EBERVAL GADELHA FIGUEIREDO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Neurologia, Faculdade de Medicina - Docente
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
147 resultados
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- Anatomic evaluation of the posterior temporal approach via the Heschl's gyrus to the thalamus, internal capsule, and atrium(2023) PALMIERO, Helbert de Oliveira Manduca; RIBAS, Eduardo Carvalhal; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaObjective Posterior temporal craniotomy allows for the exposure of the superior surface of the planum temporale. Heschl's gyrus is the most prominent structure of the planum temporale and can be an anatomical landmark to approach deep brain structures such as the internal capsule, lateral thalamus, and ventricular atrium. Methods Ten human cadavers' heads underwent a posterior bilateral temporal craniotomy and the microsurgical dissection of Heschl's gyrus was performed and variables were measured with a neuronavigation system and statistically analyzed. Results The mean distance between the keyhole and Heschl's gyrus was 61.7 +/- 7.3 mm, the mean distance between the stephanion to Heschl's gyrus was 40.8 +/- 6.0 mm, and the mean distance between the temporal lobe and Heschl's gyrus was 54.9 +/- 6.9 mm. The length of Heschl's gyrus was 24 +/- 7.5 mm, and the inclination angle in the axial plane was 20.0 +/- 3.7 degrees having the vertex as its deepest point as the base on the surface of the temporal plane. From Heschl's gyrus, the distance from the surface to the internal capsule was 29.1 +/- 5.6 mm, the distance to the lateral thalamus was 34.8 +/- 7.3 mm, and the distance to the ventricular atrium was 39.6 +/- 7.2 mm. No statistical difference was found between the right and left sides. Conclusions Through a posterior temporal craniotomy, the temporal planum is exposed by opening the Sylvian fissure, where Heschl's gyrus can be identified and used as a natural corridor to approach the internal capsule, the ventricular atrium, and the lateral thalamus.
- A Diffuse Leptomeningeal Glioneural Tumor Case Producing Hydrocephalus and Polyradiculopathy(2020) PICARELLI, Helder; NEPOMUCENO, Thales Bhering; RIBEIRO, Renan Ribeiro; YAMAKI, Vitor Nagai; FIGUEIREDO, Eberval GadelhaThe present report describes the case of a male 17-year-old patient who progressively developed a hydrocephalus and polyradiculopathy due to involvement of central nervous system (CNS) by a diffuse leptomeningeal glioneuronal tumor ( DLGNT). The tumor had partial remission in response to the treatment with radiotherapy plus procarbazine, lomustine, and vincristine (PCV) chemotherapy, and the patient had improvement in function and pain levels. The current knowledge about DLGNT, including its clinical manifestations, imaging findings, histological characteristics, and treatment are revised and discussed in the present paper.
- Computed Tomography Angiography for Detection of Middle Meningeal Artery Lesions Associated with Acute Epidural Hematomas(2014) PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira; AMORIM, Robson Luis Oliveira De; BOR-SENG-SHU, Edson; GATTAS, Gabriel; NEVILLE, Iuri Santana; CALDAS, Jose Guilherme; FIGUEIREDO, Eberval Gadelha; TEIXEIRA, Andmanoel JacobsenBackground. The natural history of traumatic aneurysms of the middle meningeal artery (MMA) is not well known, but patients with these lesions are more likely to have delayed bleeds. In this paper, we described a series of patients with epidural hematoma who underwent angiotomography (CTA) for MMA vascular lesion diagnosis. Methods. Eleven patients admitted to our emergency unit with small acute epidural hematoma were prospectively studied. All patients with temporal acute epidural hematomas underwent CTA and cerebral angiogram at our institution for diagnosis of posttraumatic lesions of middle meningeal artery. The findings of angiotomography and digital angiography were reviewed by radiologist and angiographers, respectively, to ensure that the lesions were readily diagnosed without knowing the results of angiotomography and to compare CTA findings with standard angiogram. Results. The causes of head injury were traffic accidents, falls, and aggression. Three of these patients presented traumatic MMA pseudoaneurysm. CT angiography was able to diagnose all of them, with dimensions ranging from 1.5 to 2.8 mm. Conventional angiography confirmed the findings of CT angiography, and the lesions presented with similar dimensions at both methods. Conclusions. We believe that angiotomography can be a useful technique for diagnosis of vascular lesion associated with small epidural hematoma.
