ERIC HOMERO ALBUQUERQUE PASCHOAL
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- Relationship between endothelial nitric oxide synthase (eNOS) and natural history of intracranial aneurysms: meta-analysis(2018) PASCHOAL, Eric Homero Albuquerque; YAMAKI, Vitor Nagai; TEIXEIRA, Renan Kleber Costa; PASCHOAL JUNIOR, Fernando Mendes; JONG-A-LIEM, Glaucia Suzanna; TEIXEIRA, Manoel Jacobsen; YAMADA, Elizabeth Sumi; RIBEIRO-DOS-SANTOS, Andrea; BOR-SENG-SHU, EdsonThe aneurysmal subarachnoid hemorrhage is a major public health problem described as a sudden drastic event with no warning symptoms and high morbidity and mortality rates. The role of the endothelial isoform of nitric oxide synthase gene polymorphism in intracranial aneurysms (IAs) is still a matter of controversy with divergent findings among European, American, and Asian populations. Our study purposed to test the association between intracranial aneurysms formation and nitric oxide gene polymorphisms through a systematic review and meta-analysis. Systematic search on Medline, Lilacs, and EMBASE was performed. The primary search resulted in 139 papers, out of which 9 met our inclusion criteria after a full text analysis. The dominant T786C model found a significant association with IA (OR 1.22, 95 % CI 1.04-1.44, p = 0.01), so did studies of the recessive T786C model (OR 0.37, 95 % CI 0.30-0.45, p < 0.0001) but with opposite effect. Our findings support the presence of the T786C polymorphism as a predictor for the development of intracranial aneurysm in the cerebral vascular system. More studies are necessary in order to elucidate the pathways of the endothelial nitric oxide synthase (eNOS) in cerebrovascular diseases and in defining how different allelic combinations of the eNOS gene single-nucleotide polymorphism (SNP) could favor this pathological process.
- Neck paraganglioma: Head rotation maneuver on transcranial Doppler ultrasonography(2015) PASCHOAL, Fernando Mendes; PASCHOAL, Eric Homero Albuquerque; ROGERIO, Ricardo Mendes; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
- Cerebral hemodynamic and metabolic changes in fulminant hepatic failure(2017) PASCHOAL JUNIOR, Fernando Mendes; NOGUEIRA, Ricardo de Carvalho; OLIVEIRA, Marcelo de Lima; PASCHOAL, Eric Homero Albuquerque; TEIXEIRA, Manoel Jacobsen; D'ALBUQUERQUE, Luiz Augusto Carneiro; BOR-SENG-SHU, EdsonIntracranial hypertension and brain swelling are a major cause of morbidity and mortality of patients suffering from fulminant hepatic failure (FHF). The pathogenesis of these complications has been investigated in man, in experimental models and in isolated cell systems. Currently, the mechanism underlying cerebral edema and intracranial hypertension in the presence of FHF is multi-factorial in etiology and only partially understood. The aim of this paper is to review the pathophysiology of cerebral hemodynamic and metabolism changes in FHF in order to improve understanding of intracranial dynamics complication in FHF.
- Dual origin of vertebral artery and intimal relationship with spontaneous artery dissection: a case report and systematic review(2021) NASCIMENTO, Derik Williams Barros do; CRUZ, Rafaella Macedo Monteiro da; PIMENTA, Gabriel Gomes Diniz; JR, Fernando Mendes Paschoal; LIMA NETO, Antonio de Mattos; BASTOS, Vanessa Alburquerque Paschoal Aviz; BRITO, Jose Reginaldo Nascimento; VILHENA, Bruno Sergio; LIMA, Jose Antonio Santos de; BOR-SENG-SHU, Edson; FIGUEIREDO, Eberval Gadelha; TEXEIRA, Manoel Jacobsen; PASCHOAL, Eric Homero AlbuquerqueDual origin of the vertebral artery (VA) is an uncommon anatomical variation. We describe a case of duplication origin at right vertebral artery (RVA) found incidentally in one elderly patient on investigation for cerebral aneurysm. Angiogram study showed a pseudoaneurysm at V4 segment of the RVA associated with embryological anatomy. The authors performed a systematic review of the similar cases reported worldwide.
