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
33 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 33
- 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.
- 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.
- A Bibliometric Study of the Most Cited Reports in Central Nervous System Arteriovenous Malformations(2019) RAMOS, Miguel Bertelli; TEIXEIRA, Manoel Jacobsen; PREUL, Mark C.; SPETZLER, Robert F.; FIGUEIREDO, Eberval GadelhaOBJECTIVE: We performed a bibliometric analysis of studies reporting cases of brain and spinal arteriovenous malformations (AVMs). METHODS: We retrieved the 100 most cited reports in brain and spinal AVM research from Scopus and assessed the citation count, journal of publication and its impact factor, year of publication, first author and corresponding authors and their h-index, country, institution, department, and study category. RESULTS: The median number of citations per article was 215. The Journal of Neurosurgery was the most prolific journal (39 reports and 12,069 citations), including 9 of the 10 most cited reports. Seventy reports (19,251 citations), including 8 of the 10 most cited, were from the United States. The Barrow Neurological Institute was the most cited institution (7 reports; 2792 citations), and the Mayo Clinic had the greatest number of reports (8 reports; 1994 citations). Most studies had been reported before 2000 (71 reports; 19,262 citations). The most discussed topics were treatment (40 studies; 9560 citations) and natural history and/or clinical features (37 studies; 9595 citations). Neurosurgery was the most prolific department (58 studies; 15,860 citations). Spetzler was the author with the highest number of articles (n = 7) and citations (n = 2792). CONCLUSIONS: Brain and spinal AVM research was centralized in the United States, has been mainly reported in specific neurosurgical journals, and has been more often related to treatment and natural history and/or clinical features. It is possible that high impact AVM research has been decreasing recently. Because the best approach to these pathological entities remains controversial, research stimulation within this field should be encouraged.
- Decompressive craniectomy and head injury: brain morphometry, ICP, cerebral hemodynamics, cerebral microvascular reactivity, and neurochemistry(2013) BOR-SENG-SHU, Edson; FIGUEIREDO, Eberval G.; FONOFF, Erich Talamoni; FUJIMOTO, Yasunori; PANERAI, Ronney B.; TEIXEIRA, Manoel JacobsenThere has been renewed interest in decompressive craniectomy as a surgical treatment for elevated intracranial pressure (ICP), although evidence-based clinical data are still lacking and some experimental results are conflicting. Ongoing clinical trials on the use of this operation after traumatic brain injury (TBI) may clarify the clinical application of this technique, however, some pathophysiological issues, such as the timing of this operation, its effect on brain edema formation, and its role for secondary brain damage, are still controversial. This review addresses recent clinical data on the influence of decompressive craniectomy on the brain pathophysiology in TBI. Decompressive craniectomy with dural augmentation enlarges intracranial space so that the swollen cerebral hemisphere could expand out of normal cranial limits, avoiding progression of brain herniation. The gain in intracranial volume results in both the improvement of cerebral compliance and a decrease in ICP; the latter favors a rise in both cerebral blood flow and cerebral microvascular perfusion, which can be accompanied by elevation in brain tissue oxygen tension (PbtO(2)) as well as the return of abnormal metabolic parameters to normal values in cases of cerebral ischemia. Enhancement of edema formation, impairment of cerebrovascular pressure reactivity, and non-restoration of brain aerobic metabolism due to metabolic crisis may occur after craniectomy and require further investigations. This review suggests that decompressive craniectomy as the sole treatment is likely to be insufficient; efforts must be made to maintain adequate brain hemodynamics, preferably coupled with brain metabolism, in addition to treating brain metabolic abnormalities, during postoperative stages.
