RAPHAEL BERTANI DE MAGALHAES

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 22
  • article 1 Citação(ões) na Scopus
    Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis
    (2024) BATISTA, Savio; SANCHES, Joao Pedro Bittar; ANDREA, Filipi Fim; SOUSA, Marcelo Porto; OLIVEIRA, Leonardo de Barros; FERREIRA, Marcio Yuri; BERTANI, Raphael; FILHO, Cesar Augusto Ferreira Alves; BRAGA, Fausto de Oliveira; MACHADO, Elias Antonio Tanus; PEREIRA, Paulo Jose da Mata; FILHO, Paulo Niemeyer; FILHO, Jose Alberto Almeida
    Background: Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients. Methods: A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I2 statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS <= 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed. Results: A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I-2 = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I-2 = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I-2 = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I-2 = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I-2 = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I-2 = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I-2 = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I-2 = 19 %). Conclusion: This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.
  • article 0 Citação(ões) na Scopus
    Postoperative Seizure Prophylaxis in Meningioma Resection: A Systematic Review and Meta-Analysis
    (2023) BATISTA, Savio; BERTANI, Raphael; PALAVANI, Lucca B.; OLIVEIRA, Leonardo de Barros; BORGES, Pedro; KOESTER, Stefan W.; PAIVA, Wellingson Silva
    Background: Seizures in the early postoperative period may impair patient recovery and increase the risk of complications. The aim of this study is to determine whether there is any advantage in postoperative seizure prophylaxis following meningioma resection. Methods: This systematic review was conducted in accordance with PRISMA guidelines. PUBMED, Web of Science, Embase, Science Direct, and Cochrane were searched for papers until April 2023. Results: Among nine studies, a total of 3249 patients were evaluated, of which 984 patients received antiepileptic drugs (AEDs). No significant difference was observed in the frequency of seizure events between patients who were treated with antiepileptic drugs (AEDs) and those who were not. (RR 1.22, 95% CI 0.66 to 2.40; I-2 = 57%). Postoperative seizures occurred in 5% (95% CI: 1% to 9%) within the early time period (<7 days), and 9% (95% CI: 1% to 17%) in the late time period (>7 days), with significant heterogeneity between the studies (I-2 = 91% and 97%, respectively). In seizure-naive patients, the rate of postoperative seizures was 2% (95% CI: 0% to 6%) in the early period and increased to 6% (95% CI: 0% to 15%) in the late period. High heterogeneity led to the use of random-effects models in all analyses. Conclusions: The current evidence does not provide sufficient support for the effectiveness of prophylactic AED medications in preventing postoperative seizures in patients undergoing meningioma resection. This underscores the importance of considering diagnostic criteria and conducting individual patient analysis to guide clinical decision-making in this context.
  • article
    Advancing Education in Endoscopic Spinal Navigation: Novel Methods and Technical Note
    (2023) PERTILE, Maria Eduarda; BICCA, Yan de Assuncao; MACCARI, Paula M.; NETO, Orlando R.; QUINTAS, Douglas P.; BERTANI, Raphael; BATISTA, Savio; KOESTER, Stefan W.; RUSAFA, Eloy; SERRA, Marcus Vinicius Flores de Barros Vasconcelos Fernandes
    This report aims to demonstrate how to teach anatomy and understanding of spinal endoscopic vision and navigation using mnemonics. The authors present a new surgical technique for teaching endoscopic spinal navigation in a didactic manner with tips such as the ""rule of the hand"" and decomposition of the endoscopic navigation movement. We demonstrate how the surgery is seen and illustrate how images are projected onto the screen, then divide the navigation into spatial orientation and self-navigation. The article describes the proper puncture technique, how to introduce the working portal, and how to assimilate this new anatomical vision using the ""rule of the hand."" The surgeon projects their hand on the video screen to guide themselves when starting the navigation and uses the same technique to localize regions of interest during surgery. Finally, the authors break down the navigational movement into three components: forceps positioning, triangulation, and joystick motion.One of the biggest challenges when learning spinal endoscopic surgery is understanding the anatomy seen through the endoscope. By decomposing movements required for navigation, one can understand how to make proper use of the equipment as well as improve their knowledge of this ""new anatomy.""The learning methods taught in this article have the potential to decrease the learning curve and radiation exposure to those that are still acquainting themselves to spinal endoscopic navigation. We recommend that further studies measure and quantify the impact of these methods on surgical practice.
