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Pereira FS, Jiménez LÁC, Aguaisa EDT, Apaza-Tintaya RA, Biondi-Soares LG, Paitán AFV, Soto PHT, Wuo-Silva R, Chaddad-Neto F. Superior frontal sulcus: a non-eloquent corridor for cavernomas of the internal capsule. Front Neurol 2024; 15:1355338. [PMID: 38751883 PMCID: PMC11094229 DOI: 10.3389/fneur.2024.1355338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Deep cavernomas of eloquent areas, located in the region of the basal nuclei and thalamus, account for 9 to 36% of these encephalic vascular malformations. Internal capsule cavernomas are particularly challenging, as they are surrounded by important projection fibers and their manipulation can lead to permanent deficits. To demonstrate through surgical cases that cavernomas of the internal capsule can be approached by frontal craniotomy, via the superior frontal sulcus, in a curative manner and with low morbidity. Methods We presented two cases of cavernomas of the internal capsule operated, whose treatment was microsurgical resection via frontal craniotomy and access to the lesion via the superior frontal sulcus, described step-by-step. To elucidate the rationale behind the decision, we used preoperative images with an emphasis on the patients' tractography and the importance of comparing these images with anatomical specimens dissected in the neuroanatomy and microsurgery laboratory. Results The two cases of internal capsule cavernomas, one in the anterior limb and the other in the posterior limb, were treated surgically via the superior frontal sulcus. Discussion Both patients showed radiological cure and clinical improvement in the post-operative segment. The patient consented to the procedure and to the publication of his/her image. Treatment of internal capsule cavernomas via the superior frontal sulcus has proven to be a safe and effective option.
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Affiliation(s)
- Felipe Salvagni Pereira
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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Biondi-Soares LG, Gomes Galvão da Trindade ÉS, Apaza-Tintaya RA, Canache Jiménez LÁ, Pereira FS, Teixeira Soto Iscal PH, Vilcahuamán Paitán AF, Tenelema Aguaisa ED, Chaddad-Neto F. Posterior Transtemporal Approach to a Thalamic Cavernous Malformation: 2-Dimensional Operative Video. World Neurosurg 2024; 185:72-73. [PMID: 38342174 DOI: 10.1016/j.wneu.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/04/2024] [Indexed: 02/13/2024]
Abstract
Cavernous malformations (CMs) account for 10%-15% of all vascular malformations and represent the second most common type of cerebral vascular lesion.1 They typically occur in the cerebral subcortex or white matter.2 CMs located in the thalamus are rare.3 When we isolate the group of thalamic CMs, we find a bleeding risk of >5% per year, with a rebleeding rate exceeding 60%, often occurring within 1 year of the initial bleeding.1 The deep location and proximity to eloquent brain regions make thalamic CMs challenging for neurosurgeons.4,5 Surgeons can access the posterolateral thalamus through various surgical approaches, such as transcallosal transventricular, supracerebellar transtentorial, intraparietal sulcus, and transcortical methods. Selecting the best surgical approach requires considerable expertise, considering the patient's preoperative condition and the lesion's location.6-12 We discuss a complex case involving a 24-year-old patient with a right thalamic cavernoma and a history of 3 prior bleeding events. We present a step-by-step transcortical approach through the posterior portion of the superior temporal gyrus (Video 1). The patient consented to the procedure and publication of images. We demonstrate how the transtemporal posterior trajectory provides an optimal working corridor for safely removing this cavernous malformation without introducing new deficits.
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Affiliation(s)
| | | | | | | | - Felipe Salvagni Pereira
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | | | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil.
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Ahumada-Vizcaíno JC, Lucifero AG, Serrato-Avila JL, Chang Mulato JE, Wuo-Silva R, Dória-Netto HL, de Campos Filho JM, Chaddad-Neto F. Recurrent Artery of Heubner Guiding the Clip Application for Internal Carotid Artery Bifurcation Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01141. [PMID: 38683954 DOI: 10.1227/ons.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/28/2024] [Indexed: 05/02/2024] Open
Abstract
Aneurysms of the bifurcation of the internal carotid artery (ICA) represent approximately 5% of intracranial aneurysms and tend to occur in younger patients.1-3 They typically have a superior orientation, in close relationship with the medial (branches of the anterior cerebral artery, segment A1) and lateral (branches of the middle cerebral artery, segment M1) lenticulostriate arteries (LSA), including recurrent artery of Heubner (RAH). RAH commonly originates in the junction of A1 and A2, courses medially to laterally between LSA and anterior cerebral artery, ICA bifurcation, and middle cerebral artery before entering the lateral portion of the anterior perforated substance.4-7 Damage to these arteries are catastrophic. This complex vascular anatomy makes treatment challenging, either endovascular or microsurgical.8-13 We present a video case of microsurgical clipping for the left ICA bifurcation aneurysm. This study was approved by the ethics committee of our institution. The patient, a 46-year-old man, was diagnosed with an unruptured ICA bifurcation aneurysm during workup for intermittent headache. Morphological characteristics of the aneurysm supported intervention over conservative treatment. Digital subtraction angiography showed a prominent proximal RAH crossing between the aneurysm neck and LSA, providing anatomical protection for clip application. Microsurgical clipping was chosen, and the procedure went uneventfully. The patient consented to the procedure and to the publication of his/her image. We discussed and demonstrated throughout the video how we used this anatomic variation and trajectory of the RAH to prevent clipping of LSA unwittingly and achieve complete occlusion of the aneurysm neck.
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Affiliation(s)
- Juan Carlos Ahumada-Vizcaíno
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Alice Giotta Lucifero
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Juan Leonardo Serrato-Avila
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Neurosurgery, Hospital General de Tlahuac, ISSSTE, Mexico City, Mexico
| | | | - Raphael Wuo-Silva
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Hugo Leonardo Dória-Netto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - José Maria de Campos Filho
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Feres Chaddad-Neto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
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Jong-A-Liem GS, Sarti THM, dos Santos MG, Giacon LMT, Wuo-Silva R, Baeta AM, de Campos Filho JM, Chaddad-Neto F. Case report: Association between PTEN-gene variant and an aggressive case of multiple dAVFs. Front Neurol 2024; 15:1347289. [PMID: 38651102 PMCID: PMC11033416 DOI: 10.3389/fneur.2024.1347289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/14/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Mutations of the phosphatase and tensin homolog (PTEN) gene have been associated with a spectrum of disorders called PTEN hamartoma tumor syndrome, which predisposes the individual to develop various types of tumors and vascular anomalies. Its phenotypic spectrum includes Cowden syndrome (CS), Bannayan-Riley-Ruvalcaba syndrome (BRRS), Proteus syndrome, autism spectrum disorders (ASD), some sporadic cancers, Lhermitte-Duclos disease (LDD), and various types of associated vascular anomalies. Clinical presentation A previously healthy 27-year-old woman was experiencing visual scintillating scotomas and mild chronic headaches for the past 2 years. The initial computed tomographic (CT) and magnetic resonance imaging (MRI) scans did not reveal any abnormalities, but the possibility of pseudotumor cerebri was considered. Furthermore, a cerebral angiogram showed a posterior fossa dural arteriovenous fistula (dAVF), which was initially treated through embolization. However, in spite of proper treatment, this patient experienced multiple recurrent dAVFs in different locations, requiring multiple embolizations and surgeries. Despite exhibiting altered cerebral perfusion and hemodynamics, the patient did not display any significant symptoms until she experienced a sudden stroke resulting from deep venous thrombosis, which was not associated with any medical procedures or medication use. A comprehensive analysis was performed due to the aggressive nature of the dAVFs. Surprisingly, exome sequencing of a blood sample revealed a PTEN gene variant in chromosome 10, indicative of Cowden syndrome. However, no tumors or other vascular lesions were detected in other systems that would constitute Cowden syndrome. Conclusion The rapid formation of multiple and complex dAVFs, coupled with not meeting the criteria for any other PTEN-related syndrome, unequivocally leads to the presentation of a novel phenotype of the PTEN germline variant.
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Affiliation(s)
- Glaucia Suzanna Jong-A-Liem
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Talita Helena Martins Sarti
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | | | | | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alex Machado Baeta
- Department of Neurology, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
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Korotkov D, Rodrigues de Almeida I, Wuo-Silva R, Vilcahuamán Paitán AF, Chaddad-Neto F. Enhancing the Microneurosurgical Training: Development of the Folded Placenta Model for Simulation of the Deep Operative Field Challenges of Cranial Procedures. World Neurosurg 2024; 187:29-34. [PMID: 38593912 DOI: 10.1016/j.wneu.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Neurosurgery relies heavily on advanced manual skills, necessitating effective training models for skill development. While various models have been utilized, the human placenta has emerged as a promising candidate for microneurosurgical training due to its anatomical similarities with cerebral vasculature. However, existing placenta models have primarily focused on simulating superficial procedures, often neglecting the complexities encountered in deep operative fields during cranial surgeries. METHODS This study obtained ethical approval and implemented a modified placenta model to address the limitations of existing training models. The key modification involved folding the placenta and placing it within a rigid container, closely mimicking the structural challenges of cranial procedures. The placenta preparation followed a standardized protocol, including the use of specialized equipment for documentation. RESULTS The primary feature of the modified model is the folded placenta within the rigid container, which replicates cranial anatomy. This innovative approach enables trainees to engage in a comprehensive range of microsurgical exercises, encompassing vessel dissection, aneurysm clipping, tumor resection, and more. The model successfully mirrors the complexities of real cranial procedures, providing a realistic training experience. CONCLUSIONS The presented modified placenta model serves as an effective tool for simulating the conditions encountered in deep cranial surgeries. By accurately replicating the challenges of deep operative fields, the model significantly enhances the training of neurosurgical residents. It successfully prepares trainees to navigate the intricacies and difficulties inherent in real cranial surgeries, thus contributing to improved surgical skills and readiness for neurosurgical practice.
