EDUARDO SANTAMARIA CARVALHAL RIBAS
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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conferenceObject Using color flow image to identify brain vessels during metastasis approach(2014) PASCHOAL JR., F. Mendes; OLIVEIRA, M. L. de; PICARELLI, H.; AZEVEDO, M. K.; LIMA, S. B.; BASTOS, M. F.; RIBAS, E. S. C.; TEIXEIRA, M. J.; BOR-SENG-SHU, E.- Anatomic evaluation of the posterior temporal approach via the Heschl's gyrus to the thalamus, internal capsule, and atrium(2023) PALMIERO, Helbert de Oliveira Manduca; RIBAS, Eduardo Carvalhal; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaObjective Posterior temporal craniotomy allows for the exposure of the superior surface of the planum temporale. Heschl's gyrus is the most prominent structure of the planum temporale and can be an anatomical landmark to approach deep brain structures such as the internal capsule, lateral thalamus, and ventricular atrium. Methods Ten human cadavers' heads underwent a posterior bilateral temporal craniotomy and the microsurgical dissection of Heschl's gyrus was performed and variables were measured with a neuronavigation system and statistically analyzed. Results The mean distance between the keyhole and Heschl's gyrus was 61.7 +/- 7.3 mm, the mean distance between the stephanion to Heschl's gyrus was 40.8 +/- 6.0 mm, and the mean distance between the temporal lobe and Heschl's gyrus was 54.9 +/- 6.9 mm. The length of Heschl's gyrus was 24 +/- 7.5 mm, and the inclination angle in the axial plane was 20.0 +/- 3.7 degrees having the vertex as its deepest point as the base on the surface of the temporal plane. From Heschl's gyrus, the distance from the surface to the internal capsule was 29.1 +/- 5.6 mm, the distance to the lateral thalamus was 34.8 +/- 7.3 mm, and the distance to the ventricular atrium was 39.6 +/- 7.2 mm. No statistical difference was found between the right and left sides. Conclusions Through a posterior temporal craniotomy, the temporal planum is exposed by opening the Sylvian fissure, where Heschl's gyrus can be identified and used as a natural corridor to approach the internal capsule, the ventricular atrium, and the lateral thalamus.
- Tractography of the ansa lenticularis in the human brain(2022) LI, Mengjun; RIBAS, Eduardo Carvalhal; ZHANG, Zhiping; WU, Xiaolong; WANG, Xu; LIU, Xiaohai; LIANG, Jiantao; CHEN, Ge; LI, MingchuThe aim of this study was to make a thorough investigation of the trajectory of the ansa lenticularis (AL) and its subcomponents using high-resolution fiber-tracking tractography. The subcomponents of the AL were reconstructed from one region of interest (ROI) in the area of the globus pallidus combined with another ROI in the red nucleus, substantia nigra, subthalamic nucleus, or thalamus. This fiber-tracking protocol was tested in an HCP-1065 template, 35 healthy subjects from Massachusetts General Hospital (MGH), and 20 healthy subjects from the human connectome project (HCP) using generalized q-sampling imaging (GQI)-based tractography. Quantitative anisotropy and fractional anisotropy were also computed for the AL subcomponents. The subcomponents of the AL could be reconstructed in the HCP-1065 template, 35 MGH healthy subjects, and 20 HCP healthy subjects. The AL descends from the globus pallidus and joins the ansa peduncularis for a short distance, subdividing later into fibers that continue separately to the red nucleus, substantia nigra, subthalamic nucleus, and thalamus. The study demonstrated the trajectory of the ansa lenticularis and its subcomponents using GQI-based tractography, improving our understanding of the anatomical connectivity between the globus pallidus and the thalamo-subthalamic region in the human brain. One Sentence Summary The investigation of the ansa lenticularis and its subcomponents using high-resolution diffusion images based tractography.
