MARCELO DE LIMA OLIVEIRA
Projetos de Pesquisa
Unidades Organizacionais
LIM/26 - Laboratório de Pesquisa em Cirurgia Experimental, Hospital das Clínicas, Faculdade de Medicina
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- Intraoperative Ultrasonography for Definition of Less Invasive Surgical Technique in Patients with Chiari Type I Malformation(2017) BROCK, Roger Schmidt; TARICCO, Mario Augusto; OLIVEIRA, Matheus Fernandes de; OLIVEIRA, Marcelo de Lima; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, EdsonINTRODUCTION: Chiari malformation type I (CM) is the main congenital malformation disease of the craniovertebral junction. The ideal surgical treatment is still controversial. Invasive procedures inside the cerebrospinal fluid (CSF) space and associated with dural repair are considered the gold standard; however, less invasive surgery with isolated bone decompression without dural opening may be possible in selected patients. Our study evaluates the efficacy of intraoperative CSF flow measurement with ultrasonography (USG) as a determining parameter in the selection of these patients. METHODS: We analyzed prospectively 49 patients with CM operated on at the Hospital das Clinicas, College of Medicine, University of Sao Paulo. Patients underwent decompressive surgery with or without opening of the dura mater after intraoperative USG measuring flow rate. A value of 3 cm/second was considered a cutoff. Quality of life before and after surgery and the improvement of neck pain and headache were evaluated. RESULTS: Among 49 patients enrolled, 36 patients (73%) had CSF flow >3 cm/second and did not undergo duraplasty. In 13 patients (27%) with initial flow <3 cm/second, dural opening was performed together with duraplasty. All patients improved when preoperative and postoperative scores were compared, and all clinical parameters evaluated did not differ between both surgical groups. Patients submitted to bone decompression alone had a lower complication rate. CONCLUSIONS: Intraoperative USG with measurement of CSF allows the proper selection of patients with CM for less invasive surgery with bone decompression without duraplasty.
- Ultrasonography During Surgery to Approach Cerebral Metastases: Effect on Karnofsky Index Scores and Tumor Volume(2017) OLIVEIRA, Marcelo de Lima; PICARELLI, Helder; MENEZES, Marcos Roberto; AMORIM, Robson Luis; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, EdsonBACKGROUND: The goals of treating a cerebral metastasis (CM) are to achieve local control of the disease and to improve patient quality of life. The aim of this study was to analyze the effect of conventional surgery supported by intraoperative ultrasound (IOUS) to approach a CM. To perform this analysis, we determined the postoperative Karnofsky Performance Status Scale (KPS) scores and tumor resection grades. METHODS: Patients with a CM diagnosis were included in this study. Surgical treatment was either supported or not by IOUS. Pre-and postoperative KPS scores were determined by the oncology team, and cerebral tumor volume was estimated through pre-and postoperative magnetic resonance imaging. The surgical team determined whether it was possible to perform a total CM resection. RESULTS: There were 78 patients treated using surgical management (35 with and 43 without IOUS). In the IOUS group, the postoperative KPS scores were higher (80 vs. 70, respectively; P = 0.045) and the KPS evolution was superior (P = 0.036), especially in the following subgroups: difficulty of tumor resection ranking score < 4 (P = 0.037), tumor in an eloquent area (P = 0.043), tumor not associated with vessels or nerves (P = 0.007), and solitary lesions (P = 0.038). The residual tumor volume was lower in the IOUS group (9.5% and 1.6 mm(3) vs. 30.8% and 9 mm(3), respectively; P = 0.05). In patients with a KPS score >= 70, 62% of them had <10% residual tumors (76% in the IOUS group and 45% in the non-IOUS group; P = 0.032; odds ratio, 3.8). CONCLUSIONS: IOUS may improve postoperative KPS scores and decrease residual tumor volumes in CM surgeries. These findings should be confirmed in future studies.
- Intracranial Hypertension and Cerebral Autoregulation: A Systematic Review and Meta-Analysis(2018) DE-LIMA-OLIVEIRA, Marcelo; SALINET, Angela S. M.; NOGUEIRA, Ricardo C.; AZEVEDO, Daniel S. de; PAIVA, Wellingson S.; TEIXEIRA, Manoel J.; BOR-SENG-SHU, EdsonOBJECTIVE: To present a systematic review and meta-analysis to establish the relation between cerebral autoregulation (CA) and intracranial hypertension. METHODS: An electronic search using the term ""Cerebral autoregulation and intracranial hypertension"" was designed to identify studies that analyzed cerebral blood flow autoregulation in patients undergoing intracranial pressure (ICP) monitoring. The data were used in meta-analyses and sensitivity analyses. RESULTS: A static CA technique was applied in 10 studies (26.3%), a dynamic technique was applied in 25 studies (65.8%), and both techniques were used in 3 studies (7.9%). Static CA studies using the cerebral blood flow technique revealed impaired CA in patients with an ICP >= 20 (standardized mean difference [SMD] 5.44%, 95% confidence interval [CI] 0.25-10.65, P = 0.04); static CA studies with transcranial Doppler revealed a tendency toward impaired CA in patients with ICP >= 20 (SMD -7.83%, 95% CI -17.52 to 1.85, P = 0.11). Moving correlation studies reported impaired CA in patients with ICP >= 20 (SMD 0.06, 95% CI 0.07-0.14, P < 0.00001). A comparison of CA values and mean ICP revealed a correlation between greater ICP and impaired CA (SMD 5.47, 95% CI 1.39-10.1, P = 0.01). Patients with ICP >= 20 had an elevated risk of impaired CA (OR 2.27, 95% CI 1.20-4.31, P = 0.01). CONCLUSIONS: A clear tendency toward CA impairment was observed in patients with increased ICP.