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Affiliation(s)
- Dmitriy Korotkov
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Raphael Wuo-Silva
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Feres Chaddad-Neto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
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Serrato-Avila JL, Paz Archila JA, Monroy-Sosa A, Alejandro SA, Costa MDSD, Cavalheiro S, Yagmurlu K, Lawton MT, Chaddad-Neto F. Resection of the quadrangular lobule of the cerebellum to increase exposure of the cerebellomesencephalic fissure: an anatomical study with clinical correlation. J Neurosurg 2024; 140:1160-1168. [PMID: 38564813 DOI: 10.3171/2023.7.jns222838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/20/2023] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The lateral aspect of the cerebellomesencephalic fissure frequently harbors vascular pathology and is a common surgical corridor used to access the pons tegmentum, as well as the cerebellum and its superior and middle peduncles. The quadrangular lobule of the cerebellum (QLC) represents an obstacle to reach these structures. The authors sought to analyze and compare exposure of the cerebellar interpeduncular region (CIPR) before and after QLC resection and provide a case series to evaluate its clinical applicability. METHODS Forty-two sides of human brainstems were prepared with Klingler's method and dissected. The exposure area before and after resection of the QLC was measured and statistically studied. A case series of 59 patients who underwent QLC resection for the treatment of CIPR lesions was presented and clinical outcomes were evaluated at 1-year follow-up. RESULTS The anteroposterior surgical corridor of the CIPR increased by 10.3 mm after resection of the QLC. The mean exposure areas were 42 mm2 before resection of the QLC and 159.6 mm2 after resection. In this series, ataxia, extrapyramidal syndrome, and akinetic mutism were found after surgery. However, all these cases resolved within 1 year of follow-up. Modified Rankin Scale score improved by 1 grade, on average. CONCLUSIONS QLC resection significantly increased the exposure area, mainly in the anteroposterior axis. This surgical strategy appears to be safe and may help the neurosurgeon when operating on the lateral aspect of the cerebellomesencephalic fissure.
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Affiliation(s)
- Juan Leonardo Serrato-Avila
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 3Department of Neurosurgery, Hospital General de Tlahuac, ISSSTE, México City, México
- 3Department of Neurosurgery, Hospital General de Tlahuac, ISSSTE, México City, México
| | - Juan Alberto Paz Archila
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Alejandro Monroy-Sosa
- 3Department of Neurosurgery, Hospital General de Tlahuac, ISSSTE, México City, México
- 4Center for Research and Innovation in Neurosciences, Higher School of Medicine, National Polytechnic Institute, México City, México
| | - Sebastian Aníbal Alejandro
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Marcos Devanir Silva da Costa
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
| | - Kaan Yagmurlu
- Departments of5Neurosurgery and
- 8Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Michael T Lawton
- 6Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil
- 2Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, Brazil
- 7Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, Brazil
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Sarti THM, da Costa MDS, Araujo DP, Watanabe RA, Zymberg ST, Suriano ÍC, Cavalheiro S, Chaddad-Neto F. The long-term effect on functional outcome of endoscopic brainwashing for intraventricular hemorrhage compared to external ventricular drainage alone: A retrospective single-center cohort study. Surg Neurol Int 2024; 15:109. [PMID: 38628520 PMCID: PMC11021092 DOI: 10.25259/sni_37_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
Background Intraventricular hemorrhage (IVH) is a complex condition with both mechanical and chemical effects, resulting in mortality rates of 50-80%. Recent reports advocate for neuroendoscopic treatment, particularly endoscopic brainwashing (EBW), but long-term functional outcomes remain insufficiently explored. This study aims to outline the step-by-step procedure of EBW as applied in our institution, providing results and comparing them with those of external ventricular drainage (EVD) alone. Methods We performed a retrospective analysis of adult patients with IVH who underwent EBW and patients submitted to EVD alone at our institution. All medical records were reviewed to describe clinical and radiological characteristics. Results Although both groups had similar baseline factors, EBW patients exhibited a larger hemoventricle (median Graeb score 25 vs. 23 in EVD, P = 0.03) and a higher prevalence of chronic kidney disease and diabetes. Short-term mortality was lower in EBW (52% and 60% at 1 and 6 months) compared to EVD (80% for both), though not statistically significant (P = 0.06). At one month, 16% of EBW patients achieved a good outcome (Modified Rankin scale < 3) versus none in the EVD group (P = 0.1). In the long term, favorable outcomes were observed in 32% of EBW patients and 11% of EVD patients (P = 0.03), with no significant difference in shunt dependency. Conclusion Comparing EBW and EVD, patients submitted to the former treatment have the highest modified Graeb scores and, at a long-term follow-up, have better outcomes, demonstrated by the improvement of the patients in the follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
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8
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Scorza FA, Finsterer J, de Almeida ACG, Chaddad-Neto F. Pesticide residues in food linked to sleep problems in adolescents. Sleep Med 2024; 119:34. [PMID: 38636213 DOI: 10.1016/j.sleep.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Ministério do Desenvolvimento Agrário e Agricultura Familiar (MDA), São Paulo, Brazil; Unidade de Neurocirurgia do Hospital Beneficência Portuguesa, São Paulo, Brazil.
| | - Josef Finsterer
- Neurology and Neurophysiology Center, Postfach 20, 1180, Vienna, Austria
| | - Antonio-Carlos G de Almeida
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil
| | - Feres Chaddad-Neto
- Unidade de Neurocirurgia do Hospital Beneficência Portuguesa, São Paulo, Brazil; Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
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Sarti THM, Akira Watanabe R, Jong-A-Liem GS, Ahumada-Vizcaíno JC, Ramiro Muiños PJ, Magalhães F, Chaddad-Neto F. Microsurgical Resection for Cavernous Malformation of the Uncus: 3D-Operative Video. World Neurosurg 2024; 186:50. [PMID: 38514032 DOI: 10.1016/j.wneu.2024.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
Cavernous malformations (CMs) are rare and often oligosymptomatic vascular lesions. The main symptoms include seizure and focal neurologic deficits.1-3 Depending on the symptomatology, location, size, and risk factors for bleeding, like the presence of a developmental venous anomaly, CMs can be highly morbid. Thus surgical resection may be considered. Deep-seated and eloquent CMs, like those in the uncus, can be challenging.4,5 In Video 1, we present a 23-year-old male adult who developed focal seizures (i.e., oral automatisms) after an episode of sudden intense headache 1 year ago. His neurologic examination was unremarkable. The patient consented to the procedure and publication of his image. Nevertheless, his magnetic resonance images showed an uncal 2-cm Zabramski type I CM. We exposed the insula and its limen through a right pterional craniotomy and transsylvian corridor. During the video, we discuss the surgical nuances to access and resect this CM lesion en bloc while preserving important vascular structures and white matter tracts. Postoperative neuroimaging demonstrated total resection. In postoperative day 1, the patient had 1 episode of generalized seizure and evolved with contralateral hemiparesis. The patient had a good recovery and was discharged on postoperative day 21. At the 6-month follow-up, the patient had no new epileptic events and presented complete weakness improvement. Through this minimally invasive and well-known surgical corridor, we preserve the mesial and lateral portion of the temporal lobe, reducing the risk of lesions to the Meyer loop and limbic association area.
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Affiliation(s)
- Talita Helena Martins Sarti
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Rodrigo Akira Watanabe
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Felipe Magalhães
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
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Paitán AFV, Gibbon FDL, Korotkov D, Castillo IC, Moguel AER, Salvagni FP, Chaddad-Neto F. Case report: Mirror paraclinoid aneurysm associated with mirror clinoidal meningioma. Front Neurol 2024; 15:1355865. [PMID: 38450078 PMCID: PMC10915178 DOI: 10.3389/fneur.2024.1355865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Clinoidal meningiomas and paraclinoid aneurysms are individually uncommon, with the coexistence of mirror paraclinoid aneurysms and clinoidal meningiomas presenting an even rarer scenario. While the association between meningiomas and aneurysms is documented, the simultaneous presence of mirror lesions for both pathologies is not reported in the literature. Clinical presentation We report a 62-year-old female with a three-month history of moderate bifrontal headaches. Magnetic Resonance Angiography (MRA) revealed mirror paraclinoid aneurysms, prompting surgical intervention. During the procedure, mirror clinoidal meningiomas were incidentally discovered. The left aneurysm was addressed first due to higher rupture risk, followed by the right aneurysm 3 months later. Both meningiomas were confirmed as Transitional Meningiomas (Grade 1; OMS, 2021). The aneurysms were successfully clipped, and the patient had an excellent postoperative outcome. Conclusion This case represents a unique occurrence of mirror ophthalmic segment internal carotid artery aneurysms associated with mirror clinoidal meningiomas, a combination not previously reported. Despite the limitations of MRA in detecting small meningiomas, it remains a valuable non-invasive screening tool for neurovascular diseases. The case underscores the need for further research to elucidate the association between cerebral aneurysms and meningiomas.
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Affiliation(s)
| | - Frederico de Lima Gibbon
- Department of Neurosurgery, Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Dmitriy Korotkov
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ambar E. Riley Moguel
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Felipe Pereira Salvagni
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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11
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Finsterer J, Almeida ACGD, Chaddad-Neto F, Scorza FA. Statin therapy in Parkinson's disease cuts mortality. Parkinsonism Relat Disord 2024:106043. [PMID: 38461038 DOI: 10.1016/j.parkreldis.2024.106043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/10/2024] [Indexed: 03/11/2024]
Affiliation(s)
| | - Antonio-Carlos G de Almeida
- Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), Brazil
| | - Feres Chaddad-Neto
- Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil; Unidade de Neurocirurgia do Hospital Beneficência Portuguesa, São Paulo, Brazil
| | - Fulvio A Scorza
- Unidade de Neurocirurgia do Hospital Beneficência Portuguesa, São Paulo, Brazil; Disciplina de Neurociência, Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil.