- The Brain Surface(2022) RIBAS, E. C.; RIBAS, G. C.The telencephalon is constituted by two cerebral hemispheres; and, in order to favor its better understanding, organize its nomenclature, and apply this knowledge in clinical practice, they were divided into lobes, regions, and compartments. Among other criteria, the brain can be subdivided according to its sulcal patterns, comparative anatomy, cytoarchitecture, myeloarchitecture. Myelogenesis, connectivity, and cerebral functions. These cortical subdivisions, discussed in this chapter in detail, correspond to different concepts, partly overlap, are complementary to each other, and are particularly useful for a better understanding of the brain architecture. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
- Permanent anosmia and ageusia after resection of a left temporoinsular low-grade glioma: anatomofunctional considerations(2012) RIBAS, Eduardo Santamaria Carvalhal; DUITAU, HuguesFive percent of the general population has olfactory or gustatory disorders, although most do not complain about it. However, in some cases, these symptoms can be disabling and may affect quality of life. Anosmia was reported as a possible complication following head injury and neurosurgical procedures, particularly after the resection of tumors located in the anterior fossa and the treatment of aneurysms in the anterior circulation. Nonetheless, in all of these situations, olfactory dysfunction could be explained by damage to the peripheral olfactory system. Here, the authors report a case of complete anosmia associated with ageusia following awake resection of a low-grade glioma involving the left temporoinsular region, with no recovery during a follow-up of 3 years. The frontal lobe was not retracted, and the olfactory tract was not visualized during surgery; therefore, postoperative anosmia and ageusia are likely explained by damage to the cortex and central pathways responsible for these senses. The authors suggest that the patient might have had a subclinical right hemianosmia before surgery, which is a common condition. After resection of the central structures critical for smell and taste processing in the left hemisphere, the patient could have finally had bilateral and complete olfactory and gustatory loss. This is the first known report of permanent anosmia and ageusia following glioma surgery. Because these symptoms might have been underestimated, more attention should be devoted to olfaction and taste, especially with regard to possible subclinical preoperative deficit. (http://thejns.org/doi/abs/10.3171/2012.2.JNS111982)
- Medial-tonsillar telovelar approach for resection of a superior medullary velum cerebral cavernous malformation: anatomical and tractography study of the surgical approach and functional implications(2021) BROGNA, Christian; LAVRADOR, Jose Pedro; KANDEEL, Hussein Shaaban; BEYH, Ahmad; RIBAS, Eduardo C.; VERGANI, Francesco; TOLIAS, Christos M.Background Superior medullary velum cerebral cavernous malformations pose a challenge in terms of appropriate microsurgical approach. Safe access to this deep location as well as preservation of surrounding anatomical structures, in particular the superior cerebellar peduncle just lateral to the superior medullary velum and the dentate nuclei, is paramount to achieve a good functional outcome. Methods Cadaveric dissections provide useful knowledge of the normal anatomy while tractography allows a better understanding of the individual anatomy in the presence of a lesion. The medial-tonsillar telovelar approach provides a feasible corridor for accessing superior velum cerebral cavernous malformations without compromising the fibres contained in the superior cerebellar peduncle. The major cerebellar efferents-cerebello-rubral, cerebello-thalamic and cerebello-vestibular tracts-and afferents, anterior spinocerebellar, tectocerebellar and trigeminocerebellar tracts, within the superior cerebellar peduncle are preserved, and the dentate nuclei are not affected. Results and conclusion A retraction-free exposure through this natural posterior fossa corridor allows the patient with the anatomical and functional subtract to make a good functional recovery by minimizing the risk of a superior cerebellar syndrome, ataxia, tremor and dysmetria; decomposition of movement in the ipsilateral extremities, nystagmus and hypotonia; or akinetic mutism, reduced or absent speech with onset within the first post-operative week.
