1
|
Gatto LAM, Demartini Z, Telles JPM, Figueiredo EG. Does amantadine improve cognitive recovery in severe disorders of consciousness after aneurysmal subarachnoid hemorrhage? A double-blind placebo-controlled study. Clin Neurol Neurosurg 2024; 237:108135. [PMID: 38330801 DOI: 10.1016/j.clineuro.2024.108135] [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: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Severe disorders of consciousness (sDoC) are a common sequela of aneurysmal subarachnoid hemorrhages (aSAH), and amantadine has been used to improve cognitive recovery after traumatic brain injury. OBJECTIVE This study evaluated the effect of amantadine treatment on consciousness in patients with sDoC secondary to aSAH. METHODS This double-center, randomized, prospective, cohort study included patients ≥ 18 years old with sDoC after aSAH from February 2020 to September 2023. Individual patient data of patients were pooled to determine the effect of amantadine, in comparison to placebo. The primary outcomes at 3 and 6 months after the ictus were evaluated using the modified Rankin scale (mRS) and Glasgow outcome scale (GOS). In addition to all-cause mortality, secondary endpoints were assessed weekly during intervention by scores on Rappaport's Disability Rating Scale (RDRS) and Coma Recovery Scale-Revised (CRSR). RESULTS Overall, 37 patients with sDoC and initial Glasgow Coma Scale (GCS) varying between 3 and 11 were recruited and randomized to amantadine (test group, n = 20) or placebo (control group, n = 17). The average age was 59.5 years (28 to 81 year-old), 24 (65%) were women, and the mean GCS at the beginning of intervention was 7.1. Most patients evolved to vasospasm (81%), with ischemia in 73% of them. The intervention was started between 30 to 180 days after the ictus, and administered for 6 weeks, with progressively higher doses. Neither epidemiological characteristics nor considerations regarding the treatment of the aneurysm and its complications differed between both arms. Overall mortality was 10.8% (4 deaths). During the study, four patients had potential adverse drug effects: two presented seizures, one had paralytic ileus, and another evolved with tachycardia; the medication was not suspended, only the dose was not increased. At data opening, 2 were taking amantadine and 2 placebo. CONCLUSION Despite some good results associated with amantadine in the literature, this study did not find statistically significant positive effects in cognitive recovery in patients with delayed post-aSAH sDoC. Further large randomized clinical trials in patients' subgroups are needed to better define its effectiveness and clarify any therapeutic window where it can be advantageous.
Collapse
Affiliation(s)
| | - Zeferino Demartini
- Department of Neurosurgery, Hospital de Clinicas - Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, Hospital das Clinicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
2
|
Demartini Z, Gatto LAM, Francisco AN, Koppe GL. Endovascular treatment of P3 segment of posterior cerebral artery aneurysm with stent and coils. Neurochirurgie 2021; 68:437-442. [PMID: 34499946 DOI: 10.1016/j.neuchi.2021.08.006] [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: 05/14/2018] [Revised: 02/12/2019] [Accepted: 08/24/2021] [Indexed: 11/27/2022]
Abstract
Posterior cerebral artery (PCA) aneurysms are rare and usually arise from proximal portion of the artery. The distal location is even less frequent, and aneurysms in this location tend to be larger and dissecting. Although they can be treated by direct surgery, recently endovascular procedures have been preferred in some centers. We report a case of large aneurysm of the posterior cerebral artery in a 45-year-old female presenting with headache. An uneventful endovascular treatment was performed with stent and platinum coils achieving total occlusion of the aneurysm, and the patient had good recovery. The findings are compared to earlier reports and literature regarding the issue is discussed.
Collapse
Affiliation(s)
- Z Demartini
- Neurosurgeon, Neuroradiologist, Hemodynamics Division, Federal University of Parana - UFPR, Curitiba, PR, Brazil; Neurosurgeon, Neuroradiologist, Department of Neurosurgery - Cajuru University Hospital, Pontifical University Catholic of Parana - PUCPR, Curitiba, PR, Brazil.