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Apaza-Tintaya RA, Canache Jiménez LÁ, Salvagni Pereira F, Biondi Soares LG, Tenelema Aguaisa ED, Vilcahuamán Paitán AF, Wuo-Silva R, Chaddad-Neto F. Topographical Systematization of Human Placenta Model for Training in Microneurosurgery. World Neurosurg 2024; 182:e471-e477. [PMID: 38036172 DOI: 10.1016/j.wneu.2023.11.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Neurosurgical training continuously seeks innovative methods to enhance the acquisition of essential technical skills for neurosurgeons worldwide. While various training models have been employed, few truly replicate real-life conditions optimally. Human placenta is a good model for neurosurgical microsurgery training due to its anatomic similarities to neurovascular structures. Placental vessels exhibit a branching pattern and caliber comparable with intracranial vessels, making them suitable for practicing microsurgical techniques. The study aims to delineate the anatomic zones of the placenta and propose a segmented training model, resulting in a reproducible, cost-effective, and realistic neurosurgical microsurgery training environment. METHODS Twenty human placentas were meticulously prepared, injected with dyes, and categorized into zones on the basis of anatomic features. Measurements of placental vessels were recorded and compared with cerebral vessels. The placenta was divided into 4 quadrants to facilitate specific training techniques. RESULTS Our results revealed varying vessel diameters across placental zones, closely resembling cerebral vessels. Different microsurgical techniques were applied to specific placental zones, thereby optimizing training scenarios. The applicability section described exercises such as membrane dissection, vessel skeletonization, aneurysm creation, vascular bypass, and tumor dissection within the placental model, providing detailed guidance on the zones suitable for each exercise. CONCLUSIONS Human placenta serves as an effective microsurgical training model for neurosurgery, enhancing neurosurgeons' skills through anatomic segmentation. Integrating this model into training programs can significantly contribute to skill acquisition and improved surgical outcomes. Further research is warranted to refine and expand its utilization, complemented by clinical experiences and other simulation tools.
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Affiliation(s)
| | | | - Felipe Salvagni Pereira
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
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13
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Dória-Netto HL, Rodríguez RG, Agyemang K, Cearns MD, Arias SAM, da Trindade ÉSGG, de Amorim BL, Chaddad-Neto F. The Posterior Transylvian Peri-Insular Approach to a Cavernous Malformation of the Pulvinar Thalamus: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:234-235. [PMID: 37820265 DOI: 10.1227/ons.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/04/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Hugo Leonardo Dória-Netto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP , Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo - SP , Brazil
| | - Rony Gómez Rodríguez
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP , Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo - SP , Brazil
| | - Kevin Agyemang
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP , Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo - SP , Brazil
- School of Medicine, University of Glasgow, Glasgow, UK
| | | | | | | | - Bruno Loof de Amorim
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP , Brazil
| | - Feres Chaddad-Neto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP , Brazil
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo - SP , Brazil
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14
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da Costa MDS, Lima JVF, Zanini MA, Filho PTH, Naufal RFF, Reys L, Goes P, Miguez CA, Bastos FA, Lopes DDF, Filho MAD, Buzatti I, Filho MASM, Sako EA, Wainberg RC, Ferreira DS, Moura ALDA, Chaddad-Neto F. In Reply: Risks for Oculomotor Nerve Palsy and Time to Recovery After Surgical Clipping of Posterior Communicating Artery Aneurysms: A Multicenter Retrospective Cohort Study. Neurosurgery 2024; 94:e8. [PMID: 37882547 DOI: 10.1227/neu.0000000000002744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
| | - Joao Vitor Fernades Lima
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , SP , Brazil
| | - Marco Antonio Zanini
- Department of Neurosurgery, Faculdade de Medicina da Universidade Estadual Paulista, Botucatu , SP , Brazil
| | - Pedro Tadao Hamamoto Filho
- Department of Neurosurgery, Faculdade de Medicina da Universidade Estadual Paulista, Botucatu , SP , Brazil
| | | | - Lorena Reys
- Department of Neurosurgery, Hospital Regional de Presidente Prudente, Presidente Prudente , SP , Brazil
| | - Pedro Goes
- Department of Neurosurgery, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro , RJ , Brazil
| | - Camila Ahmed Miguez
- Department of Neurosurgery, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro , RJ , Brazil
| | - Francisco Azeredo Bastos
- Department of Neurosurgery, Hospital de Urgencias Governador Otavio Lage, Goania , GO , Brazil
- Department of Neurosurgery, Hospital de Neurologia Santa Monica, Goiania , GO , Brazil
| | - Dionisio de Figueiredo Lopes
- Department of Neurosurgery, Hospital de Urgencias Governador Otavio Lage, Goania , GO , Brazil
- Department of Neurosurgery, Hospital de Neurologia Santa Monica, Goiania , GO , Brazil
| | | | - Israel Buzatti
- Department of Neurosurgery, Santa Casa de Misericordia de Belo Horizonte, Belo Horizonte , MG , Brazil
| | | | - Everson Akio Sako
- Department of Neurosurgery, Conjunto Hospitalar de Sorocaba -SECONCI, Sorocaba , SP , Brazil
| | | | - Danilo Santos Ferreira
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , SP , Brazil
| | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , SP , Brazil
- Department of Neurosurgery, Hospital Beneficencia Portuguesa de São Paulo, São Paulo , SP , Brazil
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15
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Soares LGB, Holanda VM, Lages GV, Soares AGB, Catarino MM, Ahumada-Vizcaíno JC, Pereira FS, Teixeira MLOL, Jiménez LÁC, Neto MR, Chaddad-Neto F. The Technique for Transorbital Ventricular Puncture: An Anatomic Approach. Oper Neurosurg (Hagerstown) 2024; 26:64-70. [PMID: 37811923 DOI: 10.1227/ons.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/26/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Transorbital ventricular puncture is a minimally invasive described procedure with poor landmarks and anatomic references. This approach can be easily performed to save patients with intracranial hypertension, especially when it is secondary to an acute decompensated hydrocephalus. This study aims to describe anatomic structures and landmarks to facilitate the execution of transorbital puncture in emergency cases. METHODS We analyzed 120 head computed tomographies to show the best area to perform the procedure in the orbital roof. Two adult cadavers (4 sides) were punctured in the predetermined area. Angles, distances, landmarks, and anatomic structures were registered. This approach to the ventricular system may be performed at bedside to relieve intracranial hypertension only in specific cases. RESULTS The perforation point is 2.5 cm (female) or 3.0 cm (male) lateral to the midline and immediately inferior to the superciliary arch. A vertical line, parallel to midline, was drawn on the outer edge of the patient's forehead, the needle was 45° inferiorly and 20° medially and then progressed 2.0 cm backwards to reach the bone perforation point. After that, it was advanced another 4.5cm approximately until it reached the anterior horn of the lateral ventricle. CONCLUSION Based on statistical and experimental evidences, we were able to establish reliable anatomic reference points to access the anterior horn of the lateral ventricle through transorbital puncture.
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Affiliation(s)
- Luís Gustavo Biondi Soares
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , Brazil
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
| | | | - Gustavo Veloso Lages
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
| | | | - Marcilio Monteiro Catarino
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
| | | | | | | | | | - Mateus Reghin Neto
- Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo , Brazil
| | - Feres Chaddad-Neto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo , Brazil
- Irmandade Nossa Senhora das Mercês de Montes Claros, Hospital Santa Casa de Montes Claros, Minas Gerais , Brazil
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16
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Rodríguez RG, Agyemang K, Cearns MD, Arias SAM, Nunez M, Wuo-Silva R, Ahumada-Vizcaino JC, Filho JMDC, Chaddad-Neto F. Technical Nuances of Using the Peritrigeminal and Infrafacial Entry Zones in Brainstem Cavernoma Surgery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-01011. [PMID: 38156884 DOI: 10.1227/ons.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Rony Gómez Rodríguez
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Kevin Agyemang
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- School of Medicine, University of Glasgow, Glasgow, UK
| | | | | | - Maximiliano Nunez
- Department of Neuroradiology, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - José Maria de Campos Filho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
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17
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Caramanti RL, Effgen EA, Aprígio RM, de Moraes DF, Rocha CEDA, Laurenti MR, Ribas EC, de Aguiar PHP, Figueiredo EG, Chaddad-Neto F. Transtentorial Approach for Resection of Parahippocampal Gyrus Glioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00984. [PMID: 38047688 DOI: 10.1227/ons.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/14/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Ricardo Lourenço Caramanti
- Departament of Neurosurgery, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
- Departament of Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Erica Antunes Effgen
- Departament of Neurosurgery, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Raysa Moreira Aprígio
- Departament of Neurosurgery, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Dionei Freitas de Moraes
- Departament of Neurosurgery, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | | | - Matheus Rodrigo Laurenti
- Departament of Neurosurgery, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | | | | | | | - Feres Chaddad-Neto
- Departament of Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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18
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Rodríguez RG, Marte Arias SA, Agyemang K, El Sheikh M, Gomes Galvão da Trindade ÉS, Korotkov D, Chaddad-Neto F. Orbitozygomatic Transsylvian Resection of a Craniopharyngioma: A Step-by-Step Guide. World Neurosurg 2023; 179:177. [PMID: 37657589 DOI: 10.1016/j.wneu.2023.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/03/2023]
Abstract
Adamantinomatous craniopharyngioma (ACP) is a rare sellar region tumor seen in 0.5-2 cases per million persons each year,1 presenting a bimodal distribution that peaks at 5-15 years in children and 45-60 years in adults.2 Arising from embryonic remnants of the Rathke pouch epithelium, ACPs are associated with calcifications in 90% of cases and grow cranially toward the floor of the diencephalon.1 Craniopharyngiomas are benign but locally aggressive tumors, with microsurgery being the best chance of cure.3 The natural history is to compress the optic apparatus and hypothalamic-pituitary axis as they expand, with a propensity to encase the carotids. Endoscopic transbasal approaches have gained wide acceptance in the management of these tumors.4-6 However, open microsurgical approaches via pterional and orbitozygomatic craniotomies afford wider visualization of different corridors that help mitigate the surgical risks.7-9 The orbitozygomatic craniotomy allows lesions that extend above the optic chiasm to be safely approached from an inferior-to-superior corridor.9 The wide exposure of the basal arachnoid cisterns allows protection of the lenticulostriate perforators during resection.8-11 We demonstrate a step-by-step orbitozygomatic approach with dissection of the sylvian, carotid, carotid-oculomotor, chiasmatic, and lamina terminalis cisterns that allowed safe resection of a third ventricular ACP. The patient was a male in his 70s, who presented with progressive headaches and visual impairment. Magnetic resonance imaging showed a multicystic suprasellar lesion extending through the third ventricle. The surgery was performed with no complication (Video 1). Postoperative vision stabilized, and magnetic resonance imaging showed complete resection.