- The Author Impact Factor as a Metric to Evaluate the Impact of Neurosurgical Researchers(2022) RAMOS, Miguel Bertelli; RECH, Matheus Machado; DAGOSTINI, Carolina Matte; BRITZ, Joao Pedro Einsfeld; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaOBJECTIVE: The objective of this study was to assess the Author Impact Factor (AIF) as a useful metric and as a complement to the h-index among neurosurgical researchers. METHODS: The 5-year AIF and h-index were compared among 3 groups of researchers: 1) the 100 most prolific of all time within general neurosurgical journals (""Experienced""), 2) the 100 most prolific during the 2015-2019 period within general neurosurgical journals (""Trending Group""), and 3) the 100 postgraduation year 7 neurosurgical residents with the highest h-index (""Amateur""). RESULTS: The Amateur group had a lower median h-index than the Experienced (6 vs. 55; P < 0.001) and Trending (6 vs. 43; P < 0.001) groups. The highest h-index of the Amateur group (24) was lower than the first quartile of the Experienced (46.25) and Trending (26.00) groups. The Amateur group had a lower median 5-year AIF than the Experienced (2.15 vs. 3.17; P < 0.001) and Trending (2.15 vs. 2.85; P = 0.02) groups. Unlike the h-index, the gap between the 5-year AIF distribution of the Amateur group and other groups was not profound. Although there was a positive correlation between the metrics in the 3 groups, they did not proxy for each other. For instance, while the h-index of some experienced authors that have not published recently was high, their AIFs were zero. Also, some Amateur authors published very impactful articles and had a high 5-year AIF. However, since their number of publications is inevitably low, their h-index were low. CONCLUSIONS: The AIF provides intuitive and complementary information to the h-index regarding the research output of neurosurgical authors.
- Augmented reality and physical hybrid model simulation for preoperative planning of metopic craniosynostosis surgery(2020) COELHO, Giselle; RABELO, Nicollas Nunes; VIEIRA, Eduardo; MENDES, Kid; ZAGATTO, Gustavo; OLIVEIRA, Ricardo Santos de; RAPOSO-AMARAL, Cassio Eduardo; YOSHIDA, Mauricio; SOUZA, Matheus Rodrigues de; FAGUNDES, Caroline Ferreira; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaOBJECTIVE The main objective of neurosurgery is to establish safe and reliable surgical techniques. Medical technology has advanced during the 21st century, enabling the development of increasingly sophisticated tools for preoperative study that can be used by surgeons before performing surgery on an actual patient. Laser-printed models are a robust tool for improving surgical performance, planning an operative approach, and developing the skills and strategy to deal with uncommon and high-risk intraoperative difficulties. Practice with these models enhances the surgeon's understanding of 3D anatomy but has some limitations with regard to tactile perception. In this study, the authors aimed to develop a preoperative planning method that combines a hybrid model with augmented reality (AR) to enhance preparation for and planning of a specific surgical procedure, correction of metopic craniosynostosis, also known as trigonocephaly. METHODS With the use of imaging data of an actual case patient who underwent surgical correction of metopic craniosynostosis, a physical hybrid model (for hands-on applications) and an AR app for a mobile device were created. The hybrid customized model was developed by using analysis of diagnostic CT imaging of a case patient with metopic craniosynostosis. Created from many different types of silicone, the physical model simulates anatomical conditions, allowing a multidisciplinary team to deal with different situations and to precisely determine the appropriate surgical approach. A real-time AR interface with the physical model was developed by using an AR app that enhances the anatomic aspects of the patient's skull. This method was used by 38 experienced surgeons (craniofacial plastic surgeons and neurosurgeons), who then responded to a questionnaire that evaluated the realism and utility of the hybrid AR simulation used in this method as a beneficial educational tool for teaching and preoperative planning in performing surgical metopic craniosynostosis correction. RESULTS The authors developed a practice model for planning the surgical cranial remodeling used in the correction of metopic craniosynostosis. In the hybrid AR model, all aspects of the surgical procedure previously performed on the case patient were simulated: subcutaneous and subperiosteal dissection, skin incision, and skull remodeling with absorbable miniplates. The pre- and postoperative procedures were also carried out, which emphasizes the role of the AR app in the hybrid model. On the basis of the questionnaire, the hybrid AR tool was approved by the senior surgery team and considered adequate for educational purposes. Statistical analysis of the questionnaire responses also highlighted the potential for the use of the hybrid model in future applications. CONCLUSIONS This new preoperative platform that combines physical and virtual models may represent an important method to improve multidisciplinary discussion in addition to being a powerful teaching tool. The hybrid model associated with the AR app provided an effective training environment, and it enhanced the teaching of surgical anatomy and operative strategies in a challenging neurosurgical procedure.