  • article 0 Citação(ões) na Scopus
    Efficacy and Safety of Intraoperative Radiotherapy for High-Grade Gliomas: A Systematic Review and Meta-Analysis
    (2024) PALAVANI, Lucca B.; OLIVEIRA, Leonardo de Barros; REIS, Pedro Abrahao; BATISTA, Savio; SANTANA, Lais Silva; MARTINS, Lucas Piason de Freitas; RABELO, Nicollas Nunes; BERTANI, Raphael; WELLING, Leonardo Christiaan; FIGUEIREDO, Eberval Gadelha; PAIVA, Wellingson S.; NEVILLE, Iuri Santana
    Background and ObjectivesHigh-grade gliomas (HGGs) are aggressive tumors of the central nervous system that cause significant morbidity and mortality. Despite advances in surgery and radiation therapy (RT), HGG still has a high incidence of recurrence and treatment failure. Intraoperative radiotherapy (IORT) has emerged as a promising therapeutic approach to achieve local tumor control while sparing normal brain tissue from radiation-induced damage.MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines to evaluate the use of IORT for HGG. Eligible studies were included based on specific criteria, and data were independently extracted. Outcomes of interest included complications, IORT failure, survival rates at 12 and 24 months, and mortality.ResultsSixteen studies comprising 436 patients were included. The overall complication rate after IORT was 17%, with significant heterogeneity observed. The IORT failure rate was 77%, while the survival rates at 12 and 24 months were 74% and 24%, respectively. The mortality rate was 62%.ConclusionThis meta-analysis suggests that IORT may be a promising adjuvant treatment for selected patients with HGG. Despite the high rate of complications and treatment failures, the survival outcomes were comparable or even superior to conventional methods. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation through prospective randomized controlled trials to better understand the specific patient populations that may benefit most from IORT. However, the limitations of the study, such as the lack of a control group and small sample sizes, warrant further investigation. Notably, the ongoing RP3 trial (NCT02685605) is currently underway, with the aim of providing a more comprehensive understanding of IORT. Moreover, future research should focus on managing complications associated with IORT to improve its safety and efficacy in treating HGG.
  • article 1 Citação(ões) na Scopus
    Assessing the efficacy and safety of hemangioblastoma embolization: A comprehensive systematic review and meta-analysis
    (2023) PALAVANI, Lucca B.; ANDREAO, Filipi Fim; ABREU, Livia Viviani de; BATISTA, Savio; BORGES, Jordana; OLIVEIRA, Leonardo de Barros; BERTANI, Raphael; ALMEIDA FILHO, Jose Alberto
    Background: Hemangioblastomas (HBs) are highly vascular tumors linked to substantial morbidity and mortality. Recently, interventional neuroradiology has evolved rapidly, spurring interest in preoperative embolization as a possible HB treatment.Purpose: This study evaluates the effectiveness and safety of preoperative embolization in managing HB. Methods: Adhering to PRISMA guidelines, this meta-analysis considered randomized and nonrandomized studies meeting specific criteria, encompassing intracranial HB and preoperative embolization. Primary outcomes were preoperative embolization efficacy and safety. Complications were classified as major (cerebellar ischemia, ischemic strokes, intratumoral hemorrhage, subarachnoid hemorrhage) and minor (transient nystagmus, slight facial nerve palsy, nausea, transient dysarthria, hemiparesis, hemisensory impairment, thrombotic complica-tions, extravasation).Results: Thirteen studies involving 166 patients with preoperative embolization before HB resection were included. Two studies using the Glasgow Outcome Scale (GOS) showed 5 patients with good recovery, 6 with moderate disability, and 3 with severe disability. Major complications occurred in 1% (95% CI: 0% to 3%), and minor complications occurred in 1% (95% CI: 0% to 4%). Intraoperative blood loss during resection was esti-mated at 464.29 ml (95% CI: 350.63 ml to 614.80 ml).Conclusion: Preoperative embolization holds promise in reducing intraoperative bleeding risk in neurosurgical intracranial HB treatment, primarily due to its low complication rates. Nonetheless, additional research and larger-scale studies are essential to establish its long-term efficacy and safety. These findings highlight preop-erative embolization as a valuable tool for HB management, potentially enhancing future patient outcomes.
  • article 3 Citação(ões) na Scopus
    The current state of global contribution to open access publishing in neurosurgery: A bibliometric analysis
    (2023) KOESTER, Stefan W.; BISHAY, Anthony E.; BATISTA, Savio; BERTANI, Raphael; NAIK, Anant; HAIZEL-COBBINA, Josie; ISAACS, Albert; FIGUEIREDO, Eberval Gadelha; PAIVA, Wellingson Silva; DEWAN, Michael C.
