BARBARA ALBUQUERQUE MORAIS
Índice h a partir de 2011
7
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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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.
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.
- 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.
- Reversible ventriculoperitoneal shunt dysfunction and chronic constipation: case report(2018) MORAIS, Barbara A.; CARDEAL, Daniel D.; ANDRADE, Fernanda G.; PAIVA, Wellingson S.; MATUSHITA, Hamilton; TEIXEIRA, Manoel J.Constipation can cause transient malfunction of the ventriculoperitoneal shunt (VPS). Patients with myelomeningocele or cerebral palsy are often diagnosed with hydrocephalus and constipation due to neurogenic bowel.These patients are more prone to VPS dysfunction, often requiring surgical revision. The authors report the case of a 6-year-old girl with a VPS that had been implanted due to hydrocephalus secondary to myelomeningocele. The patient was brought to the emergency department with intermittent headache, vomiting, constipation, and abdominal distension and pain. A CT scan revealed ventricular dilatation and radiography of the abdomen showed bowel loop distension. After a Fleet enema and digital maneuvers, her abdominal distension and symptoms improved. A CT scan obtained 24 hours later showed a reduction in ventricular size. The mechanism by which constipation can lead to VPS malfunction can be traced to indirect increases of intraabdominal pressure and direct obstruction of the catheter by distended intestinal loops. Treating constipation can restore the free circulation of the CSF and avoid surgical intervention. Careful neurological monitoring of these patients is essential, because some measures used to treat constipation can increase intracranial pressure. The objective of this report was to highlight constipation as a possible cause of transient VPS malfunction, thereby avoiding unnecessary surgical revisions, to which children with hydrocephalus are frequently submitted.
- Post-traumatic carotid-cavernous fistula in a pediatric patient: a case-based literature review(2018) MORAIS, Barbara Albuquerque; YAMAKI, Vitor Nagai; CALDAS, Jose Guilherme Mendes Pereira; PAIVA, Wellingson Silva; MATUSHITA, Hamilton; TEIXEIRA, Manoel JacobsenCarotid-cavernous fistula (CCF) is a shunt between the carotid artery and the cavernous sinus. Traumatic CCFs are diagnosed in 0.2% of head traumas being only 4.6% of the pediatric population. Classified by Barrow in 1985, type A CCF is the most frequent, occurring in 75% of cases. Type A is characterized by direct and high-flow CCF that generally can occur as a result of traumatic injury or rupture of an intracavernous aneurysm. The subject was an 8-year-old boy with penetrating trauma to his left eye. During the initial evaluation, a computed tomography (CT) scan was unremarkable, and after relief of symptoms, the patient was discharged. Seven days later, he developed grade I proptosis, conjunctival chemosis, ophthalmoplegia (III, IV, and VI cranial nerve palsies), and left-sided ptosis and mydriasis. Arteriography confirmed a post-traumatic CCF, and the patient was treated with an endovascular detachable balloon. CCF should be suspected in craniofacial traumas with ocular symptoms. The presence of a skull base fracture on CT is a poor predictor of CCF associated with head trauma. Early diagnosis and treatment can prevent permanent neurological deficits and unfavorable outcomes.