RAPHAEL BERTANI DE MAGALHAES

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: EBERVAL GADELHA FIGUEIREDO ×

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Agora exibindo 1 - 9 de 9
  • 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 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
    Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis
    (2024) OLIVEIRA, Leonardo de Barros; CIESLAK, Pedro Henrique; MARQUES, Guilherme Nunes; BATISTA, Savio; ANDREAO, Filipi Fim; PALAVANI, Lucca B.; BOCANEGRA-BECERRA, Jhon E.; BERTANI, Raphael; RABELO, Nicollas Nunes; WELLING, Leonardo C.; FIGUEIREDO, Eberval Gadelha
    The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3-53.1). The post-operation patency rate was 99% (95% CI: 97-100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68-96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9-32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0-2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81-96%; I2=0%), and only 3% experienced ischemia (95% CI: 0-6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.
  • article 1 Citação(ões) na Scopus
    Minimally invasive craniotomies for lesions of the anterior and middle fossa
    (2022) BERTANI, Raphael; KOESTER, Stefan; BATISTA, Savio; PERRET, Caio; BOCANEGRA-BECERRA, Jhon E.; MARIA, Paulo Santa; GALLO, Bruno Henrique Dallo; ABI-AAD, Karl; FERRAREZ, Carlos Eduardo; RABELO, Nicollas Nunes; ZUBEN, Daniela Von; SANTO, Marcelo Prudente Do Espirito; FIGUEIREDO, Eberval Gadelha
    Minimally invasive craniotomies are the subject of increasing attention over the last two decades in neurosurgery, following the current trend of attempting to increase patient safety by providing surgeries with less tissue disruption, blood loss, and decreased operative time. However, a significant information overlap exists among the various keyhole approaches regarding their indications and differences with more invasive techniques. Therefore, the present study aims to comprehensively review, illustrate, and describe the potential benefits and disadvantages of minimally invasive techniques to access the anterior and middle fossa, including the mini-pterional, mini orbito-zygomatic, supraorbital, lateral supraorbital, and extended lateral supraorbital approaches while comparing them to classic, more invasive approaches.
  • article 1 Citação(ões) na Scopus
    Incidence and nature of complications associated with ventriculoatrial shunt placement: A systematic review and single-arm meta-analysis
    (2023) OLIVEIRA, Leonardo de Barros; WELLING, Leonardo Christiaan; VIEGAS, Fabio Alex Fonseca; RIBAS, Luiz Roberto Cavassola; MACHINSKI, Elcio Oscar; WESSELOVICZ, Rubens Miguel; BATISTA, Savio; BERTANI, Raphael; PALAVANI, Lucca Biolcati; RABELO, Nicollas Nunes; FIGUEIREDO, Eberval Gadelha
    Background: Ventriculoatrial shunt (VAS) is considered the second option for treating hydrocephalus, but there remains a lack of robust evidence regarding its complications profile. Purpose: Evaluate the complications associated with VAS. Methods: Adhering to PRISMA guidelines, the authors searched Embase, PubMed, and Web of Science databases to identify articles reporting on the complications of VAS. Eligible articles were required to report whether complications occurred in a cohort of at least four patients. The extraction process focused on various outcome measures, including overall complications, pulmonary complications, cardiac complications, mortality, shunt revisions, glomerulonephritis, intracranial hemorrhage, and hygroma. Complications were defined as any adverse events related to the procedure, including revisions. Results: After retrieving a total of 2828 articles, 53 studies met the predefined criteria, involving 2862 patients. The overall complication rate was estimated at 33 % (95 % CI: 25-42 %), while the long-term complications rate was found to be 49 % (95 % CI: 32-67 %). Among the pediatric population, the complication rate was calculated to be 53 % (95 % CI: 39-68 %). The overall revision rate was estimated at 32 % (95 % CI: 23-41 %), with an infection rate of 5 % (95 % CI: 3-7 %). Notably, in the pediatric group, the infection rate was 10 % (95 % CI: 6-13 %). The random analysis indicated an estimated risk of 0 % for glomerulonephritis, intracranial hemorrhage, hygroma, cardiac complications, pulmonary complications, and shunt-related mortality. Conclusion: VAS is a safe alternative when ventriculoperitoneal shunting is not feasible. Risk of classic severe complications is minimal. Nevertheless, caution is required when shunting critical patients. Further randomized studies are warranted to establish the ideal shunt for different patients.
  • article 2 Citação(ões) na Scopus
    Stellate Ganglion Block in Subarachnoid Hemorrhage: A Promising Protective Measure Against Vasospasm?
