BARBARA ALBUQUERQUE MORAIS
Índice h a partir de 2011
7
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
19 resultados
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- 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.
- Traumatic Lumbosacral Spondyloptosis in a Pediatric Patient: Case Report and Literature Review(2018) YAMAKI, Vitor Nagai; MORAIS, Barbara Albuquerque; BROCK, Roger Schmidt; PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel JacobsenA 4-year-old girl was admitted to the emergency department after having been buried beneath a wall. A computed tomography scan revealed anterior grade V L5-S1 spondylolisthesis, and magnetic resonance imaging showed a traumatic rupture of the fibrous annulus of the L5-S1 intervertebral disc and lesion of the anterior longitudinal and yellow ligaments. The patient underwent anterior and posterior fixation. Four months later she was able to walk independently, despite a persistent left foot drop. Additionally, we conducted a literature review on lumbosacral spondyloptosis in the pediatric population published between 1990 and 2017. We found 16 cases, 86.6% of which were male, with a mean patient age of 16 +/- 5.05 years. Most patients underwent spine instrumentation. Based on the data reviewed, the neurological status at admission might be a valid predictor of outcome. Pedicle screws are a safe and reliable procedure for stable fixation of the spine in these cases. The removal of screws is discouraged. (c) 2018 S. Karger AG, Basel.
article Shunt dysfunction and constipation Response(2019) MORAIS, Barbara Albuquerque; CARDEAL, Daniel Dante; ANDRADE, Fernanda Goncalves; PAIVA, Wellingson Silva; MATUSHITA, Hamilton; TEIXEIRA, Manoel Jacobsen- 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.
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.- 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.
- Evaluation of Head Computed Tomography Assessment of Brain Swelling after Acute Traumatic Brain Injury: A Pilot study(2019) AMORIM, Robson Luis; MORAIS, Barbara Albuquerque; PEREIRA, Francisco Otavio Camargo; OLIVEIRA, Matheus Fernandes; ANDRADE, Almir Ferreira; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo Lima; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaObjective To evaluate the interobserver reliability of a new scale created for quantitatively assessing brain swelling in traumatic brain injury (TBI) patients using the computed tomography (CT) findings in three levels. Methods Computed tomography scans of severe head injury patients were randomly selected from a tertiary hospital image database and evaluated by independent groups of neurosurgeons, neurosurgery residents, radiologists, and intensivists from the same hospital. Each specialist assessed the tomographic findings, applying zero to six points in a new scale. The Kappa coefficient was calculated to assess interobserver agreement. Results The highest reliability coefficient was obtained by the neurosurgeons group (0.791; 95% confidence interval [CI]: 0.975-0.607; p < 0.001), followed by the neurosurgery residents group (0.402; 95%CI: 0.569-0.236; p < 0.001) and by the radiologists group (0.301; 95%CI: 0.488-0.113; p < 0.002). The lowest coefficient was found among the intensivists (0.248; 95%CI: 0.415-0.081; p = 0.004). Conclusion The proposed scale showed good reliability among neurosurgeons, and moderate overall reliability. This tomographic classification might be useful to better assist severe TBI victims, allowing to identify the worsening or amelioration of brain swelling, which should be further investigated. The scale seems to be feasible, even in low income countries, where the cost of intracranial pressure (ICP) monitoring is higher than that of CTs.