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Affiliation(s)
- Rony Gómez Rodríguez
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Kevin Agyemang
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil; School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Dmitriy Korotkov
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil.
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19
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Ramirez MDJE, Chaddad-Neto F, Montemurro N, Ramirez Pena IJ, Rosario Rosario A, Catillo-Rangel C, González López G, Cardona JJ, Campero A, Baldoncini M. Decibel Decisions: The Concept of Intracranial Aneurysm Surgery With a Decibel Meter on Two Surgical Cases. Cureus 2023; 15:e48993. [PMID: 38111432 PMCID: PMC10726301 DOI: 10.7759/cureus.48993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
The present cases were used to investigate the reliability of the intraoperative decibel meter as an objective method of clipping efficiency in cerebral aneurysm surgery and to assess the impact of this method on the surgical procedure itself. Different methodologies have been developed and applied to directly or indirectly evaluate the placement of a clip, for example, intraoperative digital subtraction angiography (DSA), intraoperative micro-Doppler ultrasonography, and, more recently, indocyanine green (ICG). We included two patients with a previously non-treated unruptured brain aneurysm. In both patients, intraoperative micro-Doppler was used in combination with a decibel meter app. Here, we present the cases of two patients. In patient one, the pre-clipping average sound level/equivalent continuous sound pressure level (Avg/Leq) was 96.7 dB, while the post-clipping Avg/Leq was 94.4 dB, indicating a reduction in sound level after clipping. Similarly, the pre-clipping time-weighted average noise level (TWA) was 1.2%, while the post-clipping TWA was 0.5%, indicating a decrease in exposure dose after clipping. In patient two, the average sound level for the post-clipping measurement (94.2 dB) was higher than the pre-clipping measurement (93.5 dB), but the difference was not statistically significant. These cases indicate the potential for using sound measurements as a reliable indicator of adequate aneurysm occlusion during clipping procedures. Further research is needed to confirm these findings.
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Affiliation(s)
| | - Feres Chaddad-Neto
- Department of Neurological Surgery, Universidade Federal de São Paulo, São Paulo, BRA
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, ITA
| | | | | | - Carlos Catillo-Rangel
- Neurosurgery, Servicio of the 1ro de Octubre Hospital of the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México City, MEX
| | | | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Alvaro Campero
- Department of Neurological Surgery, Hospital Padilla, Tucumán, ARG
| | - Matias Baldoncini
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires, ARG
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Dória-Neto HL, Agyemang K, Rodríguez RG, Ahumada-Vizcaíno JC, Riechelmann GS, Rose A, Chaddad-Neto F. The Microsurgical Management of a Cerebellar Vermian Arteriovenous Malformations Associated With High-Flow Fistulae: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e175-e176. [PMID: 37345927 DOI: 10.1227/ons.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/17/2023] [Indexed: 06/23/2023] Open
Affiliation(s)
- Hugo Leonardo Dória-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Kevin Agyemang
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Rony Gomez Rodríguez
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | - Anna Rose
- School of Medicine, University of Glasgow, Glasgow, UK
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
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21
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Santos M, Marussi VH, Campos CM, Doria-Netto HL, Doria-Netto RH, Chaddad-Neto F, Amaral LLF. Unusual Spinal Foraminal Hemangioblastoma With Prominent Arteriovenous Shunt. Cureus 2023; 15:e46205. [PMID: 37905285 PMCID: PMC10613454 DOI: 10.7759/cureus.46205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/02/2023] Open
Abstract
Von Hippel-Lindau (VHL) disease is a rare neurocutaneous disorder characterized by multiple benign and malignant tumors involving different organs (renal, adrenal, pancreas, liver, urogenital system, central nervous system, and head and neck region) due to mutations in the VHL tumor suppressor gene. Here, we describe a patient with unknown VHL disease who has complained of hypoesthesia of the right lower limb for about six years. A lumbar MRI was performed and revealed an expansive foraminal lesion at the right L3-L4 level and multiple serpiginous intradural and extramedullary flow voids involving the dorsal aspect of the spinal cord. The patient underwent digital subtraction angiography to exclude a spinal dural arteriovenous fistula, which revealed imaging features suggestive of spinal hemangioblastoma. In the presence of a spinal hemangioblastoma, a brain MRI was performed for further evaluation to rule out the possible diagnosis of VHL disease, and a solitary hemangioblastoma on the right cerebellar hemisphere was found. The patient underwent lumbar spine surgery, confirming the suspicious diagnosis of hemangioblastomas related to VHL disease.
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Affiliation(s)
- Mariana Santos
- Neuroradiology Department, Hospital de Braga, Braga, PRT
| | - Victor H Marussi
- Neuroradiology, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, BRA
| | - Christiane M Campos
- Neuroradiology, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, BRA
| | | | | | - Feres Chaddad-Neto
- Neurological Surgery, Universidade Federal De Sao Paulo (UNIFESP), Sao Paulo, BRA
| | - Lázaro Luís F Amaral
- Neuroradiology, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, BRA
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22
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Chaddad-Neto F, Centeno RS, da Costa MDS, Yagmurlu K, Ahumada-Vizcaino JC, Wuo-Silva R. Editorial: Vascular neurosurgery and microneuroanatomy. Front Surg 2023; 10:1229789. [PMID: 37435470 PMCID: PMC10332314 DOI: 10.3389/fsurg.2023.1229789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil
| | - Ricardo Silva Centeno
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Kaan Yagmurlu
- Departments of Neurological Surgery and Neuroscience, University of Virginia School of Medicine, Charlottesville, VA, United States
| | | | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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23
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da Costa MDS, Lima JVF, Zanini MA, Hatamoto Filho PT, Naufal RFF, Reys L, Goes P, Miguez CA, Bastos FA, Lopes DDF, Dellaretti M, Buzartti I, Machado Filho MAS, Sako EA, Wainberg RC, Ferreira DS, Moura ALDA, Chaddad-Neto F. Risks for Oculomotor Nerve Palsy and Time to Recovery After Surgical Clipping of Posterior Communicating Artery Aneurysms: A Multicenter Retrospective Cohort Study. Neurosurgery 2023; 92:1192-1198. [PMID: 36752634 DOI: 10.1227/neu.0000000000002349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/07/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Aneurysms of the posterior communicating segment of carotid artery (PcomA) have a high risk of rupture; when these nonruptured aneurysms are associated with oculomotor nerve palsy (ONP), the risk of rupture increases compared with asymptomatic nonruptured PcomA. OBJECTIVE To retrospectively analyze the risk factors involved in ONP secondary to PcomA aneurysm and to study the factors involved in the recovery time of ONP once it is established. METHODS This was a retrospective study of patients from 10 neurosurgery centers from October 2008 to December 2020. We analyzed age at diagnosis, presence of compressive neuropathy of the oculomotor nerve, presence of aneurysm rupture, largest aneurysm diameter, aneurysm projection, smoking, hypertension, diabetes, time between diagnosis and surgical treatment, as well as the outcome. RESULTS Approximately 1 in 5 patients (119/511 23.3%) with a PcomA presented with ONP. We found that patients with aneurysms measuring greater than or equal to 7.5 mm were 1.6 times more likely to have ONP than those with aneurysms smaller than 7.5 mm. In our study, the prevalence of smoking in the PcomA + ONP group was 57.76%, and we also found that smokers were 2.51 times more likely to develop ONP. A total of 80.7% showed some degree of improvement, and 45.4% showed complete improvement with a median recovery time of 90 days. CONCLUSION This study showed that 80.7% of patients with PcomA aneurysms undergoing surgical treatment with aneurysm clipping showed some degree of improvement of the ONP, with a median time to recovery between 90 and 120 days.
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Affiliation(s)
| | - Joao Vitor Fernades Lima
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Marco Antonio Zanini
- Department of Neurosurgery, Faculdade de Medicina da Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Pedro Tadao Hatamoto Filho
- Department of Neurosurgery, Faculdade de Medicina da Universidade Estadual Paulista, Botucatu, São Paulo, Brazil
| | | | - Lorena Reys
- Department of Neurosurgery, Hospital Regional de Presidente Prudente, Presidente Prudente, São Paulo, Brazil
| | - Pedro Goes
- Department of Neurosurgery, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Ahmed Miguez
- Department of Neurosurgery, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Azeredo Bastos
- Department of Neurosurgery, Hospital de Urgencias Governador Otavio Lage, Goania, Goiás, Brazil
- Department of Neurosurgery, Hospital de Neurologia Santa Monica, Goiania, Goiás, Brazil
| | - Dionisio de Figueiredo Lopes
- Department of Neurosurgery, Hospital de Urgencias Governador Otavio Lage, Goania, Goiás, Brazil
- Department of Neurosurgery, Hospital de Neurologia Santa Monica, Goiania, Goiás, Brazil
| | - Marcos Dellaretti
- Department of Neurosurgery, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil
- Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Israel Buzartti
- Department of Neurosurgery, Santa Casa BH, Belo Horizonte, Minas Gerais, Brazil
| | | | - Everson Akio Sako
- Department of Neurosurgery, Conjunto Hospitalar de Sorocaba - SECONCI, Sorocaba, São Paulo, Brazil
| | | | - Danilo Santos Ferreira
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Hospital Beneficencia Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
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Korotkov D, Abramyan A, Wuo-Silva R, Chaddad-Neto F. Cadaveric Sheep Head Model for Anterior Clinoidectomy in Neurosurgical Training. World Neurosurg 2023:S1878-8750(23)00453-9. [PMID: 37044208 DOI: 10.1016/j.wneu.2023.03.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Anterior clinoidectomy is an important procedure used in treatment of a range of pathologies of frontotemporal region, both vascular and tumoral. Mastering of this technique requires high level of manual skills training. The objective of the study is to describe easily accessible and cheap alternative model of anterior clinoidectomy, with a principal focus on the significance of mastering technical skills and training tactile feedback. METHODS Five cadaveric sheep heads (10 sides) fixed in formalin and alcohol silicone injected, were used to simulate extra dural (5 sides) and intradural (5 sides) and one head was used to prepare anatomical specimen for better demonstration of anatomy of the paraclinoid region. RESULTS Comparative anatomical analysis between ovine and human anterior clinoid process was performed. Using cadaveric sheep models all principal steps of the procedure, both in extradural and intradural route, were imitated. CONCLUSIONS Cadaveric sheep head model serves a good model of anterior clinoidectomy first in regard of manual skills training which can serve a good alternative to human cadaveric training.
