MATHEUS FERNANDES DE OLIVEIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Intraoperative Ultrasound in Chiari Type I Malformation(2020) BROCK, R. S.; TARICCO, M. A.; OLIVEIRA, M. F. De; OLIVEIRA, M. De Lima; TEIXEIRA, M. J.; BOR-SENG-SHU, E.The advent of intraoperative ultrasonography (USG) has allowed identification of craniocervical junction (CVJ) anatomy and cerebrospinal fluid dynamics and CVJ structures with real-time images. It is possible to use intraoperative USG in patients with Chiari malformation type I as a method for selection of candidates for posterior fossa decompression with bone removal alone. This chapter describes the authors’ experience using intraoperative USG. © Springer Nature Switzerland AG 2020.
- 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.
- Psychiatric symptoms are frequent in idiopathic intracranial hypertension patients(2021) OLIVEIRA, Matheus Fernandes de; YAMASHITA, R. H. G.; SORTE JR., A. A. Boa; ROTTA, J. M.; NORREMOSE, K. A.; TEIXEIRA, M. J.; PINTO, F. C. G.Idiopathic intracranial hypertension (IIH) is a rare disease with an incidence rate of 0.5-2.0/100,000/year. Characteristic symptoms are headache and several degrees of visual impairment. Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In this study, we evaluated IIH subjects to determine the association with psychiatric symptoms. We evaluated thirty consecutive patients with IIH submitted to neurosurgery from January 2017 to January 2020 in two Brazilian tertiary hospitals. They underwent clinical evaluation, obtaining medical history, comorbidities, body mass index (BMI-kg/m(2)), and applying Neuropsychiatric Inventory Questionnaire (NPI-Q). There were 28 females and 2 males. Ages ranged from 18 to 66 years old, with mean age of 37.97 +/- 12.78. Twenty-five (83%) presented comorbidities, being obese and having arterial hypertension the most frequent. Body mass index ranged from 25 to 35 kg/m(2)and mean value was 31 +/- 3.42. After application of Neuropsychiatric Interview, 26 of 30 presented psychiatric symptoms (86%). Depression-anxiety syndromes were reported in 25 patients (83%). Nighttime disturbances were reported by 14 subjects (46%). Appetite and eating disorders were described by 23 (76%). Psychiatric symptoms in association with IIH are usually poorly described and underestimated. In our sample, twenty-six out of 30 (86%) reported psychiatric symptoms. We highlight the high prevalence of psychiatric symptoms among IIH patients and the need of managing these patients with a multidisciplinary team, including psychiatrists.
- 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.
- The Retrograde Ventriculosinusal Shunt in an Animal Experimental Model of Hydrocephalus(2016) PINTO, Fernando Campos Gomes; BECCO, Rodrigo; ALHO, Eduardo Joaquim Lopes; POLI-DE-FIGUEIREDO, Luiz Francisco; SOUZA, Podalyro Amaral de; OLIVEIRA, Matheus Fernandes de; TEIXEIRA, Manoel JacobsenCurrently, hydrocephalus treatment is performed mainly with ventriculoperitoneal shunting. This experimental study aims at assessing whether the experimental model of hydrocephalus in dogs is applicable to the laboratory study of the retrograde ventriculosinusal shunt (RVSS). Four mongrel dogs were assessed. After randomization, the animals were divided into two groups: an experimental group that underwent the induction of hydrocephalus/RVSS and a control group, for the measurement of the mean arterial pressure, intracranial pressure and pressure in the superior sagittal sinus (SSS). The controls presented a mean arterial pressure of 68 mm Hg (71 and 65), an intracranial pressure of 163 mm H2O (149.6 and 176.8) and a pressure at the SSS of 40 mm H2O (40 and 40). The kaolin injection into the cisterna magna at a concentration of 0.3 mg/ml was capable of inducing the clinical and radiological mechanism of hydrocephalus (intracranial pressure = 250 mm H2O, pressure at the SSS = 50 mm H2O). The caliber of the SSS was 2.5 +/- 1.0 mm. The fact that the SSS caliber of the dog was the same size as the external diameter of the catheter used resulted in the complete obstruction of the SSS when the catheter was inserted. We believe we could design and perform an experimental model to test the RVSS. It is applicable and feasible. The model of hydrocephalus, the surgical apparatus and the scenario were adequate, but the shunt system needs to be proportionally made to the canine anatomy. (C) 2016 S. Karger AG, Basel
- Transcranial Doppler in the evaluation of infants treated with retrograde ventriculosinus shunt(2016) OLIVEIRA, Matheus Fernandes de; TEIXEIRA, Manoel Jacobsen; OLIVEIRA, Marcelo de Lima; SENG-SHU, Edson Bor; NORREMOSE, Karen Andrade; PINTO, Fernando Campos GomesHydrocephalus is a prevalent condition among infants. Retrograde ventriculosinus shunt (RVSS) proposes a feasible option to treat hydrocephalus according to the principles presented by El-Shafei. In this essay, we analyze nuances and application of transcranial Doppler (TCD) in patients submitted to RVSS. We consecutively enrolled patients diagnosed with hydrocephalus after surgical repair of myelomeningocele from January 2010 to January 2012, users of Hospital das Clinicas, University of Sao Paulo. They were treated with RVSS. Patients enrolled to the study were consecutively evaluated in an outpatient basis with TCD in preoperative, immediate postoperative period, and late postoperative period (1 year). Except for patient 3, there was an increase in mean flow velocity, decreased pulsatility index, and decreased resistance index in all vessels analyzed. In our sample, transcranial Doppler could be used as a diagnostic and follow-up tool to evaluate hemodynamics and hydrodynamics in the preoperative and postoperative phases of RVSS. It was technically feasible in all patients, had close relation with other clinical and image parameters, and was sensitive to identify system malfunction.
