ALMIR FERREIRA DE ANDRADE
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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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- Prediction of Early TBI Mortality Using a Machine Learning Approach in a LMIC Population(2020) AMORIM, Robson Luis; OLIVEIRA, Louise Makarem; MALBOUISSON, Luis Marcelo; NAGUMO, Marcia Mitie; SIMOES, Marcela; MIRANDA, Leandro; BOR-SENG-SHU, Edson; BEER-FURLAN, Andre; ANDRADE, Almir Ferreira De; RUBIANO, Andres M.; TEIXEIRA, Manoel Jacobsen; KOLIAS, Angelos G.; PAIVA, Wellingson SilvaBackground: In a time when the incidence of severe traumatic brain injury (TBI) is increasing in low- to middle-income countries (LMICs), it is important to understand the behavior of predictive variables in an LMIC's population. There are few previous attempts to generate prediction models for TBI outcomes from local data in LMICs. Our study aim is to design and compare a series of predictive models for mortality on a new cohort in TBI patients in Brazil using Machine Learning. Methods: A prospective registry was set in Sao Paulo, Brazil, enrolling all patients with a diagnosis of TBI that require admission to the intensive care unit. We evaluated the following predictors: gender, age, pupil reactivity at admission, Glasgow Coma Scale (GCS), presence of hypoxia and hypotension, computed tomography findings, trauma severity score, and laboratory results. Results: Overall mortality at 14 days was 22.8%. Models had a high prediction performance, with the best prediction for overall mortality achieved through Naive Bayes (area under the curve = 0.906). The most significant predictors were the GCS at admission and prehospital GCS, age, and pupil reaction. When predicting the length of stay at the intensive care unit, the Conditional Inference Tree model had the best performance (root mean square error = 1.011), with the most important variable across all models being the GCS at scene. Conclusions: Models for early mortality and hospital length of stay using Machine Learning can achieve high performance when based on registry data even in LMICs. These models have the potential to inform treatment decisions and counsel family members.
- Comparative anatomical analysis of the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches to the third ventricle(2017) ARAUJO, Joao Luiz Vitorino; VEIGA, Jose C. E.; WEN, Hung Tzu; ANDRADE, Almir F. de; TEIXEIRA, Manoel J.; OTOCH, Jose P.; RHOTON JR., Albert L.; PREUL, Mark C.; SPETZLER, Robert F.; FIGUEIREDO, Eberval G.OBJECTIVE Access to the third ventricle is a veritable challenge to neurosurgeons. In this context, anatomical and morphometric studies are useful for establishing the limitations and advantages of a particular surgical approach. The transchoroidal approach is versatile and provides adequate exposure of the middle and posterior regions of the third ventricle. However, the fornix column limits the exposure of the anterior region of the third ventricle. There is evidence that the unilateral section of the fornix column has little effect on cognitive function. This study compared the anatomical exposure afforded by the transforniceal-transchoroidal approach with that of the transchoroidal approach. In addition, a morphometric evaluation of structures that are relevant to and common in the 2 approaches was performed. METHODS The anatomical exposure provided by the transcallosal-transchoroidal and transcallosal-transforniceal-transchoroidal approaches was compared in 8 fresh cadavers, using a neuronavigation system. The working area, microsurgical exposure area, and angular exposure on the longitudinal and transversal planes of 2 anatomical targets (tuber cinereum and cerebral aqueduct) were compared. Additionally, the thickness of the right frontal lobe parenchyma, thickness of the corpus callosum trunk, and longitudinal diameter of the interventricular foramen were measured. The values obtained were submitted to statistical analysis using the Wilcoxon test. RESULTS In the quantitative evaluation, compared with the transchoroidal approach, the transforniceal-transchoroidal approach provided a greater mean working area (transforniceal-transchoroidal 150 +/- 11 mm(2); transchoroidal 121 8 mm(2); p < 0.05), larger mean microsurgical exposure area (transforniceal-transchoroidal 101 9 mm(2); transchoroidal 80 +/- 5 mm(2); p < 0.05), larger mean angular exposure area on the longitudinal plane for the tuber cinereum (transforniceal-transchoroidal 71 degrees +/- 7 degrees; transchoroidal 64 degrees +/- 6 degrees; p < 0.05), and larger mean angular exposure area on the longitudinal plane for the cerebral aqueduct (transforniceal-transchoroidal 62 degrees +/- 6 degrees; transchoroidal 55 degrees +/- 5 degrees; p < 0.05). No differences were observed in angular exposure along the transverse axis for either anatomical target (tuber cinereum and cerebral aqueduct; p > 0.05). The mean thickness of the right frontal lobe parenchyma was 35 +/- 3 mm, the mean thickness of the corpus callosum trunk was 10 +/- 1 mm, and the mean longitudinal diameter of the interventricular foramen was 4.6 +/- 0.4 mm. In the qualitative assessment, it was noted that the transforniceal-transchoroidal approach led to greater exposure of the third ventricle anterior region structures. There was no difference between approaches in the exposure of the structures of the middle and posterior region. CONCLUSIONS The transforniceal-transchoroidal approach provides greater surgical exposure of the third ventricle anterior region than that offered by the transchoroidal approach. In the population studied, morphometric analysis established mean values for anatomical structures common to both approaches.