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Affiliation(s)
- Dmitriy Korotkov
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP, Brazil.
| | - Arevik Abramyan
- Neurosurgery, Burdenko Neurosurgical Center, Moscow, Russia.
| | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP, Brazil.
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP, Brazil; Neurosurgery, Burdenko Neurosurgical Center, Moscow, Russia.
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25
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Agyemang K, Gómez Rodríguez R, Rocha Marussi VH, Marte Arias SA, Feliciano Vilcahuaman Paitań A, Campos Filho JM, Chaddad-Neto F. Case report: Delayed outflow obstruction of a DVA: A rare complication of brainstem cavernoma surgery. Front Neurol 2023; 14:1073366. [PMID: 36998781 PMCID: PMC10044343 DOI: 10.3389/fneur.2023.1073366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/03/2023] [Indexed: 03/16/2023] Open
Abstract
IntroductionDevelopmental venous anomalies (DVAs) are considered variants of normal transmedullary veins. Their association with cavernous malformations is reported to increase the risk of hemorrhage. Expert consensus recommends meticulous planning with MR imaging, use of anatomical “safe zones”, intraoperative monitoring of long tracts and cranial nerve nuclei, and preservation of the DVA as key to avoiding complications in brainstem cavernoma microsurgery. Symptomatic outflow restriction of DVA is rare, with the few reported cases in the literature restricted to DVAs in the supratentorial compartment.CaseWe present a case report of the resection of a pontine cavernoma complicated by delayed outflow obstruction of the associated DVA. A female patient in her 20's presented with progressive left-sided hemisensory disturbance and mild hemiparesis. MRI revealed two pontine cavernomas associated with interconnected DVA and hematoma. The symptomatic cavernoma was resected via the infrafacial corridor. Despite the preservation of the DVA, the patient developed delayed deterioration secondary to venous hemorrhagic infarction. We discuss the imaging and surgical anatomy pertinent to brainstem cavernoma surgery, as well as the literature exploring the management of symptomatic infratentorial DVA occlusion.ConclusionDelayed symptomatic pontine venous congestive edema is extremely rare following cavernoma surgery. DVA outflow restriction from a post-operative cavity, intraoperative manipulation, and intrinsic hypercoagulability from COVID-10 infection are potential pathophysiological factors. Improved knowledge of DVAs, brainstem venous anatomy, and “safe entry zones” will further elucidate the etiology of and the efficacious treatment for this complication.
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Affiliation(s)
- Kevin Agyemang
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Beneficência Portuguesa Hospital, São Paulo, Brazil
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Beneficência Portuguesa Hospital, São Paulo, Brazil
- *Correspondence: Feres Chaddad-Neto
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26
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Hernández MM, Agyemang K, Ahumada-Vizcaino JC, Cearns MD, Oliveira-Silva J, Chaddad-Neto F. The posterior-transcallosal approach to a choroidal fissure AVM: a video case of how to adapt a “bridging vein free” corridor to this complex region. World Neurosurg 2023; 174:131. [PMID: 36990346 DOI: 10.1016/j.wneu.2023.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
Choroidal fissure arteriovenous malformations (ChFis-AVMs) are uncommon and challenging to treat due to their deep location and pattern of supply.1 The choroidal fissure lies between the thalamus and fornix, from the foramen of Monroe to the inferior choroidal point.2 AVMs in this location receive their supply from the anterior, lateral posterior choroidal artery and medial posterior choroidal arteries and drain to the deep venous system.3 The anterior-transcallosal corridor to the ChFis is favored due to the ease in opening the taenia fornicis from the foramen Monroe, and it increases in length for lesions located more posteriorly.4-7 We present a case of a posterior ChFis-AVM. The patient, a previously healthy woman in her 20s, presented with a sudden severe headache. She was diagnosed with intraventricular hemorrhage. This was managed conservatively with subsequent magnetic resonance imaging and digital subtraction angiography revealing a ChFis-AVM at the body of the left lateral ventricle, between the fornix and superior layer of the tela choroidae. It received its supply from the left lateral posterior choroidal artery and medial posterior choroidal artery and drained directly into the internal cerebral vein, classified as Spetzler-Martin grade II.8 A posterior-transcallosal approach to the ChFis was chosen to reduce the working distance and afford a wider corridor by avoiding cortical bridging veins (Video 1). Complete resection of the AVM was achieved with no additional morbidity. Microsurgery in experienced hands offers the best chance of cure for AVMs.9 In this case we demonstrate how to adapt the transcallosal corridor to the choroidal fissures for safe AVM surgery in this complex location.
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Affiliation(s)
- Manuel Moreno Hernández
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Kevin Agyemang
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | - Michael D Cearns
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Jeanine Oliveira-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP, Brazil.
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27
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Hernández MM, Dória-Neto HL, Maria de Campos Filho J, Romo NG, Chaddad-Neto F. Microsurgical resection of tonsillar arteriovenous malformation: an Operative video. World Neurosurg 2023; 174:139. [PMID: 37004884 DOI: 10.1016/j.wneu.2023.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
Cerebellar arteriovenous malformation (AVM) comprises 10%-15% of intracranial AVMs.1 Rupture often leads to devastating brainstem compression, with mortality reported as high as 67%.2 AVM can be a challenging disease, especially when large in size.3 AVMs can be treated by 1 or a combination of treatment modalities, namely embolization, radiosurgery, or microsurgical resection.4,5 Arterial adhesions to tonsilobulbar and telovelonsilar segments of posterior inferior cerebellar artery (PICA) can be a challenge, increasing bleeding and ischemic risk.6 We present a 2-dimensional video case of a tonsillar AVM. The patient, a previously healthy female in her 20s, presented with a chronic headache. She had no medical history. Initial magnetic resonance imaging revealed a tonsillar AVM classified as Spetzler-Martin grade II. It received its supply from the tonsilobulbar and telovelotonsilar segments of the PICA and drained directly into the precentral vein, transverse sinus, and sigmoid sinus. An angiogram revealed severe venous engorgement-the source of the patient's headache. The AVM was partially embolized 1 month preoperatively. A medial suboccipital telovelar approach was chosen to reduce the working distance and afford a wider corridor to expose the suboccipital surface of the cerebellum.7,8 Complete resection of the AVM was achieved with no additional morbidity. Microsurgery in experienced hands offers the best chance of cure for AVMs. In Video 1, we demonstrate the relationships among the tonsila, biventral lobule, vallecula cerebelli, PICA, and cerebellomedullary fissure as an important anatomic landmark in a safe total resection of a tonsillar AVM.
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Vela Rojas EJ, Agyemang K, Ahumada-Vizcaíno JC, Rose A, Gomez Rodriguez R, Dória-Netto HL, de Campos Filho JM, Chaddad-Neto F. The Technique of Limited Quadrangular Lobe Removal to Safely Resect a Quadrigeminal Plate Arteriovenous Malformation: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00634. [PMID: 36815798 DOI: 10.1227/ons.0000000000000667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/02/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- Evelyn Judith Vela Rojas
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Kevin Agyemang
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, School of Medicine, University of Glasgow, United Kingdom
| | - Juan Carlos Ahumada-Vizcaíno
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Anna Rose
- Department of Neurosurgery, School of Medicine, University of Glasgow, United Kingdom
| | - Rony Gomez Rodriguez
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Hugo Leonardo Dória-Netto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - José Maria de Campos Filho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
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Rodríguez RG, Agyemang K, Arias SAM, Cearns MD, Chaddad-Neto F. Importance of Arachnoid Dissection in Arteriovenous Malformation Microsurgery: A Technical Note. World Neurosurg 2023; 173:12. [PMID: 36775233 DOI: 10.1016/j.wneu.2023.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Intracranial arteriovenous malformations (AVMs) are congenital anomalies where arteries and veins connect without a capillary bed. AVMs are the leading cause of nontraumatic intracerebral hemorrhages in people younger than 35 years old.1 The leptomeninges (arachnoid and pia) form from the meninx primitiva.2,3 Endothelial channels produce a vascular plexus in the meninx connected by primitive arachnoid. Remodeling of the plexus in response to changing metabolic demands results in a recognizable pattern of arteries and veins.2,3 Defects at the level of capillaries during arteriovenous specification are most likely responsible for arteriovenous fistula formation.4-6 Interplay between the congenital dysfunction and flow-related maturation in adulthood, when vasculogenesis has stopped, produces the AVM.6,7 The relationship between the primitive arachnoid and aberrant AVM vessels is preserved and forms the basis of microsurgical disconnection discussed in Video 1. Several authors have described dissecting these natural planes to delineate the abnormal AVM vessels, relax the brain, and avoid morbidity during AVM surgery.8-10 We recommend sharp arachnoid dissection with a scalpel or microscissors, occasionally helped by blunt dissection with patties or bipolar forceps. We present a 2-dimensional video of the microsurgical resection of a right parietal AVM. The patient, a healthy 30-year-old female, presented with intermittent headaches and mild impairment of arithmetic and visuospatial ability. Magnetic resonance imaging and digital subtraction angiography showed a compact 3.5-cm supramarginal gyrus AVM supplied by the middle cerebral artery, with superficial drainage. Complete microsurgical resection was performed without morbidity. We demonstrate the principles of arachnoid dissection requisite to disentanglement of the nidus and safe resection of the AVM.
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Affiliation(s)
- Rony Gómez Rodríguez
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | - Kevin Agyemang
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil; School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | - Michael D Cearns
- Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil.