- Clinical performance of fixed-pressure Sphera Duo (R) hydrocephalus shunt(2020) PINTO, Fernando Campos Gomes; OLIVEIRA, Matheus Fernandes de; CASTRO, Joao Paulo Souza de; MORAIS, Joao Vitor Rocha; PINTO, Flavia Morais Gomes; TEIXEIRA, Manoel JacobsenIntroduction: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera (R) Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. Methods: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. Results: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. Discussion: Sphera Duo (R) shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. Conclusion: Sphera Duo (R) shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.
- Revisiting Retrograde Ventriculosinus Shunt as an Alternative for Treating Hydrocephalus in Children(2017) OLIVEIRA, Matheus Fernandes; TEIXEIRA, Manoel Jacobsen; OLIVEIRA, Marcelo Lima; SHU, Edson Bor Seng; PINTO, Fernando Campos GomesIntroduction Retrograde ventriculosinus shunt (RVSS) is a useful option in the daily routine of neurosurgeons dealing with hydrodynamics. The objective of this manuscript is to review the main data about RVSS. Methods We performed a critical review. The keywords used were hydrocephalus, shunt, venous sinus, ventriculosinus shunt, retrograde ventriculosinus shunt, and sagittal sinus. The search was performed in the Medline (Pubmed) and EMBASE databases. Results Van Canneyt et al (2008) and Pinto et al (2016) performed experimental studies confirming the effectiveness of RVSS. El Shafei et al (1985, 1987, 2001) authors reported several cases treated with efficacy and few complications. Oliveira et al (2015, 2016) compared RVSS and ventriculoperitoneal shunt (VPS) in the treatment of hydrocephalus after myelomeningocele repair in infants, with similar functional results. Oliveira et al (2015, 2016) also described the applicability of RVSS in situations when VPS is not feasible, or when the peritoneum is not useful. Discussion Retrograde ventriculosinus shunt is a safe and more physiological option, which requires the use of less prostheticmaterial. It is feasible and applicable. Especially in children, it generates a normotensive state after shunting, allowing centrifugal head growth, once there is no intracranial hypotension due to overdrainage, which may reflect in long-term better psychomotor development. Conclusions The surgical technique of RVSS is feasible. The clinical results are comparable with those of the VPS.
- Failed Ventriculoperitoneal Shunt: Is Retrograde Ventriculosinus Shunt a Reliable Option?(2016) OLIVEIRA, Matheus Fernandes de; TEIXEIRA, Manoel Jacobsen; REIS, Rodolfo Casimiro; PETITTO, Carlo Emanuel; PINTO, Fernando Campos GomesBACKGROUND: Currently, the treatment of hydrocephalus is mainly carried out through a ventriculoperitoneal shunt (VPS) insertion. However, in some cases, there may be surgical revisions and requirement of an alternative distal site for shunting. There are several described distal sites, and secondary options after VPS include ventriculopleural and ventriculoatrial shunt, which have technical difficulties and harmful complications. OBJECTIVES: In this preliminary report we describe our initial experience with retrograde ventriculosinus shunt (RVSS) after failed VPS. RESULTS: In 3 consecutive cases we applied RVSS to treat hydrocephalus in shunt-dependent patients who had previously undergone VPS revision and in which peritoneal space was full of adhesions and fibrosis. RVSS was performed as described by Shafei et al., with some modifications to each case. All 3 patients kept the same clinical profile after RVSS, with no perioperative or postoperative complications. However, revision surgery was performed in the first operative day in 1 out of 3 patients, in which the catheter was not positioned in the superior sagittal sinus. CONCLUSIONS: We propose that in cases where VPS is not feasible, RVSS may be a safe and applicable second option. Nevertheless, the long-term follow-up of patients and further learning curve must bring stronger evidence.