- Embolic Signals during Routine Transcranial Doppler Ultrasonography in Aneurysmal Subarachnoid Hemorrhage(2015) PASCHOAL JR., Fernando Mendes; RONCONI, Karla de Almeida Lins; OLIVEIRA, Marcelo de Lima; NOGUEIRA, Ricardo de Carvalho; PASCHOAL, Eric Homero Albuquerque; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval Gadelha; BOR-SENG-SHU, EdsonIntroduction. Cerebral emboli may occur in subarachnoid hemorrhage (SAH) and intracranial aneurysm surgery. Although embolic signs (ES) have been reported in SAH, their origin remains unclear. The aim of this study was to report the detection of ES during routine TCD monitoring in patients with aneurysmal SAH. Methods. A total of 105 patients with aneurysmal SAH were submitted to TCD evaluation. Patients were monitored almost daily (5 times per week). In each monitoring session, one experienced operator performed TCD to detect or assess vasospasm and ES in arteries of the Willis polygon. Results. Four patients out of a total of 105 patients with aneurysmal SAH were found to present spontaneous cerebral embolization during routine TCD monitoring. The average age of the 4 patients (mean +/- standard deviation) was 59.5 +/- 8.34 years (range 49-68 ys); female patients predominated representing 75%(3/4) of subjects. Conclusion. Although detection of ES was relatively rare in this study, rates of emboli occurrence may be higher under systematic monitoring. The detection of ES after SAH surgery reinforces the need to study the role of embolus in this condition and may be an indicator for prophylactic antithrombotic treatment.
- Surgical Treatment of Posterior Circulation Aneurysms - Anatomical Study and Surgical Technique(2018) YAMAKI, Vitor Nagai; PASCHOAL, Eric Homero Albuquerque; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaPosterior circulation aneurysms represent 10-15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms. Resumo Aneurismas de circulacAo posterior representam de 10-15% dos aneurismas intracranianos. O diagnostico, frequentemente, e secundario a hemorragia subaracnoide devido a apresentacAo assintomatica na maioria dos casos e ao alto risco de sangramento comparado com aneurismas da circulacAo anterior. O tratamento cirurgico de aneurismas de circulacAo posterior e complexo e desafiador para os neurocirurgioes devido a anatomia particular da regiAo, profundidade do acesso cirurgico, e relacAo intima com o tronco encefalico e os nervos cranianos. Aneurismas de diferentes localizacoes tem diferentes relacoes anatomicas e, portanto, acessos cirurgicos especificos para melhor disseccAo e visibilizacAo de estruturas. Logo, um conhecimento detalhado de anatomia e mandatorio para planejamento operatorio individualizado e bons resultados clinico-radiologicos. Foram selecionadas as principais localizacoes de aneurismas de circulacAo posterior: Arteria cerebelar postero-inferior; tronco de arteria basilar, bifurcacAo de arteria basilar, arteria cerebral posterior, e arteria cerebelar superior para detalhamento anatomico da anatomia relevante. O estudo objetiva realizar uma revisAo da literatura dos principais resultados sobre tratamento cirurgico de aneurismas de circulacAo posterior, alem de descrever os principais pontos anatomicos relevantes a tecnica microcirurgica.
- Cerebral autoregulation in a fulminant hepatic failure patient who underwent liver transplantation(2019) PASCHOAL- JR., Fernando M.; NOGUEIRA, Ricardo C.; DE-LIMA-OLIVEIRA, Marcelo; PASCHOAL, Eric H.; TEIXEIRA, Manoel J.; D'ALBUQUERQUE, Luiz A.; BOR-SENG-SHU, Edson
- Use of beta-blocker in cerebral proliferative angiopathy: A case report(2023) JONG-A-LIEM, Glaucia Suzanna; CARNEIRO, Lillian dos Santos; PASCHOAL JUNIOR, Fernando Mendes; NETO, Feres Eduardo Aparecido Chaddad; GADELHA, Eberval Figueiredo; BOR-SENG-SHU, Edson; PASCHOAL, Eric Homero AlbuquerqueDescribe a case of cerebral proliferative angiopathy in a patient with disabling headaches in which we noticed CPA lesion shrinkage with the use of a betablocker. Report the clinical details, radiographic and angiogram findings and medical management of a case based on the MOOSE Guidelines. The case described in this paper is about a young man with CPA who, at first, complained of headache with migraine characteristics. Headaches became disabling. According to international protocols for the treatment of migraine, the prophylactic treatment of migraine with tricyclics and beta-blockers is recommended. During outpatient follow-up, the good therapeutic response to the medications was notorious, with a reduction in the frequency and intensity of migraine attacks. During the outpatient follow-up, a new control angiography was performed, seven years after the first, in which major changes in the vasculature with shrinkage of the lesion were found. This beta-blocker, more specifically propranolol, is widely studied and used in infantile haemangioma, in which it acts as a VEGF inhibitory agent. This, in turn, is a master regulator of angiogenesis. Experimental studies have shown that propranolol has a cytotoxic and antiproliferative effect on stem and endothelial cells, thus also affecting the perivascular cell contraction of infantile haemangioma - thus leading to lesion regression, and often avoiding surgical procedures. There are some studies that have also demonstrated the efficacy of propranolol on cerebral cavernomas of fa-milial presentation that are difficult to access surgically. Could Propranolol have a similar antiproliferativa and cytotoxic influence in CPA? Propranolol may have an antiproliferative effect on CPA. Studies with a higher level of evidence will need to be carried out to take this as true and as a therapeutic or adjuvant method for cases of CPA. For the time being, we still recommend a conservative therapeutic approach.