GUILHERME ALVES LEPSKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina - Líder
14 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 14
- MRI-Based Radiation-Free Method for Navigated Percutaneous Radiofrequency Trigeminal Rhizotomy(2015) LEPSKI, Guilherme; MESQUITA FILHO, Paulo Moacir; RAMINA, Kristofer; BISDAS, Sotirios; ERNEMANN, Ulrike; TATAGIBA, Marcos; MORGALLA, Matthias; FEIGL, GuentherBackground/Study Aims Percutaneous radiofrequency trigeminal rhizotomy (RTR) is a standardized treatment for trigeminal neuralgia, yet it has been associated with serious complications related to the cannulation of the foramen ovale. Some of these complications, such as carotid injury, are potentially lethal. Neuronavigation was recently proposed as a method to increase the procedure's safety. All of the techniques described so far rely on pre- or intraoperative computed tomography scanning. Here we present a simple method based on magnetic resonance imaging (MRI) (radiation free) used to target the foramen ovale under navigation guidance. Patients/Material and Methods We retrospectively analyzed nine patients who had undergone navigated percutaneous RTR based solely on preoperative MRI and compared them with 35 patients who underwent conventional RTR guided by fluoroscopy. We analyzed immediate and late outcome and categorized the results into pain free, > 70% pain reduction, and persistent pain. We also compared groups in terms of the duration of the procedure and the complication rates. Here we describe the navigation method in detail and review the anatomical landmarks for target definition. Results The duration of the surgical procedure was similar in both groups (32.1 in the standard technique versus 34.5 minutes with navigation; p = 0.5157). There was no significant difference between groups regarding pain reduction at the immediate (p = 1.0) or late follow-up (p = 0.6284) time points. Furthermore, no serious complications were observed in the navigated group. Conclusions We present a simple radiation-free method for neuronavigation-assisted percutaneous RTR. This method proved to be safe and effective, and it is especially recommended for young, inexperienced neurosurgeons.
bookPart Bases no Tratamento Cirúrgico da Dor(2015) FONOFF, Erich Talamoni; TEIXEIRA, Manoel Jacobsen; DUARTE, Kleber Paiva; LEPSKI, GuilhermeconferenceObject High Frequency Stimulation of the Subthalamic Nucleus Improves Graft Survival and Behavioural Outcome in a Rat Model of Parkinson's Disease(2015) FURLANETTI, Luciano L.; CORDEIRO, Joacir G.; CORDEIRO, Karina K.; GARCIA, Joanna A.; WINKLER, Christian; LEPSKI, Guilherme; COENEN, Volker A.; DOEBROESSY, Mate D.- Adult stem cells in neural repair: Current options, limitations and perspectives(2015) MARIANO, Eric Domingos; TEIXEIRA, Manoel Jacobsen; MARIE, Suely Kazue Nagahashi; LEPSKI, GuilhermeStem cells represent a promising step for the future of regenerative medicine. As they are able to differentiate into any cell type, tissue or organ, these cells are great candidates for treatments against the worst diseases that defy doctors and researchers around the world. Stem cells can be divided into three main groups: (1) embryonic stem cells; (2) fetal stem cells; and (3) adult stem cells. In terms of their capacity for proliferation, stem cells are also classified as totipotent, pluripotent or multipotent. Adult stem cells, also known as somatic cells, are found in various regions of the adult organism, such as bone marrow, skin, eyes, viscera and brain. They can differentiate into unipotent cells of the residing tissue, generally for the purpose of repair. These cells represent an excellent choice in regenerative medicine, every patient can be a donor of adult stem cells to provide a more customized and efficient therapy against various diseases, in other words, they allow the opportunity of autologous transplantation. But in order to start clinical trials and achieve great results, we need to understand how these cells interact with the host tissue, how they can manipulate or be manipulated by the microenvironment where they will be transplanted and for how long they can maintain their multipotent state to provide a full regeneration.
article Intraoperative assistive technologies-the way ahead comments(2015) LEPSKI, Guilherme- Epidural Hematoma: A Prospective Analysis of Morbidity and Mortality in 173 Patients(2015) ROSI JUNIOR, Jefferson; ANDRADE, Almir Ferreira; YENG, Lint Chia; KOTERBA, Edwin; FIGUEIREDO, Eberval Gadelha de; LEPSKI, Guilherme; TEIXEIRA, Manoel JacobsenObjectives A few recent studies have focused on epidural hematomas (EDHs) that are routine in emergency rooms. The study was to evaluate the latest situation of affected patients by encephalic trauma associated with EDH in our service. Methods Prospective study between September 1, 2003 and May 30, 2009. Data were computed regarding age, sex, traumamechanism, qualification by Glasgow coma scale admission, presence of anisocoria, and evaluation by the recovery of Glasgow scale high, with all patients by computed tomography (CT) scan. Results Among the 173 analyzed patients, mortality reached 20 patients (11.5%). Mortality was higher in the subgroup of 76 patients (44%) admitted with Glasgow coma scale (GCS <= 8) with 17 deceased, corresponding to 85% of total deaths. Prevalence of male subjects (140 cases, 81%) with bruises located in the temporal, frontal and parietal regions; 147 (85%) patients underwent neurosurgical treatment by craniotomy. The worst prognosis was in patients with hematomas of higher-volume (50 mL), midline structures deviations greater than 1.5 mm and basal cisterns CSF closed. Conclusion The authors emphasize the correct indication of neurosurgery and the postoperative intensive care unit (ICU) as key factors for success in the treatment of patients with EDHs.
