GUSTAVO SOUSA NOLETO
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article Subdural hematoma as a rarecomplication of a percutaneous balloon compression: case report(2016) NETO, Sergio; NOLETO, Gustavo; DUARTE, Kleber Paiva; ROSA, Nilton Caetano da; TEIXEIRA, Manoel JacobsenBackground: Trigeminal neuralgia (TN) it's the most common of all 14 types of facial pain and it's a well-described pathology presenting as a paroxysmal (clusters of sharp lancinating) shock-like pain in abrupt crises, limited to the trigeminal domain side. We present a complication of a percutaneous balloon compression never reported before. Presentation: A 86 Years old (Y.O), Male patient on the immediate post operative of a PBC (percutaneous balloon compression) presented suddenly unresponsive and with right pupilanisocoria. Conclusion: The authors believe that the cause of the Hematoma was due to the stretch and rupture of bridging dural veins secondarily to the expansion of the balloon. The quick detection and treatment was the key for a good outcome for the patient.bookPart Hipertensão intercraniana(2021) SANTOS, José Gustavo Rocha Peixoto dos; NOLETO, Gustavo Sousa- Experimental rnodel of intracranial hypertension with continuous multiparametric monitoring in swine(2013) ANDRADE, Almir Ferreira de; SOARES, Matheus Schmidt; PATRIOTA, Gustavo Cartaxo; BELON, Alessandro Rodrigo; PAIVA, Wellingson Silva; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo de Lima; NASCIMENTO, Clarissa Nobrega; NOLETO, Gustavo Sousa; ALVES JUNIOR, Aderaldo Costa; FIGUEIREDO, Eberval Gadelha; OTOCH, Jose Pinhata; TEIXEIRA, Manoel JacobsenObjective: Intracranial hypertension (IN) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods: We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results: None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion: The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.
- Dural sinus and internal jugular vein thrombosis complicating a blunt head injury in a pediatric patient(2013) BEER-FURLAN, Andre; ALMEIDA, Cesar Cimonari de; NOLETO, Gustavo; PAIVA, Wellingson; FERREIRA, Almir Andrade; TEIXEIRA, Manoel JacobsenCerebral venous sinus thrombosis (CVST) following a blunt head trauma is a rare condition, described in the literature along with the lack of consensus regarding diagnosis and management. We present a case of a pediatric patient with a blunt head injury and epidural hematoma, who developed dural sinus and internal jugular vein thrombosis with fatal outcome. Most of reports show good outcome and recovery, but CVST might be related to poor recovery and even lead to death. The diagnosis and management of this condition are discussed based on a literature review. It is important to keep a high degree of suspicion of CVST since early diagnosis may prevent potentially treatable catastrophic outcomes.
- Traumatic carotid-cavernous fistula at the anterior ascending segment of the internal carotid artery in a pediatric patient(2013) PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira de; BEER-FURLAN, Andre; NEVILLE, Iuri Santana; NOLETO, Gustavo S.; BERNARDO, Luca Silveira; CALDAS, Jose Guilherme; TEIXEIRA, Manoel JacobsenTraumatic carotid-cavernous fistula (CCF) in children is a rare condition. Early diagnosis and treatment is still a challenge, and it is associated with good neurological recovery. We present a rare case of a 10-year-old boy with mild head trauma, who developed a CCF at the anterior segment of the ascending internal carotid artery. The patient was treated with endovascular coil embolization and evolved with a favorable outcome. Most of reports in the literature address the traumatic CCF in adult patients, in which early treatment may prevent poor recovery or fatal outcomes. The diagnosis and management of this condition are discussed based on a literature review. It is important to keep a high degree of suspicion for CCF, especially in traumatic head injury associated with skull base fracture, since the early diagnosis and treatment may prevent potentially permanent neurological deficits.