| | - L A M Gatto
- Neurosurgeon, Neuroradiologist, Department of Neurosurgery - Cajuru University Hospital, Pontifical University Catholic of Parana - PUCPR, Curitiba, PR, Brazil
| | - A N Francisco
- Neurosurgeon, Department of Neurosurgery - Cajuru University Hospital, Pontifical University Catholic of Parana - PUCPR, Curitiba, PR, Brazil
| | - G L Koppe
- Interventional Radiologist, Department of Neurosurgery-Hospital Vita Curitiba, Curitiba, PR, Brazil
| |
Collapse
|
3
|
Maranha Gatto LA, Galdino Chaves JP. Women in neurosurgery and interventional neuroradiology in Brazil and other countries: can lightning strike the same place twice? Neuroradiol J 2021:19714009211026895. [PMID: 34284683 DOI: 10.1177/19714009211026895] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neurosurgery is historically a specialty with a wide male predominance. Interventional neuroradiology, considered in many countries to be a subspecialty of neurosurgery (but also radiology and neurology), has never been the setting for this discussion, but the even greater gender inequality of professionals working in this area is well known. AIMS The initial objective of this research was to describe the personal and professional profile of the few women in Brazil who practise neurosurgery and interventional neuroradiology, and the difficulties they encountered throughout their careers just because they are women. However, the shocking stories they experienced led the team to expand searches around the world, obtaining data from some other countries, mainly in South America. Machismo, harassment, misogyny, discrimination and wage inequality go beyond borders. DISCUSSION Current times do not allow these situations anymore, but which, according to the narrative descriptions of 28 interventional neuroradiology women interviewed, still occur very frequently. A more inclusive vision must be sought by interventional neuroradiology societies, and it is up to the leaders to take care of those who need more attention (which does not mean they are more fragile).
Collapse
Affiliation(s)
- Luana Antunes Maranha Gatto
- Department of Neurosurgery and Department of Interventional Neuroradiology, Cajuru University Hospital of the Pontifical Catholic University of Paraná, Brazil
| | - Jennyfer Paula Galdino Chaves
- Department of Neurosurgery and Department of Interventional Neuroradiology, Cajuru University Hospital of the Pontifical Catholic University of Paraná, Brazil
| |
Collapse
|
4
|
Demartini Z, Maeda AK, Koppe GL, Gatto LAM, Cardoso-Demartini A. Letter: Spinal Neurovascular Malformations in Klippel-Trenaunay Syndrome: A Single Center Study. Neurosurgery 2021; 89:E182-E183. [PMID: 34161588 DOI: 10.1093/neuros/nyab206] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas Universidade Federal do Parana Curitiba, Brazil.,Complexo Hospital Pequeno Principe Curitiba, Brazil.,Hospital Universitário Cajuru Pontifícia Universidade Católica do Paraná Curitiba, Brazil
| | | | - Gelson Luis Koppe
- Complexo Hospital Pequeno Principe Curitiba, Brazil.,Hospital Universitário Cajuru Pontifícia Universidade Católica do Paraná Curitiba, Brazil
| | - L A M Gatto
- Hospital Universitário Cajuru Pontifícia Universidade Católica do Paraná Curitiba, Brazil
| | | |
Collapse
|
5
|
Abstract
Ondine's curse is one of the most enchanting mythical tales in the field of Medicine. The nymph Ondine was an immortal water spirit who became human after falling in love for a man, marrying him, and having a baby. In one of the versions of the tale, when she caught her husband sleeping with another woman, she cursed him to remain awake in order to control his own breathing. During the 19th century, the rare syndrome characterized by loss of autonomic breath control, while voluntary respiration remains intact, was cleverly named “Ondine's curse”. Nowadays, the term Ondine's curse is usually associated with congenital central hypoventilation syndrome; however, in medical literature, it also designates several respiratory disorders. Here, we present a review of the myth focused on history, arts and medicine.
Collapse
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clinicas - Universidade Federal of Parana, Curitiba, PR, Brazil
- Hospital Universitário Cajuru, Pontifical Catholic University of Parana - PUCPR, Curitiba, PR, Brazil
- Corresponding author. Departamento de Neurocirurgia, Rua General Carneiro 181, 8º andar, Curitiba, PR, Brazil.