- Surgical approaches for the lateral mesencephalic sulcus(2020) CAVALCANTI, Daniel Dutra; MORIS, Barbara Albuquerque; FIGUEIREDO, Eberval Gadelha; SPETZLER, Robert F.; PREUL, Mark C.OBJECTIVE The brainstem is a compact, delicate structure. The surgeon must have good anatomical knowledge of the safe entry points to safely resect intrinsic lesions. Lesions located at the lateral midbrain surface are better approached through the lateral mesencephalic sulcus (LMS). The goal of this study was to compare the surgical exposure to the LMS provided by the subtemporal (ST) approach and the paramedian and extreme-lateral variants of the supracerebellar infratentorial (SCIT) approach. METHODS These 3 approaches were used in 10 cadaveric heads. The authors performed measurements of predetermined points by using a neuronavigation system. Areas of microsurgical exposure and angles of the approaches were determined. Statistical analysis was performed to identify significant differences in the respective exposures. RESULTS The surgical exposure was similar for the different approaches-369.8 +/- 70.1 mm(2) for the ST; 341.2 +/- 71.2 mm(2) for the SCIT paramedian variant; and 312.0 +/- 79.3 mm(2) for the SCIT extreme- lateral variant (p = 0.13). However, the vertical angular exposure was 16.3 degrees +/- 3.6 degrees for the ST, 19.4 degrees +/- 3.4 degrees for the SCIT paramedian variant, and 25.1 degrees +/- 3.3 degrees for the SCIT extreme- lateral variant craniotomy (p < 0.001). The horizontal angular exposure was 45.2 degrees +/- 6.3 degrees for the ST, 35.6 degrees +/- 2.9 degrees for the SCIT paramedian variant, and 45.5 degrees +/- 6.6 degrees for the SCIT extreme-lateral variant opening, presenting no difference between the ST and extreme-lateral variant (p = 0.92), but both were superior to the paramedian variant (p < 0.001). Data are expressed as the mean +/- SD. CONCLUSIONS The extreme-lateral SCIT approach had the smaller area of surgical exposure; however, these differences were not statistically significant. The extreme-lateral SCIT approach presented a wider vertical and horizontal angle to the LMS compared to the other craniotomies. Also, it provides a 90 degrees trajectory to the sulcus that facilitates the intraoperative microsurgical technique.
- Hyperhomocysteinemia as a Risk Factor for Intracranial Aneurysms: A Case-Control Study(2018) ROSI, Jefferson; MORAIS, Barbara A.; PECORINO, Lucas S.; OLIVEIRA, Allan R.; SOLLA, Davi J. F.; TEIXEIRA, Manoel J.; FIGUEIREDO, Eberval G.OBJECTIVE: Homocysteine, an amino acid derived from methionine metabolism, has gained great importance as an important risk factor for cardiovascular diseases as the result of its thrombogenic properties and endothelial injury association. However, its role in the etiology and screening of intracranial aneurysms (IAs) has not been well studied. We aimed to test the hypothesis of a positive association between hyperhomocysteinemia (HHcy) and IAs. METHODS: A case-control study was performed at a vascular neurosurgery unit in Brazil between 2016 and 2017. In total, 180 patients were included: 142 patients with previous IAs (case group) and 38 patients with a previous diagnosis of arteriovenous malformation and no aneurysms on imaging evaluation (control group). HHcy was defined as homocysteine levels greater than 15 mu mol/L. Multivariate models were designed to adjust for potential confounders: age, sex, hypertension, dyslipidemia, and smoker status. RESULTS: The case group was older (56.3 + 12.6 years vs. 40.9 +/- 14.0 years, P < 0.001) and had a greater prevalence of women (76.1% vs. 55.3%, P = 0.012), as well as hypertension (45.1% vs. 2.6%, P < 0.001), dyslipidemia (60.6% vs. 10.5%, P = 0.001), and smokers (41.5% vs. 0.0%, P < 0.001). Median homocysteine in the cases was similar to the controls (10.5 mu mol/L [8.3-14.0] vs. 10.7 mu mol/L [8.2-13.3], respectively, P = 0.450). There was a trend toward greater HHcy prevalence in the case group (20.4% vs. 7.9%, P = 0.073). HHcy was associated with greater age, male sex, hypertension, and smoking status. After multivariate adjustment, HHcy had no association with IAs (odds ratio 1.34, 95% confidence interval 0.30-5.97, P = 0.703). CONCLUSIONS: No association was found between HHcy and IAs.