- Vestibular schwannoma: predictive factors of long-term postoperative neurological outcome(2020) ABBAS-KAYANO, Raiene Telassin; SOLLA, Davi Jorge Fontoura; RABELO, Nicollas Nunes; GOMES, Marcos de Queiroz Teles; CABRERA, Hector Tomas Navarro; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaIntroduction: Vestibular schwannoma (VS) is a slow-growing, benign tumor that is usually diagnosed when symptoms develop. Surgical management aims to reduce long-term sequelae (LTS) associated with late diagnosis. Objective: Identify predictive factors of LTS after VS surgery and clinical outcome measured by modified Rankin scale (mRS). Methods: This cohort study included patients submitted to VS surgery from 1999 to 2014, with a mean follow-up of 6.4 +/- 4.5 years. Disability was assessed across the mRS the primary outcome was defined by scores 3 to 6, which implied poor outcome in neurological recovery. Predictive factors were identified through multivariate logistic regression. Results: A total of 101 patients were included in this study. Fifty-one (50.49%) presented mRS >= 3 on the late postoperative period. Men comprise 22.8%, and the mean age was 47.1 +/- 16.0 years (range19-80). Patients with mRS >= 3 presented larger tumors (3.7 +/- 1.1 cm vs. 3.2 +/- 1.0 cm, p < .001), less total resection (50% vs. 76.7%, p < .010) and more neurofibromatosis II(NFII) (84.9% vs. 64.3%, p = .023). On multivariate analysis NFII, tumor size and type resection were predictive of degree of autonomy (mRS >= 3: NF II (OR 3.5, 95% CI 1.08-11.36, p = .036) and tumor size (each 1 cm, OR1.51, 95% CI 0.96-2.38, p = .050). Conclusion: Tumor size, presence of NFT II, type of surgical approach and number of surgeries were identified as predictive factors of functional sequelae in long-term follow-up after VS surgery.
- Efficacy and Safety of Extracranial-Intracranial Bypass Surgery for Posterior Circulation Aneurysms: A Systematic Review and Single-Arm Meta-Analysis(2024) OLIVEIRA, Leonardo de Barros; SOUSA, Marcelo Porto; RIBAS, Luiz Roberto Cavassola; PALAVANI, Lucca B.; BATISTA, Savio; RABELO, Nicollas Nunes; BERTANI, Raphael; WELLING, Leonardo Christiaan; FIGUEIREDO, Eberval Gadelha-OBJECTIVE: Treating complex posterior circulation aneurysms poses chal-lenges, and extracranial to intracranial (EC-IC) bypass techniques are potential therapeutic options. However, the safety and efficacy of this approach for pos-terior circulation aneu
- MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms): A Prospective Randomized Single-Center Clinical Trial With Long-Term Follow-Up Comparing Different Minimally Invasive Surgery Techniques with Standard Open Surgery(2021) MANDEL, Mauricio; TUTIHASHI, Rafael; LI, Yiping; JR, Jefferson Rosi; JENG, Brasil Chian Ping; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaBACKGROUND: Unruptured intracranial aneurysms (UIAs) are increasingly diagnosed but treatment is still controversial. Although the descriptions and use of minimally invasive surgery (MIS) have increased, comparative studies with standard approaches are rare. OBJECTIVE: MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms) is a prospective randomized single-center clinical trial with longterm follow-up comparing different MIS techniques with standard open surgery for treatment of UIAs. METHODS: We randomly allocated a standard pterional approach (PtA) or MIS (1:2) to 111 patients with UIAs of the anterior circulation (mean dome diameter, 6.4 mm; range, 3-20 mm). Patients selected for MIS underwent a second randomization between a transeyelid approach (TelA) or nanopterional approach (NPtA) (1:1). RESULTS: Forty-one patients were randomized to and treated with the PtA, 36 with the TelA, and 34 with the NPtA. Only patients treated with PtA had permanent facial nerve palsy (n = 4 [10%]; P = 0.032). MIS cosmetic results were considered better than those of PtA by independent observers (P < 0.001), and less temporal atrophy in the MIS & nbsp; group was also observed (P = 0.0034). The proportion of excellent results was higher in the TelA group than in the NPtA group (86% vs. 67.6%; P = 0.039). Patients undergoing MIS also reported consistently higher satisfaction and quality-of-life scores (P < 0.001). CONCLUSIONS: MIS is superior to standard PtA for microsurgical clipping of small UIAs of the anterior circulation in terms of cosmetic, satisfaction, and quality-of life outcomes. The TelA or NPtA for UIAs did not show significant outcome differences at 12-18 months.
- Reliability and safety of a new upper cervical spine injury treatment algorithm(2017) JOAQUIM, Andrei Fernandes; BROCK, Roger Schmidt; GUIRADO, Vinicius Monteiro de Paula; SANDON, Luis Henrique; SILVA, Otavio Turolo da; TARICCO, Mario Augusto; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaIn the present study, we evaluated the reliability and safety of a new upper cervical spine injury treatment algorithm to help in the selection of the best treatment modality for these injuries. Methods: Thirty cases, previously treated according to the new algorithm, were presented to four spine surgeons who were questioned about their personal suggestion for treatment, and the treatment suggested according to the application of the algorithm. After four weeks, the same questions were asked again to evaluate reliability (intra-and inter-observer) using the Kappa index. Results: The reliability of the treatment suggested by applying the algorithm was superior to the reliability of the surgeons' personal suggestion for treatment. When applying the upper cervical spine injury treatment algorithm, an agreement with the treatment actually performed was obtained in more than 89% of the cases. Conclusion: The system is safe and reliable for treating traumatic upper cervical spine injuries. The algorithm can be used to help surgeons in the decision between conservative versus surgical treatment of these injuries.