- Decompressive hinge craniectomy with linear durotomies for ischemic stroke: a pilot study(2021) ANDRADE, Almir Ferreira; SILVA, Saul Almeida da; IGLESIO, Ricardo Ferrareto; NESPOLI, Vitor Salviato; NOLETO, Gustavo; TELLES, Joao Paulo Mota; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaOBJECTIVE: Decompressive craniectomy may be a life-saving measure in ischemic stroke patients, who still have several associated complications. The objective of this study is to evaluate a novel decompressive surgery technique for severe hemispheric ischemic stroke. METHODS: For the hinge decompressive craniectomy (HDC), linear durotomies were performed. Vertical (one or two frontal and two parietal), and two horizontal (temporal), with approximately 5 cm long, linear durotomies were carried out. Duroplasty was performed using an autologous subgaleal tissue graft fixed with separate sutures to avoid CSF leak and direct contact of the cortex with the bone flap. The bone flap was fixed in three parietal locations. We compared 10 patients who underwent our modified HDC with 9 patients submitted to classical decompressive craniectomy (CDC). The primary outcome of this study was mortality. RESULTS: Nineteen patients were included, with a mean age of 52.3 years (+/- 8.2). Four ( 44%) patients from the HDC group had to be reoperated to remove the bone flap because of brain swelling worsening, but none of them died. The average time of HDC was 90 minutes. Overall 14-days mortality was 21.1% (n=4), and cumulative six-months mortality was 42.1% (n=8). Five (50%) patients submitted to CDC died, while 3 (33.3%) submitted to HDC died (.2=0.07, p=0.79). The mean length of stay was 46.7 days (+/- 32.1) for HDC and 38.7 (+/- 27.1) for CDC (p=0.60). CONCLUSIONS: We present a modified technique of hinge craniectomy with linear vertical and horizontal durotomies, which seems to have reduced operative time and mortality compared to classical decompressive craniotomy, although the difference was not statistically significant.
- Functional improvements associated with cranioplasty after stroke and traumatic brain injury: a cohort study(2023) COELHO, F.; NOLETO, G. S.; SOLLA, D. J. F.; MARTINS, P. N.; ANDRADE, A. F.; TEIXEIRA, M. J.; PAIVA, W. S.; ANGHINAH, R.Objective: Decompressive craniectomy is part of the acute management of several neurosurgical illnesses, and is commonly followed by cranioplasty. Data are still scarce on the functional and cognitive outcomes following cranioplasty. We aim to evaluate these outcomes in patients who underwent cranioplasty following traumatic brain injury (TBI) or stroke. Methods: n this prospective cohort, we assessed 1-month and 6-month neuropsychological and functional outcomes in TBI and stroke patients who underwent cranioplasty at a Brazilian tertiary center. The primary outcome was the change in the Digits Test at 1 and 6 months after cranioplasty. Repeated measures general linear models were employed to assess the patients' evolution and interactions with baseline characteristics. Effect size was estimated by the partial eta(2). Results: A total of 20 TBI and 14 stroke patients were included (mean age 42 +/- 14 years; 52.9% male; average schooling 9.5 +/- 3.8 years; 91.2% right-handed). We found significant improvements in the Digits Tests up to 6 months after cranioplasty (p = 0.004, partial eta(2) = 0.183), as well as in attention, episodic memory, verbal fluency, working memory, inhibitory control, visuoconstructive and visuospatial abilities (partial eta 2 0.106-0.305). We found no interaction between the cranioplasty effect and age, sex or schooling. Patients submitted to cranioplasty earlier (<1 year) after injury had better outcomes. Conclusion: Cognitive and functional outcomes improved after cranioplasty following decompressive craniectomy for stroke or TBI. This effect was consistent regardless of age, sex, or education level and persisted after 6 months. Some degree of spontaneous improvement might have contributed to the results.