- Long-term Dysphagia following Acoustic Neuroma Surgery: Prevalence, Severity and Predictive Factors(2021) ABBAS-KAYANO, Raiene Telassin; SOLLA, Davi Jorge Fontoura; RABELO, Nicollas Nunes; GOMES, Marcos de Queiroz Teles; CABRERA, Hector Tomas Navarro; TEIXEIRA, Manoel J.; FIGUEIREDO, Eberval GadelhaBackground Acoustic neuroma (AN) may compress the cerebellum and brainstem and may cause dysfunction of bulbar cranial nerves. Objective To describe swallowing function outcomes in the late postoperative period after AN surgery. Methods This cohort study included patients operated on between 1999-2014, with a mean follow up of 6.4 4.5 years. The swallowing function was assessed through the functional oral intake scale (FOIS). The primary outcome was defined by scores 5 to 1, which implied oral feeding restriction or adaptation. Risks factors were identified through multivariate logistic regression. Results 101 patients were evaluated. As many as 46 (45.5%) presented dysphagia on the late postoperative period. Women comprised 77.2%, and the mean age was 47.1 +/- 16.0 years (range 19-80). Dysphagic patients presented more type II neurofibromatosis (NF II) (32.6% vs. 10.9%, p = 0.007), larger tumors (3.8 +/- 1.1 vs. 3.1 +/- 1.0 cm, p < 0.001), partial resection (50.0% vs. 85.5%, p < 0.001) and needed more surgeries (>= 2, 39.1% vs. 18.2%, p = 0.019). Important peripheral facial palsy (PFP) (House-Brackmann [HB] grade >= 3) was present before the surgery on 47.5% and worsened on 55.4%. Postoperative PFP (p < 0.001), but not preoperative PFP, was predictive of postoperative dysphagia. On multivariate analysis, the following factors were risk factors for dysphagia: NF II (OR 5.54, p = 0.034), tumor size (each 1 cm, OR 2.13, p = 0.009), partial resection (OR 5.23, p = 0.022) and postoperative HB grade >= 3 (OR 12.99, p = 0.002). Conclusions Dysphagia after AN surgery is highly correlated to postoperative facial motor function. NF II, tumor size, and extent of resection were also predictive of this morbidity in the late postoperative period.
- Cavernous carotid artery aneurysms: Epidemiology, natural history, diagnostic and treatment. An experience of a single institution(2014) ROSI JUNIOR, Jefferson; WELLING, Leonardo C.; YENG, Lin Tchia; CALDAS, Jose Guilherme; SCHAFRANSKI, Marcelo; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground: Cavernous carotid aneurysms (CCA) account for 2-9% of all intracranial aneurysms. They have been considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. These aneurysms are unique, their rupture can present in many different forms, they can suffer spontaneous thrombotic changes and the symptomatology related to the mass effect involves the neuro-ophthalmologic system. In this scenario the natural history and clinical presentation are largely different from other intracranial aneurysms. Some investigators advocate treatment of both symptomatic and asymptomatic CCAs, others recommend no treatment. The reason for this controversy relates to a lack of information on the long term natural history of these aneurysms, as well as on the long term results of treatment. Methods: In this article the authors discuss their single institution experience in diagnosis, natural history and management of 123 asymptomatic and oligosympotomatic aneurysms located in the cavernous portion of internal carotid artery. Conclusions: According to our results asymptomatic or olygosymptomatic (pain) CCAs should be conservatively managed with serial images while the others presentations should be analyzed by a multidisciplinary team, involving the neuroendovascular and microsurgical services.
