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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- 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.
- 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.
- The Role of Endoscopic Assistance in Ambient Cistern Surgery: Analysis of Four Surgical Approaches(2015) FIGUEIREDO, Eberval Gadelha; BEER-FURLAN, Andre; NAKAJI, Peter; CRAWFORD, Neil; WELLING, Leonardo C.; RIBAS, Eduardo C.; TEIXEIRA, Manoel J.; RHOTON JR., Albert L.; SPETZLER, Robert F.; PREUL, Mark C.OBJECTIVE: We used microscopy with endoscopic assistance to conduct an objective analysis of 4 surgical approaches commonly used in the surgery of the ambient cistern: infratentorial supracerebellar (SC), occipital inter-hemispheric (OI), subtemporal (ST), and transchoroideal (TC). In addition, we performed a parahippocampalis gyrus resection in the ST context. METHODS: Each approach (SC, OI, ST, TC) was performed on 3 cadaveric heads (6 sides). After the microscopic anatomic dissection, the 30-degree endoscope was used to explore the exposure. The parahippocampalis gyrus was resected through an ST approach and the exposure was evaluated. The quantitative analysis was based on linear exposure of the vascular structures (linear exposure), such as the posterior choroidal artery (PChA), the P2 and P3 segments of the posterior cerebral artery (PCA) with their branches, the basal vein of Rosenthal, and the area of exposure of the ambient cistern region (area of exposure) limited by points on its superior, mesial, and anterior walls. In all cases, a P value of less than 0.05 was considered significant. RESULTS: There was a significant difference (P < 0.05) in linear exposure of the PCA and medial PChA between microsurgery and endoscopic assistance using the ST approach. This approach also improved the medial, superior, and total exposure of the ambient cistern region. CONCLUSIONS: This study demonstrates that endoscope assistance improved exposure of the ambient cistern region when using the ST approach. Endoscopic assistance provided similar surgical exposure compared with ST associated with parahippocampalis resection.
- Microsurgical Approaches to the Ambient Cistern Region: An Anatomic and Qualitative Study(2016) FIGUEIREDO, Eberval Gadelha; BEER-FURLAN, Andre; WELLING, Leonardo C.; RIBAS, Eduardo C.; SCHAFRANSKI, Marcelo; CRAWFORD, Neil; TEIXEIRA, Manoel J.; RHOTON JR., Albert L.; SPETZLER, Robert F.; PREUL, Mark C.OBJECTIVE: We used microscopy to conduct qualitative and quantitative analysis of 4 surgical approaches commonly used in the surgery of the ambient cistern: infratentorial supracerebellar (SC), occipital interhemispheric, subtemporal (ST), and transchoroidal (TC). In addition, we performed a parahippocampal gyrus resection in the ST context. METHODS: Each approach was performed in 3 cadaveric heads (6 sides). After the microscopic anatomic dissection, the parahippocampal gyrus was resected through an ST approach. The qualitative analysis was based on anatomic observation and the quantitative analysis was based on the linear exposure of vascular structures and the area of exposure of the ambient cistern region. RESULTS: The ST approach provided good exposure of the inferior portion of the cistern and of the proximal segments of the posterior cerebral artery. After the resection of the parahippocampal gyrus, the area of exposure improved in all components, especially the superior area. A TC approach provided the best exposure of the superior area compared with the other approaches. The posterolateral approaches (SC/occipital interhemispheric) to the ambient cistern region provided similar exposure of anatomic structures. There was a significant difference (P < 0.05) in linear exposure of the posterior cerebral artery when comparing the ST/TC and ST/SC approaches. CONCLUSIONS: This study has demonstrated that surgical approaches expose dissimilarly the different regions of the ambient cistern and an approach should be selected based on the specific need of anatomic exposure.