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30
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Ahumada-Vizcaino JC, Wuo-Silva R, Hernández MM, Chaddad-Neto F. The art of combining neuroanatomy and microsurgical skills in modern neurosurgery. Front Neurol 2023; 13:1076778. [PMID: 36712447 PMCID: PMC9877616 DOI: 10.3389/fneur.2022.1076778] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 01/13/2023] Open
Abstract
Neurosurgical training outside the operating room has become a priority for all neurosurgeons around the world. The exponential increase in the number of publications on training in neurosurgery reflects changes in the environment that future neurosurgeons are expected to work in. In modern practice, patients and medicolegal experts demand objective measures of competence and proficiency in the growing list of techniques available to treat complex neurosurgical conditions. It is important to ensure the myriad of training models available lead to tangible improvements in the operating room. While neuroanatomy textbooks and atlases are continually revised to teach the aspiring surgeon anatomy with a three-dimensional perspective, developing technical skills are integral to the pursuit of excellence in neurosurgery. Parapharsing William Osler, one of the fathers of neurosurgical training, without anatomical knowledge we are lost, but without the experience and skills from practice our journey is yet to begin. It is important to constantly aspire beyond competence to mastery, as we aim to deliver good outcomes for patients in an era of declining case volumes. In this article, we discuss, based on the literature, the most commonly used training models and how they are integrated into the treatment of some surgical brain conditions.
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Affiliation(s)
| | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Manuel Moreno Hernández
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil,Department of Neurosurgery, Beneficência Portuguesa Hospital, São Paulo, SP, Brazil,*Correspondence: Feres Chaddad-Neto ✉
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31
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Agyemang K, Paganelli SL, de Oliveira Silva J, Korotkov D, Bryce A, Ahumada Vizcaino JC, Mikue JME, Riechelmann GS, Rodríguez RG, Hernandez MM, de Campos Filho JM, Dória-Netto HL, Wuo-Silva R, Chaddad-Neto F. Resection of a Midbrain AVM-A Combined Microsurgical and Endovascular Strategy: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 24:e368-e369. [PMID: 36716000 DOI: 10.1227/ons.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/18/2022] [Indexed: 01/31/2023] Open
Affiliation(s)
- Kevin Agyemang
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Dimitriy Korotkov
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Neurosurgery, National Children Medical Center, Tashkent Uzbekistan
| | - Adam Bryce
- School of Medicine, University of Glasgow, Glasgow, United Kingdom
| | | | - José Mayo Elo Mikue
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Rony Gómes Rodríguez
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Manuel Moreno Hernandez
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - José Maria de Campos Filho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Hugo Leonardo Dória-Netto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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Párraga RG, Lahirish IAM, Ribas GC, Sarti TM, da Costa MDS, Chaddad-Neto F. Transanterior Limiting Sulcus of the Insula Approach: Novel Surgical Approach to the Ventral Striatum Region. World Neurosurg 2023; 169:e9-e15. [PMID: 36208868 DOI: 10.1016/j.wneu.2022.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lesions in the ventral striatum region (above the anterior perforated substance) are a challenge for neurosurgeons due to their direct relationship with the lenticulostriate arteries, which difficult the surgical access. The standard approaches for this region include the following: 1) transfrontal approach, 2) transanterior perforating substance approach, 3) transcallosal transventricular approach, and 4) pterional transsylvian-transinsular route. In this study, we aimed to describe a novel anatomical approach through the anterior limiting sulcus of the insula in order to access the ventral striatum. METHODS We reviewed the literature and performed a detailed dissection of this region by using Klingler's technique with brain specimens injected with silicone, paying special attention to the white fibers and lenticulostriate arteries, and provided a description of an illustrative case of a cavernous malformation. RESULTS Neuroanatomical dissections showed that the lenticulostriate arteries had an inverted C-shaped anterior concavity, leaving less significant vascular relationships in the depth of the anterior limiting sulcus of the insula. In the case we described, the cavernous malformation was completely resected and the patient was discharged without any neurological deficits. CONCLUSIONS The transanterior limiting sulcus of the insula approach to the ventral striatum offers a safe access route for selected cases and can be performed on the basis of anatomical references. Three-dimensional understanding of the intrinsic brain architecture and its relationships with vascular structures in this specific area is important and can be acquired mainly through laboratory training.
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Affiliation(s)
| | | | | | - Talita Martins Sarti
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | | | - Feres Chaddad-Neto
- Department of Neurosurgery, Hospital Beneficência Portuguesa, São Paulo - SP, Brazil; Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, Brazil.
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Serrato-Avila JL, Archila JAP, da Costa MDS, Biol PRR, Marques SR, de Moraes LOC, Yagmurlu K, Lawton MT, Cavalheiro S, Chaddad-Neto F. Microsurgical Anatomy of the Cerebellar Interpeduncular Entry Zones. World Neurosurg 2022; 166:e933-e948. [PMID: 35948221 DOI: 10.1016/j.wneu.2022.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The cerebellar interpeduncular region, particularly the middle cerebellar peduncle (MCP) and interpeduncular sulcus (IPS) are significant surgical relevance areas due to the high prevalence of vascular and tumoral pathologies, such as cavernomas, arteriovenous malformations, and gliomas. We defined safer access areas of the MCP and the IPS, according to the surface anatomy, involved vessels, and fiber tracts of the cerebellar interpeduncular region. METHODS Fifteen formalin-fixed and silicone-injected cadaveric heads and 23 human brainstems with attached cerebellums prepared with the Klingler's technique were bilaterally dissected to study the vascular and intrinsic anatomy. RESULTS Surface anatomy: The mean length of the IPS was 12.73 mm (standard deviation [SD],2.15 mm), and the average measured angle formed by the IPS and the lateral mesencephalic sulcus was 144.53°. The mean distance from the uppermost point of the IPS to cranial nerve IV was 2.63 mm (SD, 2.84 mm). Vascular anatomy: The perforating branches of the superior cerebellar peduncle, IPS, and MCP originated predominantly from the caudal trunk of the superior cerebellar artery. The inferior third of the superior cerebellar peduncle and IPS was the third most pierced by perforating arteries, and for the MCP, was its superior third. Crossing vessels: The branches of the pontotrigeminal vein and the caudal trunk of the superior cerebellar artery crossed the IPS mostly. The superior third of the IPS was the most crossed by arteries and veins. CONCLUSIONS The middle thirds of the IPS and MCP as entry zones might be safer than their superior and inferior thirds due to fewer perforating branches, arterial trunks, and veins crossing the sulcus as fewer eloquent tracts.
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Affiliation(s)
- Juan Leonardo Serrato-Avila
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Juan Alberto Paz Archila
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Marcos Devanir Silva da Costa
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Ricardo Rocha Biol
- Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Sergio Ricardo Marques
- Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | | | - Kaan Yagmurlu
- Departments of Neurosurgery and Neuroscience, University of Virginia, Health System, Charlottesville, Virginia, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de Sao Paulo, Sao Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
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Chang Mulato JE, Alejandro SA, Paganelli SL, Vela Rojas EJ, Silva da Costa MD, Doria-Netto HL, Campos Filho JM, Chaddad-Neto F. Transcallosal Transchoroidal Approach to the Third Ventricle for Resection of a Thalamic Cavernoma-Anatomic Landmarks Review: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e120. [PMID: 35838465 DOI: 10.1227/ons.0000000000000244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/07/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
| | | | | | | | | | - Hugo Leonardo Doria-Netto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Jose María Campos Filho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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Nascimento VS, Coelho DDS, Chang Mulato JE, Filho JMC, Doria-Netto HL, Ferreira APVN, Chaddad-Neto F. Cerebral arteriovenous malformation and foreign accent syndrome: a case report. Br J Neurosurg 2022:1-5. [PMID: 35475414 DOI: 10.1080/02688697.2022.2057434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/07/2022] [Accepted: 03/20/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This case study aims to present the Foreign Accent Syndrome (FAS) in a patient with Cerebral Arteriovenous Malformation (cAVM), considering neuropsychological, radiological and microsurgical aspects. METHODS The patient underwent preoperative neuropsychological assessment and MRI and Tractography were performed to identify fibers close to the lesion site. In the surgical procedure, a craniotomy was performed for excision of the cAVM. After surgery and 6 months after the surgical procedure, the patient underwent further and neuropsychological evaluations. RESULTS The presence of AVM located in the posterior part of the medial surface of the left superior frontal gyrus was identified and the neuropsychological evaluation found cognitive deficits and symptoms characteristic of FAS, which disappeared after resection. CONCLUSION This report presented a case of cAVM in which symptoms were found even without rupture, which was no longer observed after the surgical procedure, demonstrating the relationship of cAVM with the symptoms and neuroanatomical bases of FAS.
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Affiliation(s)
| | - Daniela de Souza Coelho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - José Maria Campos Filho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Hugo Leonardo Doria-Netto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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Caramanti R, Aprígio RM, D`Aglio Rocha CE, Morais DF, Góes MJ, Chaddad-Neto F, Tognola WA. Is Edema Zone Volume Associated With Ki-67 Index in Glioblastoma Patients? Cureus 2022; 14:e24246. [PMID: 35602791 PMCID: PMC9116516 DOI: 10.7759/cureus.24246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 11/05/2022] Open
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Paganelli SL, Alejandro SA, Campos Filho JM, Dória-Netto HL, Chaddad-Neto F. Tips and tricks in microsurgical treatment for previously embolized aneurysms - 3D video. World Neurosurg 2022; 163:39. [PMID: 35427791 DOI: 10.1016/j.wneu.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - José Maria Campos Filho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo - SP, Brazil
| | - Hugo Leonardo Dória-Netto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo - SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo - SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo - SP, Brazil.