- Pterional, Pretemporal, and Orbitozygomatic Approaches: Anatomic and Comparative Study(2019) SILVA, Saul Almeida da; YAMAKI, Vitor Nagai; SOLLA, Davi Jorge Fontoura; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel Jacobsen; SPETZLER, Robert F.; PREUL, Mark C.; FIGUEIREDO, Eberval GadelhaOBJECTIVE: Although pterional craniotomy and its variants are the most used approaches in neurosurgery, few studies have evaluated their precise indications. We evaluate the pterional (PT), pretemporal (PreT), and orbitozygomatic (OZ) approaches through quantitative measurements of area, linear, and angular exposures of the major intracranial vascular structures. METHODS: Eight fresh, adult cadavers were operated with the PT, followed by the PreT, and ending with the OZ approach. The working area, angular exposure of vascular structures and linear exposure of the basilar artery were measured. RESULTS: The OZ approach presented a wider area (1301.3 +/- 215.9 mm(2)) with an increase of 456.7 mm(2) compared with the PT and of 167.4 mm(2) to the PreT (P = 0.011). The extension from PT to PreT and OZ increases linear exposure of the basilar artery. When comparing the PreT and OZ, we found an increase in the horizontal and vertical angle to the bifurcation of the ipsilateral middle cerebral artery (P = 0.005 and P = 0.032, respectively), horizontal angle to the basilar artery tip (P = 0.02), and horizontal angle to the contralateral ICA bifurcation (P = 0.048). CONCLUSIONS: The OZ approach offered notable surgical advantages compared with the traditional PT and PreT regarding to the area of exposure and linear exposure to basilar artery. Regarding angle of attack, the orbital rim and zygomatic arch removal provided quantitatively wider exposure and increased surgical freedom. A detailed anatomic study for each patient and surgeon experience must be considered for individualized surgical approach indication.
- The Bone Flap Dilemma in Acute Subdural Hematoma Surgery(2016) BEER-FURLAN, Andre; PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira de; FIGUEIREDO, Eberval Gadeiha
- Treatment of traumatic acute posterior fossa subdural hematoma: report of four cases with systematic review and management algorithm(2014) AMORIM, Robson Luis Oliveira de; STIVER, Shirley I.; PAIVA, Wellingson Silva; BOR-SENG-SHU, Edson; STERMAN-NETO, Hugo; ANDRADE, Almir Ferreira de; TEIXEIRA, Manoel JacobsenTraumatic posterior fossa subdural hematomas (SDHs) are rare lesions. Despite improvements in intensive care and surgical management of traumatic brain injuries over the last decades, the outcome for posterior fossa subdural hematomas remains poor. We conduct a retrospective study over a 2-year period of patients sustaining traumatic brain injury and posterior fossa SDH. Additionally, a systematic review of case series published to date was performed. The incidence of posterior fossa SDH was 0,01 % (4/326). All patients in this current series had poor prognosis. Three out of four exhibited ischemic/edema lesions in postoperative CT scans leading to fourth ventricle effacement and persistent brainstem compression. Our literature review retrieved 57 patients from only seven case series. Unfavorable outcomes were seen in 63 % of patients. Our data and data from the literature do not provide sufficient evidence to establish an optimal treatment strategy for posterior fossa SDH. However, based on lessons learned with these four cases, together with results from review of the literature, we propose an algorithm for the management of this rare condition.