- Different morphology, stage and treatment affect immune cell infiltration and long-term outcome in patients with non-small-cell lung carcinoma(2012) SOUZA, Paola da Costa; PARRA, Edwin Roger; ATANAZIO, Marcelo Junqueira; SILVA, Osmar Bianchi da; NOLETO, Gustavo Sousa; AB'SABER, Alexandre Muxfeldt; FERNEZLIAN, Sandra de Morais; TAKAGAKI, Tereza; CAPELOZZI, Vera LuizaAims: Development of effective immune-based therapies for patients with non-small-cell lung carcinoma (NSCLC) depends on an accurate characterization of complex interactions that occur between immune cells and the tumour environment. Methods and results: Innate and adaptive immune responses were evaluated in relation to prognosis in 65 patients with surgically excised NSCLC. Immunohistochemistry and morphometry were used to determine the abundance and distribution of immune cells. We found low numbers of immune cells and levels of cytokines in the tumour environment when compared with surrounding parenchyma. Smoking was associated inversely with the adaptive immune response and directly with innate immunity. We observed a prominent adaptive immune response in squamous cell carcinomas (SCC) but greater innate immune responses in adenocarcinomas and large cell carcinomas. Cox model analysis showed a low risk of death for smoking <41 packs/year, N-0 tambour stage, squamous carcinoma, CD4(+) > 16.81% and macrophages/monocytes >4.5%. Collectively, the data indicate that in NSCLC there is not a substantive local immune cell infiltrate within the tumour. Conclusion: Although immune cell infiltration is limited in NSCLC it appears to have an impact on prognosis and this may be of relevance for new immunotherapeutic approaches.
- Monoblock external ventricular drainage system in the treatment of patients with acute hydrocephalus: A pilot study(2014) ANDRADE, Almir Ferreira de; PAIVA, Wellingson Silva; NEVILLE, Iuri Santana; NOLETO, Gustavo Sousa; ALVES JUNIOR, Aderaldo; SANDON, Luiz Henrique Dias; BOR-SENG-SHU, Edson; AMORIM, Robson Luis; TEIXEIRA, Manoel JacobsenBackground: Infection is a major complication in patients undergoing external ventricular drainage (EVD). Our study aimed to evaluate the incidence of infection in a series with the monoblock EVD system. Material/Methods: 46 patients treated with EVD at our emergency department were analyzed prospectively to research the incidence of infections with a new EVD system. Results: The average rate of infection was 8.7%. When we stratified the patients according to the exclusive use of EVD without craniotomies, we identified a reduction in the overall incidence of ventriculitis from 8.7% to 2.3%. Age, etiology, and the presence of ventricular bleeding were not statistically significant risk factors. Conclusions: Despite the small sample examined in this study, we believe that the monoblock system is a simple, inexpensive device that reduces accidental disconnection of the system.
article 4 Citação(ões) na Scopus Giant acute epidural hematoma after ventriculoperitoneal shunt: a case report and literature review(2014) NOLETO, Gustavo; NEVILLE, Iuri Santana; TAVARES, Wagner Malago; SAAD, Felippe; PINTO, Fernando Campos; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaCerebrospinal fluid over-drainage is a common complication of ventriculoperitoneal devices. In terms of haemorrhage, subdural haematomas are usually more frequent lesions than epidural hematomas, which, more rarely, may also be seen after ventricular shunt procedures and may lead to rapid neurological decline and even death unless a surgical procedure can be promptly performed. This study reports the case of a 47 years-old Dandy Walker man, with clinical condition compatible with the diagnosis of normal pressure hydrocephalus submitted to a ventriculoperitoneal shunt with a high fixed pressure valve. After discharge, on the second day after the procedure, he presented with headache and impaired level of consciousness. At hospital admission he was in a coma and anisochoric. Underwent endotracheal intubation and a head CT, showed epidural hematoma. We performed emergency craniotomy to drain the hematoma, the patient died in the operating room despite resuscitation attempts. In conclusion, prompt diagnosis and emergency craniotomy is recommended in these cases. We must be aware of this possible evolution and maintain high suspicion besides a longer in-hospital observation after these procedures.