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Paganelli SL, Alejandro SA, Chang Mulato JE, Vela Rojas EJ, de Souza Coelho D, Dória-Netto HL, Campos Filho JM, Chaddad-Neto F. Awake Microsurgical Resection for a Precentral Gyrus Arteriovenous Malformation-Three-Dimensional Video and Anatomic Landmarks. World Neurosurg 2022; 163:37. [PMID: 35405319 DOI: 10.1016/j.wneu.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 12/01/2022]
Abstract
Arteriovenous malformations (AVMs) are complex, heterogeneous, and uncommon neurovascular disorders that frequently manifest in young adults. Parenchymal AVMs are thought to be congenital, but this has been recently questioned in the literature.1,2 AVMs can change over time and cause focal neurological signs or neurocognitive deficits.3 The clinical presentation of an AVM is variable and depends mainly on the occurrence of bleeding as well as its location, size, and ability to take flow from adjacent areas.4 AVMs can be treated by a single modality or a combination of different modalities. According to the Expert Consensus on the Management of Brain Arteriovenous Malformations, neurosurgery may be the best option for Spetzler-Martin grade 2 AVMs.5 However, the treatment of these lesions when located in eloquent areas, especially in the central lobe, is controversial. Awake craniotomy allows identification of eloquent gyrus and can potentially facilitate resection with functional preservation. An alternative is stereotactic radiosurgery, but a qualitative comparative analysis revealed higher obliteration rate with awake AVM excision compared with stereotactic radiosurgery.6 Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. It was used in the past for surgical management of intractable epilepsy, but its indications are increasing, and it is a widely recognized technique for resection of mass lesions involving the eloquent cortex and for deep brain stimulation.7 Its application for resection of vascular lesions, including AVMs, is still limited. In the Video, we present a case of a cerebral AVM of the precentral gyrus in which we achieved complete resection with awake microsurgical treatment without any neurological sequelae for the patient.
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Affiliation(s)
| | | | | | | | | | - Hugo Leonardo Dória-Netto
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | - José Maria Campos Filho
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil.
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Lessa SS, Chang Mulato JE, Dória-Netto HL, Wuo-Silva R, Filho JMC, Chaddad-Neto F. Microsurgery for a medial left giant lesser sphenoid wing meningioma complicated by postoperative vasospasm of the ipsilateral supraclinoid carotid artery. Surg Neurol Int 2022; 13:113. [PMID: 35509597 PMCID: PMC9062936 DOI: 10.25259/sni_90_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Sphenoid wing meningiomas present close contact with intracranial arteries and have great potential for vascular complications. Here, we describe the case of a patient who presented a medial left giant lesser sphenoid wing meningioma involving the supraclinoid carotid artery. One week after surgery, she developed vasospasm whose treatment using milrinone achieved excellent results. Case Description: This is the case of a 23-year-old female with a large meningioma of the middle third of the lesser wing of the left sphenoid. Furthermore, the patient had symptoms of headache, diplopia, and left amaurosis (Video 1). The lesion involved the supraclinoid left carotid artery, causing significant stenosis of the vessel. The patient underwent surgical treatment without complications. One week after the procedure, she evolved with lowered level of consciousness, complete, and proportionate right hemiparesis and right Babinski’s sign. Angiographic study demonstrated significant stenosis of the left supraclinoid artery. After endovascular treatment with milrinone, the patient evolved with immediate improvement of signs and symptoms. Conclusion: Giant meningiomas with vascular involvement involve a higher risk of postoperative vascular complications. Other studies should be carried out to predict these complications and thus develop preventive measures.
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Affiliation(s)
| | | | | | - Raphael Wuo-Silva
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo,
| | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo,
- Hospital Beneficência Portuguesa de São Paulo, São Paulo – SP, Brazil
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Chang Mulato JE, Kus WP, Biondi Soares LG, Pereira FS, Aníbal Alejandro S, Dória-Netto HL, Campos Filho JM, Chaddad-Neto F. Microsurgical Treatment for Arteriovenous Malformation in Eloquent Area. A 2-Dimensional Surgical Video & Step-by-Step Practical Guide. World Neurosurg 2022; 161:4. [DOI: 10.1016/j.wneu.2022.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
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Lourenço Caramanti R, Effgen EA, Moreira Aprígio R, Freitas de Moraes D, Eduardo Rocha C, Goes MJ, Chaddad-Neto F. Transtentorial Approach for a Tentorial Meningioma with Superior Extension: 3-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 22:e131. [DOI: 10.1227/ons.0000000000000062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
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Goiri MAA, de Amorim BL, Sarti THM, da Costa MDS, Chaddad-Neto F. Building a microneurosurgical laboratory in Latin America: challenges and possibilities. Surg Neurol Int 2021; 12:573. [PMID: 34877059 PMCID: PMC8645469 DOI: 10.25259/sni_978_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background Training in microsurgical neuroanatomy is a priority for neurosurgical education. During the 20th century, microsurgical laboratories arose and provided a way to develop surgical skills. Few reports addressed the assembly, construction, and details of a training laboratory. Methods We have conducted a literature review and searched legislation on the need to plan the structure of the laboratory. Results We projected and built a laboratory through a public-private partnership. High-tech workstations and instruments were planned to meet the needs of residents, fellows, and student. All steps and materials were in accordance with the Brazilian legislation and articles previously selected. Conclusion We described our experience and demonstrated the implementation of a micro neurosurgical skills laboratory.
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Affiliation(s)
| | - Bruno Loof de Amorim
- Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Feres Chaddad-Neto
- Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
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Chang Mulato JE, Riechelmann GS, Alejandro SA, Paganelli SL, Vela Rojas EJ, Dória-Netto HL, Campos Filho JM, Chaddad-Neto F. Microsurgical Treatment for a Ruptured Posterior Inferior Cerebellar Artery Aneurysm: A 3-Dimensional Surgical Video and Anatomic Landmarks Review. World Neurosurg 2021; 158:180. [PMID: 34856402 DOI: 10.1016/j.wneu.2021.11.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
Aneurysms are the most frequent issue for the posterior inferior cerebellar artery (PICA). PICA aneurysms account for 1.4% to 4.5% of all intracranial aneurysms.1-3 Although the majority of PICA aneurysms arise from their junction with the vertebral artery, they can be found in any of 5 segments.4,5 Although PICA is more prone to form nonsaccular aneurysms than other intracranial arteries, ruptured aneurysms are usually saccular.6 Nearly all PICA aneurysms are located intracranially, above the foramen magnum. Extracranial PICA aneurysms are rare, with few reports in literature.7 Microsurgical clipping remains a good treatment alternative for these aneurysms. Higher risk of rerupture has even been reported with embolization of the distal PICA aneurysm with parent artery preservation.8 Here we present the case of a 64-year-old male patient who presented right after a thunderclap headache, followed by a temporary loss of consciousness and disorientation. He was diagnosed with a modified Fisher 4 and Hunt and Hess 2 subarachnoid hemorrhage and found to have a partially thrombosed left PICA saccular aneurysm of the caudal loop just below the foramen magnum. The lesion was approached via a midline suboccipital craniotomy with C1 laminectomy. Microsurgical clipping of the aneurysm was performed without any complications (Video 1). Postoperatively, the patient was discharged without neurologic deficits. We present the first surgical video of the necessary steps in order to perform a microsurgical clipping of an extracranially located caudal loop PICA aneurysm through a midline suboccipital craniotomy with C1 laminectomy.
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Affiliation(s)
| | | | | | | | | | - Hugo Leonardo Dória-Netto
- Department of Neurology & Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Jose Maria Campos Filho
- Department of Neurology & Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology & Neurosurgery, Universidade Federal de São Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil.
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Serrato-Avila JL, Paz Archila JA, Silva da Costa MD, Riechelmann GS, Rocha PR, Marques SR, Carvalho de Moraes LO, Cavalheiro S, Yağmurlu K, Lawton MT, Chaddad-Neto F. Three-Dimensional Quantitative Analysis of the Brainstem Safe Entry Zones Based on Internal Structures. World Neurosurg 2021; 158:e64-e74. [PMID: 34715371 DOI: 10.1016/j.wneu.2021.10.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Brainstem safe entry zones (EZs) are gates to access the intrinsic pathology of the brainstem. We performed a quantitative analysis of the intrinsic surgical corridor limits of the most commonly used EZs and illustrated these through an inside perspective using 2-dimensional photographs, 3-dimensional photographs, and interactive 3-dimensional model reconstructions. METHODS A total of 26 human brainstems (52 sides) with the cerebellum attached were prepared using the Klingler method and dissected. The safe working areas and distances for each EZ were defined according to the eloquent fiber tracts and nuclei. RESULTS The largest safe distance corresponded to the depth for the lateral mesencephalic sulcus (4.8 mm), supratrigeminal (10 mm), epitrigeminal (13.2 mm), peritrigeminal (13.3 mm), lateral transpeduncular (22.3 mm), and infracollicular (4.6 mm); the rostrocaudal axis for the perioculomotor (11.7 mm), suprafacial (12.6 mm), and transolivary (12.8 mm); and the mediolateral axis for the supracollicular (9.1 mm) and infracollicular (7 mm) EZs. The safe working areas were 46.7 mm2 for the perioculomotor, 21.3 mm2 for the supracollicular, 14.8 mm2 for the infracollicular, 33.1 mm2 for the supratrigeminal, 34.3 mm2 for the suprafacial, 21.9 mm2 for the infrafacial, and 51.7 mm2 for the transolivary EZs. CONCLUSIONS The largest safe distance in most EZs corresponded to the depth, followed by the rostrocaudal axis and, finally, the mediolateral axis. The transolivary had the largest safe working area of all EZs. The supracollicular EZ had the largest safe area to access the midbrain tectum and the suprafacial EZ for the floor of the fourth ventricle.