- Prophylactic antiseizure drugs for spontaneous intracerebral hemorrhage: An updated systematic review and meta-analysis(2023) TELLES, Joao Paulo Mota; ROCHA, Rebeka Bustamante; CENCI, Giulia Isadora; NAGER, Gabriela Borges; SILVA, Guilherme Diogo; FIGUEIREDO, Eberval GadelhaBackground: There is concern that recommendations on prophylactic antiseizure drugs (PASDs) for patients with spontaneous intracerebral hemorrhage (sICH) are biased by studies using older drugs and no electrographic monitoring. Aims: We performed a systematic review and meta-analysis to determine whether PASDs in patients with sICH reduced seizure occurrence and improved functional outcomes. We included analyses of newer trials, newer antiseizure drugs, and effectiveness in patients with consistent electrographic monitoring. Methods: Medline, Embase, and Cochrane were searched from inception until 12 August 2022, to identify studies with patients with sICH treated with PASDs, regardless of study design. The studied outcomes were functional status and occurrence of seizures. Results: Fourteen studies were included, including 6742 patients. Risk of bias was low overall. There was no effect of PASD on seizure occurrence overall (odds ratio (OR) 0.73, 95% confidence interval (CI) 0.47-1.15), but they were associated with reduced occurrence in studies with electrographic monitoring (OR 0.36, 95% CI 0.18-0.70). There was no effect of PASDs on functional outcomes (OR 1.15; 95% CI 0.91-1.47) or mortality (OR 0.85, 95% CI 0.65-1.11). Conclusion: Prophylactic antiseizure medications after sICH reduce seizures in studies with electroencephalogram monitoring in high-risk patients. However, this benefit did not reflect in the improvement of functional outcomes, even in studies with newer, less toxic, antiseizure drugs.
- Smartphone-assisted minimally invasive neurosurgery(2019) MANDEL, Mauricio; PETITO, Carlo Emanuel; TUTIHASHI, Rafael; PAIVA, Wellingson; MANDEL, Suzana Abramovicz; PINTO, Fernando Campos Gomes; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval GadelhaOBJECTIVE Advances in video and fiber optics since the 1990s have led to the development of several commercially available high-definition neuroendoscopes. This technological improvement, however, has been surpassed by the smartphone revolution. With the increasing integration of smartphone technology into medical care, the introduction of these high-quality computerized communication devices with built-in digital cameras offers new possibilities in neuroendoscopy. The aim of this study was to investigate the usefulness of smartphone-endoscope integration in performing different types of minimally invasive neurosurgery. METHODS The authors present a new surgical tool that integrates a smartphone with an endoscope by use of a specially designed adapter, thus eliminating the need for the video system customarily used for endoscopy. The authors used this novel combined system to perform minimally invasive surgery on patients with various neuropathological disorders, including cavernomas, cerebral aneurysms, hydrocephalus, subdural hematomas, contusional hematomas, and spontaneous intracerebral hematomas. RESULTS The new endoscopic system featuring smartphone-endoscope integration was used by the authors in the minimally invasive surgical treatment of 42 patients. All procedures were successfully performed, and no complications related to the use of the new method were observed. The quality of the images obtained with the smartphone was high enough to provide adequate information to the neurosurgeons, as smartphone cameras can record images in high definition or 4K resolution. Moreover, because the smartphone screen moves along with the endoscope, surgical mobility was enhanced with the use of this method, facilitating more intuitive use. In fact, this increased mobility was identified as the greatest benefit of the use of the smartphone-endoscope system compared with the use of the neuroendoscope with the standard video set. CONCLUSIONS Minimally invasive approaches are the new frontier in neurosurgery, and technological innovation and integration are crucial to ongoing progress in the application of these techniques. The use of smartphones with endoscopes is a safe and efficient new method of performing endoscope-assisted neurosurgery that may increase surgeon mobility and reduce equipment costs.