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
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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.
- Evandro de Oliveira, ""The Brain Whisperer""(2019) FIGUEIREDO, Eberval Gadelha; ROTTA, Jose Marcus; TEIXEIRA, Manoel Jacobsen
- 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.
- 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.
- Superficial-Temporal-Artery-To-Middle-Cerebral-Artery Bypass in Cerebrovascular Occlusive Disease and Hemodynamic-Related Ischemia: Illustrative Case and Literature Review(2021) ISOLAN, Gustavo Rassier; CARACANTE, Ricardo de Andrade; TELLES, Joao Paulo Mota; RABELO, Nicollas Nunes; FIGUEREDO, Eberval GadelhaStroke is the third most common cause of death worldwide. About 10% to 15% of strokes related to the territory of the carotid artery are associated with its complete occlusion. There is an important subgroup of patients with cerebrovascular occlusive diseases who might benefit from an external-carotid-to-internal-carotid bypass. In the present study, we report a case of a 53-year-old male patient with stenosis of the M2 branch of themiddle cerebral artery (MCA), with a history of similar to 20 episodes of transient ischemic accidents (TIA)s, in whom an anastomosis of the M4 branch of the superficial temporal artery-MCA was performed. The patient was discharged in three days, and in the two years of follow-up, they were no more TIAs. We also conducted a review of the literature on cerebrovascular occlusive disease and extracranial-intracranial bypass surgery. New methods to evaluate cerebral hemodynamics made it possible to classify a new subgroup of patients with symptomatic cerebrovascular disease and documented cerebrovascular compromise in whom the drug therapy fails, who can benefit from the extracranial-intracranial bypass. Our case report illustrates the advantages of revascularization in these selected patients.
- Traumatic Oculomotor Nerve Avulsion after Mild Head Injury(2016) WELLING, Leonardo; WELLING, Mariana; ANTUNES, Eduardo; JUMES, Ariana; UMEDA, Roberto; FIGUEIREDO, Eberval GadelhaThe authors describe a 37-year-old female who suffered a mild head injury after a car accident. She was found with an initial Glasgow coma scale score of 15. On further inspection, complete right ophthalmoplegia was observed. Initial computerized tomography (CT) scan of the head was normal, but magnetic resonance imaging showed right oculomotor nerve avulsion. The patient was discharged from the hospital without any improvement in complete ophthalmoplegia. To our knowledge, this is the first radiographically documented case of oculomotor nerve root avulsion with associated irreversible oculomotor nerve palsy after mild head injury. Considering the poor prognosis for recovery of the nerve function, an appropriate counseling should be provided to the patient and family. Neurosurgical techniques for attempting nerve reconstruction have yet to be investigated but could be a new area for clinical and surgical research.
- Homocysteine serum levels in patients with ruptured and unruptured intracranial aneurysms: a case-control study(2024) TELLES, Joao Paulo Mota; ROSI JUNIOR, Jefferson; YAMAKI, Vitor Nagai; RABELO, Nicollas Nunes; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground There is very few data regarding homocysteine's influence on the formation and rupture of intracranial aneurysms. Objective To compare homocysteine levels between patients with ruptured and unruptured intracranial aneurysms, and to evaluate possible influences of this molecule on vasospasm and functional outcomes. Methods This is a retrospective, case-control study. We evaluated homocysteinemia differences between patients with ruptured and unruptured aneurysms; and the association of homocysteine levels with vasospasm and functional outcomes. Logistic regressions were performed. Results A total of 348 participants were included: 114 (32.8%) with previous aneurysm rupture and 234 (67.2%) with unruptured aneurysms. Median homocysteine was 10.75 mu mol/L (IQR = 4.59) in patients with ruptured aneurysms and 11.5 mu mol/L (IQR = 5.84) in patients with unruptured aneurysms. No significant association was detected between homocysteine levels and rupture status (OR = 0.99, 95% CI = 0.96-1.04). Neither mild (>15 mu mol/L; OR = 1.25, 95% CI 0.32-4.12) nor moderate (>30 mu mol/L; OR = 1.0, 95% CI = 0.54-1.81) hyperhomocysteinemia demonstrated significant correlations with ruptured aneurysms. Neither univariate (OR = 0.86; 95% CI 0.71-1.0) nor multivariable age-adjusted (OR = 0.91; 95% CI = 0.75-1.05) models evidenced an association between homocysteine levels and vasospasm. Homocysteinemia did not influence excellent functional outcomes at 6 months (mRS <= 1) (OR = 1.04; 95% CI = 0.94-1.16). Conclusion There were no differences regarding homocysteinemia between patients with ruptured and unruptured intracranial aneurysms. In patients with ruptured aneurysms, homocysteinemia was not associated with vasospasm or functional outcomes.
- Does the use of oral contraceptives or hormone replacement therapy offer protection against the formation or rupture of intracranial aneurysms in women?: a systematic review and meta-analysis(2023) SANTANA, Diana Lara Pinto de; GONCALVES, Mariangela Barbi; ZIMPEL, Vanessa Milanese Holanda; FIGUEIREDO, Eberval GadelhaOBJECTIVE: The aim of this study was to carry out a systematic review of the literature with meta-analysis to evaluate the effect of using oral contraceptive and hormone replacement therapy as a protective factor in the formation of intracranial aneurysms and subarachnoid hemorrhage.METHODS: This is a systematic review of the literature with meta-analysis, using PubMed and Embase as databases and the PRISMA method. Casecontrol and cohort studies published until December 2022 were included in this review.RESULTS: Four studies were included in this review; three of which were eligible for meta-analysis. Regarding the use of oral contraceptive and the development of subarachnoid hemorrhage, there was a lower risk of aneurysm rupture with an odds ratio 0.65 (confidence interval 0.5-0.85). In the analysis of patients using hormone replacement therapy and developing subarachnoid hemorrhage, there was also a lower risk of aneurysm rupture with an OR 0.54 (CI 0.39-0.74). Only one article analyzed the formation of intracranial aneurysm and the use of hormone replacement therapy and oral contraceptive, and there was a protective effect with the use of these medications. oral contraceptive: OR 2.1 (CI 1.2-3.8) and hormone replacement therapy: OR 3.1 (CI 1.5-6.2).CONCLUSION: The use of hormone replacement therapy and oral contraceptive has a protective effect in intracranial aneurysm rupture and formation.
- Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios and prognosis after aneurysmal subarachnoid hemorrhage: a cohort study(2023) OLIVEIRA, Adilson Jose Manuel de; RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; SOLLA, Davi Jorge Fontoura; COELHO, Antonio Carlos Samaia da Silva; BARBOSA, Guilherme Bitencourt; BARBATO, Natalia Camargo; YOSHIKAWA, Marcia Harumy; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBackground Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors.Objective We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months.Methods This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission.Results A total of 74.1% of the patients were female, with mean age of 55.6 & PLUSMN; 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm.Conclusion Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field.