMENTO, Clarissa Nobrega Gambarra; TEIXEIRA, Manoel JacobsenBackgroundApert syndrome is a rare form of syndromic craniosynostosis, also known as acrocephalosyndactyly, which is a disorder characterized by a unique set of craniofacial, hand, and foot abnormalities. Diagnosis is made through a genetic analysis, where the mutation of FGFR2, Ser252Trp, and Pro253Arg confirms the diagnosis.Case presentationAlthough craniosynostosis is the most common characteristic in clinical presentation, we present an atypical case of a one-and-a-half-year-old girl with Apert syndrome confirmed by genetic testing but without craniosynostosis.
- Hydrocephalus: a rare initial manifestation of sporadic intramedullary hemangioblastoma(2017) MORAIS, Barbara Albuquerque; CARDEAL, Daniel Dante; RIBEIRO, Renan Ribeiro e; FRASSETTO, Fernando Pereira; ANDRADE, Fernanda Goncalves; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenBackground Intramedullary hemangioblastomas are rare benign vascular tumors, infrequent in pediatric patients. Clinical symptoms vary according to the age of presentation, tumor size, location, and concomitant syringomyelia. This is the second reported case of hemangioblastoma presenting with acute hydrocephalus. Case presentation A 3-month-old infant with acute hydrocephalus was asymptomatic after a ventriculoperitoneal shunt was placed. She returned 3 months later with irritability, acute paraplegia, and respiratory distress. Magnetic resonance imaging (MRI) showed an intramedullary T8-T9 tumor with syringomyelia. She underwent surgical resection with good results during the 6-month follow-up. Conclusion Intramedullary tumors may present as hydrocephalus and other nonspecific symptoms, with invariably delayed diagnosis in children, but must be considered in suspicious cases.
- Perimedullary arteriovenous fistulas in children: report on six cases(2012) MATUSHITA, Hamilton; CALDAS, Jose Guilherme Mendes Pereira; TEXEIRA, Manoel JacobsenBackground Perimedullary arteriovenous fistulas (PMAVFs) are rare spinal lesions and even more uncommon in children. Objective The aim of this study was to document rare occurrences of this type of arteriovenous malformation in six children treated at our institution. Methods The clinical data, radiological findings, and treatment in six cases of PMAVFs were reviewed. Six patients with PMAVFs were managed at our institution over a 5-year period. The patients (four girls and two boys), ranging in age from 6 to 15 years, presented with initially fluctuating, and eventually permanent and progressive, sudden-onset paraparesis, sensory disturbances, and sphincter dysfunction. The duration of symptoms before diagnosis ranged from 1 week to 13 years. Results All the patients underwent magnetic resonance imaging and spinal selective angiography, which demonstrated the characteristic imaging of an arteriovenous fistula. Embolization of the arteriovenous fistula was initially attempted in three patients with successful occlusion of the fistula in two. For the remaining cases, open surgery was performed, with complete occlusion of the fistula. There was no morbidity, regardless of the treatment performed. All the patients experienced neurological improvement after treatment. Conclusions No specific clinical or radiological characteristic of PMAVFs in the pediatric population was observed when our series was compared with a general series. Early diagnosis and timing of the therapeutic intervention seemed to avoid the development of irreversible ischemic myeloradiculopathy and prevented hemorrhage. Treatment for PMAVFs is difficult to standardize because these are extremely rare lesions with different angioarchitecture configurations.
- Pediatric intrinsic brainstem lesions: clinical, imaging, histological characterization, and predictors of survival(2020) MORAIS, Barbara Albuquerque; SOLLA, Davi Jorge Fontoura; MATUSHITA, Hamilton; TEIXEIRA, Manoel Jacobsen; MONACO, Bernardo A.Purpose Brainstem lesions comprise 10-20% of all pediatric brain tumors. Over the past years, the benefits of stereotactic biopsy versus the use alone of MRI features to guide treatment have been controversial. Methods Retrospective study with pediatric patients submitted to stereotactic brainstem biopsies between 2008 and 2018. Demographic, clinical, imaging, and surgical characteristics were recorded, as well as the histological diagnosis, complications, and survival. Predictors of survival were evaluated through Cox regression models after multivariate adjustment. Results Twenty-six patients (mean age of 8.8 +/- 4.3 years and 14 female). Diagnosis was reached on 84.6% (95% CI 65.1-95.6%) of the patients. Glioma was diagnosed on 20 cases (11 high-grade and 9 low-grade lesions). There was no association between age and gender and the dichotomized histological diagnosis. Contrast enhancement, diffuse distribution, invasion of adjacent structures, and remote injury were present on 62.5%, 75.0%, 62.5%, and 25.0% of the cases. Hydrocephalus at admission was present on almost half of the patients (46.2%). Only radiological invasion of adjacent structures had a possible association with high-grade lesions (p = 0.057). Surgical trajectory was trans-cerebellar in most of the cases (79.9%). There were no major complications and only two minor/transitory complications. Poorer survival was independently associated with high-grade lesions (HR 32.14, 95% CI 1.40-735.98, p = 0.030) and contrast enhancement at MRI (HR 36.54, 95% CI 1.40-952.26, p = 0.031). Conclusions Stereotactic biopsy was safe and allows successful tissue sampling for a definite diagnosis. Poorer survival was independently associated with high-grade and contrast-enhancing lesions.
conferenceObject DIFFUSE LEPTOMENINGEAL DISSEMINATED GLIONEURONAL TUMOR: CASE-SERIES(2020) SANDERS, Felipe Hada; MATUSHITA, Hamilton; AZAMBUJA, Alessandra; FRASSETO, Fernando; ROSEMBERG, Sergio; ODONE, Vicente; TEIXEIRA, Manoel Jacobsen- Subependymal giant cell astrocytoma associated with tuberous sclerosis presenting with intratumoral bleeding. Case report and review of literature(2013) STERMAN, Hugo; FURLAN, Andre Beer; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenThe authors describe a rare case of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex that presented with intratumoral bleeding with extension to the ventricles. The literature regarding intracranial hemorrhage of SEGA is reviewed and only five cases have been reported in the literature. We have not identified a histological feature associated with bleeding.