RAPHAEL BERTANI DE MAGALHAES
Índice h a partir de 2011
2
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- 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
- Awake surgery for glioma resection during pregnancy: a systematic review(2023) BOCANEGRA-BECERRA, Jhon E.; BATISTA, Savio; VIEITAS, Fernando Costa; TAKAHASHI, Rafael; OLIVEIRA, Leonardo de Barros; CASTILLO-HUERTA, Nicole M.; LUDENA-ESQUIVEL, Alonso; BERTANI, RaphaelBrain tumors are rarely present during pregnancy. However, they can severely impact the fetus and mother's well-being due to a complex interaction of disease and physiological factors. Moreover, awake surgery for gliomas has been scarcely reported during this life stage, and the nuances and techniques merit further investigation. Herein, we performed a systematic review of the literature about awake surgery for glioma resection during pregnancy. A total of six patients with a median age of 30.5 years (interquartile range: 40-27) were analyzed. Awake surgery was performed in the third trimester in 50% of patients (median time: 24.5 weeks) without reported intraoperative complications. Conscious sedation was achieved by remifentanil and propofol infusion in 67% of cases, and intraoperative fetal heart monitoring was utilized in 83% of cases. Most studies revealed good clinical maternal-fetal outcomes at follow-up; however, long-term safety effects remain undetermined and warrant further research. In conclusion, awake surgery for glioma resection under a multidisciplinary approach can be a reasonable treatment option for select patients during pregnancy.
- 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 GadelhaThe 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.
- 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 GadelhaMinimally 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.
- Enhancing meningioma resection: a comprehensive study on the safety and effectiveness of Onyx™ presurgical embolization(2023) BATISTA, Savio; ANDREAO, Filipi Fim; PALAVANI, Lucca B.; BORGES, Pedro; VERLY, Gabriel; BERTANI, Raphael; FILHO, Jose Alberto Almeida; PAIVA, Wellingson S.; ABREU, Livia V. de; PESSOA, Bruno L.Presurgical embolization (PE) has emerged as an interesting strategy to help turn brain tumor resection more amenable. This study aims to systematically review the safety and effectiveness of Onyx (TM) PE in meningioma resection. We followed Cochrane Collaboration and PRISMA for systematic review and meta-analysis, querying PUBMED, Cochrane Library, Web of Science, and Embase databases. Major complications were defined as other artery occlusion, visual deficits due to PE, or non temporary nerve damage, while minor included transitory conditions and others without clinical implications. A total of 186 patients were included, in which 120 were WHO grade I (80%), II (16%), and III (4%). Patient baseline characteristics and complications were distributed in groups without or with individual patient data analysis. Individual Patient Data Meta-Analysis (IPDMA) was performed on the last category, comprising 51 meningiomas that underwent Onyx (TM) PE. Among available data, 70%, 17%, and 13% were WHO grade I, II, and III, respectively. Considering all studies, tumor characteristics regarding grade underscored a certain homogeneity. Complications occurred at a rate of 9% (95% CI, 4 to 14%; I2 = 35%), with the rate of major complications significantly lower at only 1% (95% CI, 0 to 3%; I2 = 32%), whereas of minor complications was 7% (95% CI, 3 to 10%; I2 = 0%). Mean surgery blood loss was 668.7 (95% CI, 534.9 to 835.8; I2 = 0%) in IPDMA. Onyx (TM) PE is promising for safer surgical meningioma resection, despite limitations. Further studies are required to validate efficacy, enhance patient selection, and refine techniques.
- 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 GadelhaBackground: 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.
- 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 GadelhaBACKGROUND: 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.
- Safety of withholding perioperative steroids for patients with pituitary resection with an intact hypothalamus-pituitary-adrenal axis: A meta-analysis of randomized clinical trials(2023) BATISTA, Savio; ALMEIDA, Jose Alberto; KOESTER, Stefan; GASPARRI, Luisa Glioche; SANTANA, Lais Silva; GALLO, Bruno Henrique Dallo; PALAVANI, Lucca B.; BERTANI, Raphael; LANDEIRO, Jose AlbertoIntroduction: Several observational studies have evaluated the effects of pre-operative steroids (STER) for transsphenoidal pituitary removal in patients with an intact hypothalamus-pituitary-adrenal axis. However, a consensus built upon randomized studies has not been previously performed. Purpose: To comprehensively evaluate the clinical effects of patients receiving STER when compared to those not receiving steroids (NOSTER) in transsphenoidal pituitary resection, a meta-analysis of randomized clinical trials (RCT) was conducted. Methods: A systematic review of the literature of RCTs comparing STER and NOSTER was performed in accordance with the PRISMA guidelines. Databases, including PUBMED, Cochrane Library, Web of Science, and Embase were queried. The primary outcomes were adrenal insufficiency (AI) and diabetes insipidus (DI) postoperatively. Results: A total of 4 final studies were included, in which 530 total patients were analyzed. The meta-analysis suggested that there was no significant difference between STER and NOSTER groups post-operatively related to transient AI (RR= 0.83, 95% CI [0.51-1.35], p = 0.45; I-2 = 52%), permanent AI (RR= 0.97, 95% CI [0.41-2.31], p = 0.95; I-2 = 0%), and permanent DI (RR= 0.62, 95% CI [0.16-2.33], p = 0.48; I-2 = 0%). Nevertheless, STER group had significantly lower rates of transient DI (RR= 0.60, 95% CI [0.38-0.95], p = 0.03; I-2 = 5%), and post-op hyponatremia (RR = 0.49, 95% CI [0.28-0.87], p = 0.02; I-2 = 0%). Conclusion: This study demonstrates evidence from RCTs that patients receiving pre-operative STER are both safe and effective pre-operatively for resection of pituitary adenomas with an intact hypothalamus-pituitary-adrenal axis.
- 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 GadelhaBypass 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.
- 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