GUSTAVO SOUSA NOLETO
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- 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.
- 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.