- Microsurgical approaches to the pulvinar: A comparative analysis(2022) FIGUEIREDO, Eberval Gadelha; RIBAS, Eduardo Carvalhal; MOSCARDI, Ricardo; NAKAJI, Peter; TELLES, Joao Paulo Mota; SPETZLER, Robert F.; PREUL, Mark C.Objective: To compare the area of exposure to the cisternal thalamus associated with four surgical techniques: supracerebellar-infratentorial (SCIT), occipital interhemispheric (OI), transchoroidal (TC) and subtemporal before and after parahippocampal resection (ST and STh, respectively). Methods: All approaches were performed on both sides of three heads. Qualitative anatomical analyses were performed to understand anatomical limits, advantages, and flaws of each technique. Quantitative analyses for multiple repeated dependent variables assessed significant differences between areas of exposure. Results: Exposure area was significantly more extensive using TC and STh approaches compared to ST, OI, and SCIT. STh achieved a significantly wider exposure compared to ST. Regarding dissection angle, surrounding structures and limitations, ST approaches do not provide adequate exposure, nor alignment with the thalamic axis. The OI and STh may provide a better field of exposure, but without adequate alignment and challenging deeper dissections. TC provides better exposure of the cisternal pulvinar with access to lateral pulvinar at the atrium's anterior wall but is a transcortical route that disrupts non-pathological tissue. SCIT provides an adequate area of exposure with the possibility of alignment with the thalamus axis, thus allowing an easier dissection of deeper lesions. Conclusions: For lesions at the pulvinar surface, OI and STh are adequate. For lesions restricted to medial pulvinar and deep along the thalamus axis, SCIT approaches are recommended. Lesions extending to the lateral pulvinar and ventricular atrium are best removed through TC approaches. The ST approach was not suitable to the cisternal pulvinar due to its limited angular exposure.
- Commentary: Fiber Microdissection Technique for Demonstrating the Deep Cerebellar Nuclei and Cerebellar Peduncles(2021) RIBAS, Eduardo Carvalhal; YAGMURLU, Kaan
- Quality of life in adult intradural primary spinal tumors: 36-Item Short Form Health Survey correlation with McCormick and Aminoff-Logue scales(2013) GUIRADO, Vinicius M. P.; TARICCO, Mario A.; NOBRE, Moacyr R. C.; COUTO JUNIOR, Euro B.; RIBAS, Eduardo S. C.; MELUZZI, Alexandre; BROCK, Roger S.; DIAS, Mario R. Pena; RODRIGUES, Rodrigo; TEIXEIRA, Manoel J.Object. The most appropriate method to determine the quality of life of patients with intradural primary spinal tumors (IPSTs) is not still well established. Methods. Clinical data in 234 patients who underwent surgery for intradural spinal disease were collected prospectively. The 36-Item Short Form Health Survey (SF-36), a generic score scale, was administered to 148 patients with IPSTs to demonstrate if the survey can be used to effectively evaluate these patients. Forty-eight patients were excluded because they did not complete the protocol. The study was finally conducted with 100 patients (45 male and 55 female) with IPSTs, and the results were compared with those of 2 other scales: the McCormick scale and the Aminoff-Logue scale. Results. Construct validity was demonstrated by confirming the hypothesized relationship between the scores of the SF-36 and the McCormick scale (p = 0.003), the Aminoff-Logue gait subscale (p = 0.025), the Aminoff-Logue micturition subscale (p = 0.013), and the Aminoff-Logue defecation subscale (p = 0.004). Reliability was demonstrated for all 8 SF-36 domain scales and the Physical Component Summary and the Mental Component Summary of the SF-36, where in each the Cronbach alpha satisfied the Nunnally criterion of > 0.85. Conclusions. The authors' results demonstrated that SF-36 provides valid and reliable data for patients with IPSTs and that the survey can be used appropriately to evaluate these patients.
- Letter to the Editor Regarding ""Effect of Surgeon Experience on Surgical Outcome of 80-Year-Old or Older Intracranial Meningioma Patients""(2021) YAMAKI, Vitor Nagai; NEVILLE, Iuri Santana; RIBAS, Eduardo Carvalhal; PAIVA, Wellingson Silva