- Posttraumatic Refractory Intracranial Hypertension and Brain Herniation Syndrome: Cerebral Hemodynamic Assessment before Decompressive Craniectomy(2013) BOR-SENG-SHU, Edson; PAIVA, Wellingson Silva; FIGUEIREDO, Eberval G.; FUJIMOTO, Yasunori; ANDRADE, Almir Ferreira de; FONOFF, Erich Talamoni; TEIXEIRA, Andmanoel JacobsenBackground. The pathophysiology of traumatic brain swelling remains little understood. An improved understanding of intracranial circulatory process related to brain herniation may have treatment implications. Objective. To investigate the cerebral hemodynamic changes associated with brain herniation syndrome due to traumatic brain swelling. Methods. Nineteen head-injured patients with evidence of refractory intracranial hypertension and transtentorial herniation were prospectively studied. Cerebral hemodynamic assessment by transcranial Doppler (TCD) ultrasonography was performed prior to decompressive craniectomy. Patients and their cerebral hemispheres were classified according to TCD-hemodynamic patterns, and the data correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results. A wide variety of cerebral hemodynamic findings were observed. Ten patients (52.7%) presented with cerebral oligoemia, 3 patients (15.8%) with cerebral hyperemia, and 6 patients with nonspecific circulatory pattern. Circulatory disturbances were more frequently found in the side of maximal cerebral swelling than in the opposite side. Pulsatility index (PI) values suggested that ICP varied from acceptable to considerably high; patients with increased PI, indicating higher microvascular resistance. No correlation was found between cerebral hemodynamic findings and outcome. Conclusions. There is a marked heterogeneity of cerebral hemodynamic disturbances among patients with brain herniation syndrome.
- Brainstem injury by penetrating head trauma with a knife(2012) PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira De; AMORIM, Robson Luis; FIGUEIREDO, Eberval Gadelha; TEIXEIRA, Manoel JacobsenThe authors describe a rare case about a traumatic lesion of brain and brain stem with a knife. In this case the patient had good clinical condition, diagnosed with TBI by infectious complications. We have highlighted the unusual diagnosis, proximity of vascular structures, the technique used in the treatment and the good outcome of the injury.
- Vascularization of the uncus – Anatomical study and clinical implications(2021) ISOLAN, G. R.; MARRONE, A. C. Huf; MARRONE, L. C. Porcellos; STEFANI, M. A.; COSTA, J. C. da; TELLES, J. P. Mota; CHOI, G. G.; SILVA, S. A. da; RABELO, N. N.; FIGUEIREDO, E. G.Background: The objective of this paper was to describe the arterial supply of the uncus and quantify the branches directed to the anteromedial aspect of the human temporal cortex. Methods: We studied 150 human cerebral hemispheres identifying main afferent arteries supplying the anteromedial temporal cortex with particular attention to the uncus, determining the territory supplied by each artery through either cortical or perforating branches. Results: The uncus was supplied by 419 branches of the anterior choroidal artery (AChA), 210 branches of the internal carotid artery (ICA), 353 branches of the middle cerebral artery (MCA), and 122 branches of the posterior cerebral artery (PCA). The total of supplying vessels was 1104 among the 150 hemispheres studied, which corresponds to 7.36 arteries per uncus. The average of branches per hemisphere was as follows: 2.79 from AChA, 1.40 from ICA, 2.35 from MCA, and 0.81 from PCA. The relative contribution of each artery for the total of specimens studied was as follows: 38% from AChA, 19% from ICA, 32% from the MCA, and 11% from the PCA. We identified cortical anastomoses mostly between the MCA and PCA (27 cases). Conclusion: We described and quantified the uncus’ vascularization, including anatomical variations. This updated, detailed description of the mesial temporal vascularization is paramount to improve the treatment of neurosurgical conditions. © 2021 Published by Scientific Scholar on behalf of Surgical Neurology International.