    (2024) OLIVEIRA, Leonardo de Barros; BATISTA, Savio; PRESTES, Milena Zadra; BOCANEGRA-BECERRA, Jhon E.; RABELO, Nicollas Nunes; BERTANI, Raphael; WELLING, Leonardo Christiaan; FIGUEIREDO, Eberval Gadelha
    BACKGROUND: Stellate ganglion block (SGB) may have protective effects in patients at risk of vasospasm following subarachnoid hemorrhage (SAH) due to reduced sympathetic activity. However, the safety and clinical outcomes of SGB in this scenario are not definitively known. The objective was to evaluate the safety, clinical outcomes, and cerebral blood flow velocity in patients submitted to SGB or cervical sympathectomy with SAH.METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review and meta-analysis of studies investigating SGB or cervical sympathectomy use in SAH were conducted. PubMed, Cochrane Library, and Embase were evaluated. Patients with mRS from 0 to 2, GOS from 4 to 5, or symptom resolution were considered favorable clinical outcomes. Related mortality was defined as death by vasospasm or delayed cerebral ischemia. RESULTS: The analysis included 8 studies comprising 182 patients. Only 2 studies employed SGB prophylactically. The results revealed favorable outcomes in 52% of patients (95% CI: 37%-65%). The overall incidence of complications was 2% (95% CI: 0%-26%). The mortality rate was 13% (95% CI: 7%21%), with a vasospasm-related mortality rate of 11% (95% CI: 2%-20%). A decrease of cerebral blood flow velocity was reported in 4 studies.CONCLUSIONS: The notable reduction in cerebral blood flow velocity following SGB, alongside positive outcomes and a low occurrence of mortality and complications, highlights its significance as a therapeutic intervention for vasospasm following SAH. While the number of studies evaluating SGB as a preventive measure is limited, the promising results emphasize the importance of future research.
  • article 0 Citação(ões) na Scopus
    Complications associated with combined direct and indirect bypass in Moyamoya Disease: A meta-analysis
    (2024) BATISTA, Savio; KOESTER, Stefan; BISHAY, Anthony E.; BERTANI, Raphael; OBERMAN, Dan Zimelewicz; ABREU, Livia V. de; BOCANEGRA-BECERRA, Jhon E.; AMARAL, Dillan; ISAACS, Albert M.; DEWAN, Michael; FIGUEIREDO, Eberval Gadelha
    Bypass revascularization helps prevent complications in Moyamoya Disease (MMD). To systematically review complications associated with combined direct and indirect (CB) bypass in MMD and analyze differences between the adult and pediatric populations. A systematic literature review was conducted per PRISMA guidelines. PUBMED, Cochrane Library, Web of Science, and CINAHL, were queried from January 1980 to March 2022. Complications were defined as any event in the immediate post-surgical period of a minimum 3 months follow-up. Exclusion criteria included lack of surgical complication reports, non-English articles, and CB unspecified or reported separately. 18 final studies were included of 1580 procured. 1151 patients (per study range = 10-150, mean = 63.9) were analyzed. 9 (50.0%) studies included pediatric patients. There were 32 total hemorrhagic, 74 total ischemic and 16 total seizure complications, resulting in a rate of 0.04 (95% CI 0.03, 0.06), 0.7 (95% CI 0.04, 0.10) and 0.03 (95% CI 0.02, 0.05), respectively. The rate of hemorrhagic complications in the pediatric showed no significant difference from the adult subgroup (0.03 (95% CI 0.01-0.08) vs. 0.06 (95% CI 0.04-0.10, p = 0.19), such as the rate of ischemic complications (0.12 (95% CI 0.07-0.23) vs. 0.09 (95% CI 0.05-0.14, p = 0.40). Ischemia is the most common complication in CB for MMD. Pediatric patients had similar hemorrhagic and ischemic complication rates compared to adults.
  • article 1 Citação(ões) na Scopus
    Current State of Brazilian Neurosurgery: Evaluation of Burden of Care and Case Volume
    (2023) KOESTER, Stefan W.; BERTANI, Raphael; BATISTA, Savio; BISHAY, Anthony E.; PERRET, Caio; DEWAN, Michael C.; PAIVA, Wellingson; CAMPOS, Wuilker Knoner; FIGUEIREDO, Eberval G.
    -BACKGROUND: Low-and middle-income countries (LMICs) bear a heavier burden of neurosurgical diseases than high-income countries. Brazil, a growing middle -income country, holds promise as a health care market. However, there exists a lack of information t
  • 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.