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Affiliation(s)
- Juan Leonardo Serrato-Avila
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Juan Alberto Paz Archila
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marcos Devanir Silva da Costa
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Guilherme Salemi Riechelmann
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paulo Ricardo Rocha
- Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Ricardo Marques
- Department of Morphology and Genetics, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kaan Yağmurlu
- Department of Neurosurgery, University of Virginia, Health System, Charlottesville, Virginia, USA; Department of Neuroscience, University of Virginia, Health System, Charlottesville, Virginia, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil; Laboratory of Microneurosurgery Anatomy, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
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Serrato-Avila JL, Paz Archila JA, Costa MDSD, Rocha PR, Marques SR, Moraes LOCD, Cavalheiro S, Yağmurlu K, Lawton MT, Chaddad-Neto F. Microsurgical approaches to the cerebellar interpeduncular region: qualitative and quantitative analysis. J Neurosurg 2021:1-14. [PMID: 34678772 DOI: 10.3171/2021.6.jns204457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The cerebellar interpeduncular region (CIPR) is a gate for dorsolateral pontine and cerebellar lesions accessed through the supracerebellar infratentorial approach (SCITa), the occipital transtentorial approach (OTa), or the subtemporal transtentorial approach (STa). The authors sought to compare the exposures of the CIPR region that each of these approaches provided. METHODS Three approaches were performed bilaterally in eight silicone-injected cadaveric heads. The working area, area of exposure, depth of the surgical corridor, length of the interpeduncular sulcus (IPS) exposed, and bridging veins were statistically studied and compared based on each approach. RESULTS The OTa provided the largest working area (1421 mm2; p < 0.0001) and the longest surgical corridor (6.75 cm; p = 0.0006). Compared with the SCITa, the STa provided a larger exposure area (249.3 mm2; p = 0.0148) and exposed more of the length of the IPS (1.15 cm; p = 0.0484). The most bridging veins were encountered with the SCITa; however, no significant differences were found between this approach and the other approaches (p > 0.05). CONCLUSIONS To reach the CIPR, the STa provided a more extensive exposure area and more linear exposure than did the SCITa. The OTa offered a larger working area than the SCIT and the STa; however, the OTa had the most extensive surgical corridor. These data may help neurosurgeons select the most appropriate approach for lesions of the CIPR.
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Affiliation(s)
| | | | | | - Paulo Ricardo Rocha
- 2Laboratory of Microneurosurgery Anatomy, and.,3Department of Morphology and Genetics, Universidade Federal de Sao Paulo, Brazil
| | | | | | - Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery.,2Laboratory of Microneurosurgery Anatomy, and
| | - Kaan Yağmurlu
- 4Departments of Neurosurgery and.,5Neuroscience, University of Virginia Health System, Charlottesville, Virginia
| | - Michael T Lawton
- 6Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona; and
| | - Feres Chaddad-Neto
- 1Department of Neurology and Neurosurgery.,2Laboratory of Microneurosurgery Anatomy, and.,7Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, Brazil
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Alejandro SA, Serrato-Avila JL, Paganelli SL, Chang Mulato JE, Vela Rojas EJ, Viera Neves AP, de Souza Coelho D, Silva da Costa MD, Dória-Netto HL, Campos Filho JM, Chaddad-Neto F. Awake Microsurgical Resection for Optochiasmatic Cavernous Malformation. World Neurosurg 2021; 157:159. [PMID: 34687930 DOI: 10.1016/j.wneu.2021.10.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
Cavernous malformations (CM) affect approximately 0.5% of the population, with only a limited portion being located in the optic nerve and chiasma. The clinical presentation is determined by their locations. In the optochiasmatic CM, the acute visual disturbance is the most common presentation. Chronically, many show a progressive visual loss, chronic headache, and pituitary disturbances. The differential diagnosis includes optic glioma, arteriovenous malformations, aneurysm, craniopharyngioma, pituitary apoplexy, and inflammatory conditions. In Video 1, we present the case of a 39-year-old woman with a history of a hemorrhagic optochiasmatic cavernoma in 2016, who started using propranolol to reduce the lesion and symptoms of visual loss. Moreover, the first microsurgical resection of the cavernoma and evacuation of the hematoma were performed in the same year. Owing to evolvement from a partial to a total vision loss in the left eye and presentation of new symptoms in the right eye, the patient underwent microsurgical resection. The surgery was performed sequentially. An awake craniotomy was performed to monitor the chiasma and right optic nerve. The postoperative magnetic resonance imaging showed complete resection of the CM, and the patient fully recovered. The patient signed the institutional consent form, stating that he or she accepts the procedure and allows the use of his or her images and videos for any type of medical publications in conferences and/or scientific articles.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hugo Leonardo Dória-Netto
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - José Maria Campos Filho
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil.
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Chang M JE, Alejandro SA, Paganelli SL, Vela Rojas EJ, Viera Neves AP, Da Costa MD, Dória-Netto HL, Campos Filho JM, Chaddad-Neto F. Microsurgical Treatment for Posthemorrhagic Cavernoma of Frontal Lobe Coexisting with Unruptured Ipsilateral Middle Cerebral Artery Aneurysm. World Neurosurg 2021; 156:27. [PMID: 34508908 DOI: 10.1016/j.wneu.2021.08.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
Cerebral cavernous malformations, also known as cavernomas, are vascular abnormalities of the brain that are clinically associated with a variety of neurologic symptoms that may include hemorrhagic strokes. They are the most common vascular abnormality, representing 10%-25% of all vascular malformations.1 Lesions associated with cavernomas include developmental venous anomalies, capillary telangiectasias, and other vascular malformations2 but not intracranial aneurysms. The latter association is extremely rare; in fact, there is only 1 case reported in the literature, in which the cavernoma was obscured by the presence of a cerebral hemorrhage and an unruptured aneurysm, which was presumed to be the primary cause of the bleeding, thereby misleading the surgeons to treat only the aneurysm.2 There are different alternatives for the management of different types of lesions.3-5 In this 3-dimensional operative video (Video 1), we present a case of a cavernoma associated with hemorrhage coexisting with an unruptured aneurysm in which we achieved complete resolution of both with microsurgical treatment through a pterional approach.6 The patient consented to publication of images.
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Affiliation(s)
- José Ernesto Chang M
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil
| | | | | | | | | | | | - Hugo Leonardo Dória-Netto
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - José Maria Campos Filho
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil
| | - Feres Chaddad-Neto
- Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo-SP, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo-SP, Brazil.
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Lessa SS, Paz-Archilla JA, Amorim BL, Filho JMC, de Siqueira Campos CM, de Deus Silva L, Choque RGP, da Costa MDS, Chaddad-Neto F. Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment. Surg Neurol Int 2021; 12:214. [PMID: 34084641 PMCID: PMC8168656 DOI: 10.25259/sni_187_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/02/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Arteriovenous malformations (AVMs) are relatively uncommon congenital vascular anomalies, and only 7–15% of AVMs occur in the posterior fossa. Most posterior fossa AVMs clinically present with hemorrhage and are associated with a high risk of neurological deficits and mortality. These malformations are associated with a high incidence of flow-related aneurysms. Endovascular treatment of infratentorial AVMs is challenging in pediatric patients. Case Description: We describe an 11-year-old female adolescent with cerebellar syndrome [Video 1], who was diagnosed with a cerebellomesencephalic fissure AVM. We observed a sequential increase in the size of the AVM after multiple sessions of endovascular treatment and performed successful microsurgical resection of the lesion. Conclusion: This illustrative video highlights the role of microsurgery as a feasible therapeutic strategy for complete resection of cerebellar AVMs after endovascular embolization.
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Affiliation(s)
| | | | - Bruno Loof Amorim
- Department of Neurosurgery, Universidade Federal de São Paulo, Brazil
| | | | | | - Leonardo de Deus Silva
- Department of Interventional Neuroradiology, Pontificia Universidade Católica de Campinas, Campinas, São Paulo, Brazil
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Loof de Amorim B, Wainberg RC, Paz-Archila JA, Lessa SS, Bustamante Vargas GM, Bocca LF, de Campos Filho JM, de Siqueira Campos CM, Silva da Costa MD, Chaddad-Neto F. Combined treatment for a hemispheric cerebellar AVM. Neurosurgical Focus: Video 2021; 4:V14. [PMID: 36284612 PMCID: PMC9542305 DOI: 10.3171/2020.10.focvid2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
Posterior fossa arteriovenous malformations (AVMs) can be a challenging disease, especially those large in size. AVMs can be treated with a combination of endovascular treatment and microsurgery. Here, the authors present the case of a 16-year-old female patient with progressive dizziness and episodic syncope. The workup of the patient showed a hemispheric cerebellar AVM, Spetzler-Martin grade IV. She underwent combined treatment (endovascular and microsurgery) with no complications and cure of the malformation. The video can be found here: https://youtu.be/rNw_Kyd76Mg
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Affiliation(s)
- Bruno Loof de Amorim
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP/EPM); and
| | | | | | - Silvio Sarmento Lessa
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP/EPM); and
| | | | - Leonardo Favi Bocca
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP/EPM); and
| | - José Maria de Campos Filho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP/EPM); and
- Divisions of Neurosurgery and
| | | | | | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP/EPM); and
- Divisions of Neurosurgery and
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da Costa MDS, Lopes RRDS, Serrato-Avila JL, Cavalheiro S, Chaddad-Neto F. Endoscopic brainwash after clipping a ruptured aneurysm of the communicating segment of the intracranial carotid artery. Surg Neurol Int 2020; 11:396. [PMID: 33282457 PMCID: PMC7710481 DOI: 10.25259/sni_680_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Intracranial aneurysms are common vascular malformation occurring in 1-2% of the population and accounting for 80–85% of nontraumatic subarachnoid hemorrhages. About 10% of the ruptured aneurysm causing subarachnoid hemorrhage (SHA) develop intraventricular hemorrhage (IVH). In this scenario, the external ventricular drain (EVD) is a usual treatment for IVH. To reduce the time for the clot absorption, the neuroendoscopy with clot removal and ventricular irrigation is a feasible option, although not routinely used. Case Description: This 2D video shows a case of a 60-year-old female, with sudden headache associated with nausea and vomit. The brain angiotomography revealed aneurysm in the communicating segment of the left internal carotid artery, with 10.5 mm of diameter; also showed intraparenchymal, subarachnoid, and IVH, with a Fisher Modified Grade of 4 and a prompt aneurysm clipping and EVD were performed. Two days after the first surgical procedure, a neuroendoscopy was performed to remove the ventricular clots and improve the patient outcomes. Conclusion: In the presented case, at the 6th postoperative month, the patient was Grade 1 in the Rankin Modified Scale and without hydrocephalus. This procedure can be used routinely as an additional tool to microsurgical clipping to improve patients outcome.
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Affiliation(s)
| | | | | | - Sergio Cavalheiro
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Brazil
| | - Feres Chaddad-Neto
- Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Brazil.,Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
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