  • article 1 Citação(ões) na Scopus
    A Systematic Review and Meta-Analysis on the Management and Outcome of Isolated Skull Fractures in Pediatric Patients
    (2023) PALAVANI, Lucca B.; BERTANI, Raphael; OLIVEIRA, Leonardo de Barros; BATISTA, Savio; VERLY, Gabriel; ANDREAO, Filipi Fim; FERREIRA, Marcio Yuri; PAIVA, Wellingson Silva
    Background: The impact of traumatic brain injury (TBI) on the pediatric population is profound. The aim of this study is to unveil the state of the evidence concerning acute neurosurgical intervention, hospitalizations after injury, and neuroimaging in isolated skull fractures (ISF). Materials and Methods: This systematic review was conducted in accordance with PRISMA guidelines. PubMed, Cochrane, Web of Science, and Embase were searched for papers until April 2023. Only ISF cases diagnosed via computed tomography were considered. Results: A total of 10,350 skull fractures from 25 studies were included, of which 7228 were ISF. For the need of acute neurosurgical intervention, the meta-analysis showed a risk of 0% (95% CI: 0-0%). For hospitalization after injury the calculated risk was 78% (95% CI: 66-89%). Finally, for the requirement of repeated neuroimaging the analysis revealed a rate of 7% (95% CI: 0-15%). No deaths were reported in any of the 25 studies. Conclusions: Out of 7228 children with ISF, an almost negligible number required immediate neurosurgical interventions, yet a significant 74% were hospitalized for up to 72 h. Notably, the mortality was zero, and repeat neuroimaging was uncommon. This research is crucial in shedding light on the outcomes and implications of pediatric TBIs concerning ISFs.
  • article 0 Citação(ões) na Scopus
    Efficacy and Safety of Extracranial-Intracranial Bypass Surgery for Posterior Circulation Aneurysms: A Systematic Review and Single-Arm Meta-Analysis
    (2024) OLIVEIRA, Leonardo de Barros; SOUSA, Marcelo Porto; RIBAS, Luiz Roberto Cavassola; PALAVANI, Lucca B.; BATISTA, Savio; RABELO, Nicollas Nunes; BERTANI, Raphael; WELLING, Leonardo Christiaan; FIGUEIREDO, Eberval Gadelha
    -OBJECTIVE: Treating complex posterior circulation aneurysms poses chal-lenges, and extracranial to intracranial (EC-IC) bypass techniques are potential therapeutic options. However, the safety and efficacy of this approach for pos-terior circulation aneu
  • article 0 Citação(ões) na Scopus
    Assessing the safety and efficacy of EVOH Pre-Embolization in head and neck paraganglioma tumors: A comprehensive analysis of current literature
    (2024) BATISTA, Savio; PALAVANI, Lucca B.; ANDREAO, Filipi Fim; OLIVEIRA, Leonardo de Barros; ABREU, Livia Viviani de; PINHEIRO, Agostinho C.; FONTOURA, Julia; FERREIRA, Marcio Yuri; BERTANI, Raphael; JR, Erion de Andrade; FILHO, Jose Alberto Almeida; PAIVA, Wellingson S.
    Background: Head and Neck Paragangliomas are characterized by having a rich blood supply. Presurgical embolization with Onyx as a neoadjuvant treatment is not a consensus regarding its efficacy and safety. Our study aimed to answer this matter through a single-arm meta-analysis. Methods: We systematically reviewed 4 databases. Sixteen studies were described and suitable papers were selected for meta-analysis of estimated intraoperative blood loss (EBL), percentage of tumor devascularization, and complications associated with embolization. Results: The study identified 198 patients with 203 tumors, aged between 8 and 70 years. Commonly reported symptoms included neck mass perception and cranial nerve impairment. Carotid Body Tumors were most prevalent (127, 62.5 %), followed by jugular (48, 23.6 %), or vagal (29, 14.2 %) tumors. Eight studies reported estimated intraoperative blood loss (EBL) averaging 261.89 ml (95 %CI: 128.96 to 394.81 ml). In an analysis of 9 studies, 99 % (95 %CI: 96 to 100 %) achieved 70 % or more devascularization, and 79 % (95 %CI: 58 to 100 %) achieved 90 % or more devascularization. Complications from endovascular procedures were observed in 3 % (95 %CI: 0 to 8 %) of 96 patients across 10 studies, including 4 facial nerve deficits. Eighteen postoperative neurological deficits were reported across 15 articles. Conclusion: Despite acknowledged limitations, with refined indications, EVOH, especially Onyx embolization may significantly bolster patient safety, decreasing EBL and easing surgical resection. Further research with larger studies will refine criteria, optimize techniques, and improve patient care and treatment outcomes in the management of head and neck paragangliomas.
  • conferenceObject
    Management of a shunt dysfunction case using non-invasive ICP waveform monitoring
    (2022) CARVALHO, Tamires Guimaraes Cavalcante Carlos de; BERTANI, Raphael; PERRET, Caio; KOESTER, Stefan; MARIA, Paulo Santa; BATISTA, Savio; RABELO, Nicolas