conferenceObject Deep brain stimulation of the dentate nucleus improves cerebellar ataxia: A double-blind n=1 study(2015) TEIXEIRA, M. J.; CURY, R. G.; GALHARDONI, R.; BARBOZA, V. R.; ALHO, E.; SEIXAS, C. M.; LEPSKI, G.; ANDRADE, D. Ciampi debookPart Hipertensão intracraniana(2015) SOUSA JUNIOR, Leonardo de Moura; LEPSKI, Guilherme- Residual Upper Arm Motor Function Primes Innervation of Paretic Forearm Muscles in Chronic Stroke after Brain-Machine Interface (BMI) Training(2015) CURADO, Marco Rocha; COSSIO, Eliana Garcia; BROETZ, Doris; AGOSTINI, Manuel; CHO, Woosang; BRASIL, Fabricio Lima; YILMAZ, Oezge; LIBERATI, Giulia; LEPSKI, Guilherme; BIRBAUMER, Niels; RAMOS-MURGUIALDAY, AnderBackground Abnormal upper arm-forearm muscle synergies after stroke are poorly understood. We investigated whether upper arm function primes paralyzed forearm muscles in chronic stroke patients after Brain-Machine Interface (BMI)-based rehabilitation. Shaping upper arm-forearm muscle synergies may support individualized motor rehabilitation strategies. Methods Thirty-two chronic stroke patients with no active finger extensions were randomly assigned to experimental or sham groups and underwent daily BMI training followed by physiotherapy during four weeks. BMI sessions included desynchronization of ipsilesional brain activity and a robotic orthosis to move the paretic limb (experimental group, n = 16). In the sham group (n = 16) orthosis movements were random. Motor function was evaluated with electromyography (EMG) of forearm extensors, and upper arm and hand Fugl-Meyer assessment (FMA) scores. Patients performed distinct upper arm (e.g., shoulder flexion) and hand movements (finger extensions). Forearm EMG activity significantly higher during upper arm movements as compared to finger extensions was considered facilitation of forearm EMG activity. Intraclass correlation coefficient (ICC) was used to test inter-session reliability of facilitation of forearm EMG activity. Results Facilitation of forearm EMG activity ICC ranges from 0.52 to 0.83, indicating fair to high reliability before intervention in both limbs. Facilitation of forearm muscles is higher in the paretic as compared to the healthy limb (p<0.001). Upper arm FMA scores predict facilitation of forearm muscles after intervention in both groups (significant correlations ranged from R = 0.752, p = 0.002 to R = 0.779, p = 0.001), but only in the experimental group upper arm FMA scores predict changes in facilitation of forearm muscles after intervention (R = 0.709, p = 0.002; R = 0.827, p<0.001). Conclusions Residual upper arm motor function primes recruitment of paralyzed forearm muscles in chronic stroke patients and predicts changes in their recruitment after BMI training. This study suggests that changes in upper arm-forearm synergies contribute to stroke motor recovery, and provides candidacy guidelines for similar BMI-based clinical practice.
- Continuous High-Frequency Stimulation of the Subthalamic Nucleus Improves Cell Survival and Functional Recovery Following Dopaminergic Cell Transplantation in Rodents(2015) FURLANETTI, Luciano L.; CORDEIRO, Joacir Graciolli; CORDEIRO, Karina Kohn; GARCIA, Joanna A.; WINKLER, Christian; LEPSKI, Guilherme A.; COENEN, Volker A.; NIKKHAH, Guido; DOEBROESSY, Mate D.Subthalamic nucleus (STN) high-frequency stimulation (HFS) is a routine treatment in Parkinson's disease (PD), with confirmed long-term benefits. An alternative, but still experimental, treatment is cell replacement and restorative therapy based on transplanted dopaminergic neurons. The current experiment evaluated the potential synergy between neuromodulation and grafting by studying the effect of continuous STN-HFS on the survival, integration, and functional efficacy of ventral mesencephalic dopaminergic precursors transplanted into a unilateral 6-hydroxydopamine medial forebrain bundle lesioned rodent PD model. One group received continuous HFS of the ipsilateral STN starting a week prior to intrastriatal dopaminergic neuron transplantation, whereas the sham-stimulated group did not receive STN-HFS but only dopaminergic grafts. A control group was neither lesioned nor transplanted. Over the following 7 weeks, the animals were probed on a series of behavioral tasks to evaluate possible graft and/or stimulation-induced functional effects. Behavioral and histological data suggest that STN-HFS significantly increased graft cell survival, graft-host integration, and functional recovery. These findings might open an unexplored road toward combining neuromodulative and neuroregenerative strategies to treat severe neurologic conditions.