| | | | - Gelson Luis Koppe
- Hospital Universitário Cajuru, Pontifical Catholic University of Parana - PUCPR, Curitiba, PR, Brazil
| | | | - Enio Eduardo Guerios
- Complexo Hospital de Clinicas - Universidade Federal of Parana, Curitiba, PR, Brazil
| |
Collapse
|
6
|
Demartini ZJ, Alencar G, Koppe GL, De Oliveira TVH, Francisco AN, Gatto LAM. Solitaire ab stent deployment for treatment of basilar apex aneurysm via the posterior communicating artery. Turk Neurosurg 2021; 32:517-520. [DOI: 10.5137/1019-5149.jtn.34847-21.3] [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] [Indexed: 10/20/2022]
|
7
|
Demartini Z, Koppe GL, Corrêa de Almeida Teixeira B, Keijiro A, Francisco AN, Maranha Gatto LA. Matas test revisited: carotid compression for embolization of high-flow pediatric pial arteriovenous fistulas. J Neurosurg Pediatr 2020; 27:364-367. [PMID: 33338991 DOI: 10.3171/2020.7.peds20401] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cerebral pial arteriovenous fistula (AVF) is a rare vascular malformation and may cause hemorrhage and neurological deficit. The presence of high-flow shunts constitutes a challenge when performing the endovascular technique, due to risk of distal embolization. The authors report a simple maneuver, adapted from the Matas test, that was successfully applied to treat a child with two pial AVFs. METHODS An 8-year-old boy presented with headache and vomiting due to two single-channel high-flow intracerebral pial AVFs. He was treated with an endovascular approach using brief, gentle compression of the ipsilateral cervical carotid artery. The temporary flow arrest ensured proper placement of the first coil, allowing definitive obliteration of the shunt. RESULTS There were no complications with the procedure, and the patient recovered uneventfully. Throughout the 9-month follow-up, the patient experienced a stable neurological condition, with both fistulas occluded and improvement of local circulation. CONCLUSIONS This easy-to-perform maneuver allows precise positioning of embolic material into high-flow shunts to facilitate treatment of pial AVF.
Collapse
Affiliation(s)
- Zeferino Demartini
- 1Department of Neurosurgery, Complexo Hospital de Clinicas, Universidade Federal do Paraná-UFPR.,2Department of Neurosurgery, Hospital Pequeno Principe.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | - Gelson Luis Koppe
- 2Department of Neurosurgery, Hospital Pequeno Principe.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | | | - Adriano Keijiro
- 1Department of Neurosurgery, Complexo Hospital de Clinicas, Universidade Federal do Paraná-UFPR.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | - Alexandre Novicki Francisco
- 2Department of Neurosurgery, Hospital Pequeno Principe.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | - Luana Antunes Maranha Gatto
- 3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| |
Collapse
|
8
|
Maranha Gatto LA, Rodrigues Seabra DDM, Koppe GL, Demartini Z. Complications of Endovascular Treatment in Fibromuscular Dysplasia. Neurol India 2020; 68:1220-1223. [PMID: 33109882 DOI: 10.4103/0028-3886.299152] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Fibromuscular dysplasia affects generally renal artery, causing renovascular hypertension. The most classical angiographic pattern, string-of-beads, can be found in cervical and more rarely in other arteries. With the advance of endovascular procedures techniques, the number of open surgeries is decreasing, and complications related to the selective catheterization of diseased vessels are increasing. CASE REPORT A 37-year-old man presenting with subarachnoid hemorrhage was submitted to angioplasty for dissecting aneurysms of vertebral artery with a good outcome. Several arteries were angiographically diagnosed with the dysplasia (renal, carotid, femoral), and some complications like stenosis, dissection, arteriovenous fistula, and dissecting aneurysm occurred in sequence. CONCLUSIONS FMD of cervical arteries is usually asymptomatic. There are no guidelines or protocols to cervical FMD treatment, being indicated only for the complications. Because of the vessels fragility, a several spontaneous or post endovascular procedure complications can be disastrous.
Collapse
Affiliation(s)
- Luana Antunes Maranha Gatto
- Neurosurgeon and Interventional Neuroradiologist of Cajuru University Hospital of Pontifical Catholic University of Paraná (HUC-PUC PR), Curitiba - Parana, Brazil
| | | | - Gelson Luis Koppe
- Head of Department of Interventional Neuroradiology of HUC-PUC PR, Curitiba - Parana, Brazil
| | - Zeferino Demartini
- Neurosurgeon and Interventional Neuroradiologist of Cajuru University Hospital of Pontifical Catholic University of Paraná (HUC-PUC PR), Curitiba - Parana, Brazil
| |
Collapse
|
9
|
Demartini Júnior Z, Guimarães RMDR, Vialle EN, Koppe GL, Francisco AN, Gatto LAM. Origem da artéria cerebelar inferoposterior sobre o arco posterior de C1. Rev Bras Ortop 2019; 54:605-608. [PMID: 31686717 PMCID: PMC6819159 DOI: 10.1016/j.rbo.2017.12.025] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/21/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Zeferino Demartini Júnior
- Departamento de Neurocirurgia, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
- Endereço para correspondência Zeferino Demartini Júnior Departamento de Neurocirurgia, Pontifícia Universidade Católica do Paraná (PUC-PR)Curitiba, PRBrasil
| | | | - Emiliano Neves Vialle
- Departamento de Neurocirurgia, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
| | - Gelson Luis Koppe
- Departamento de Neurocirurgia, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brasil
| | | | | |
Collapse
|
10
|
Gatto LAM, De Souza TFS, Naves de Lima Alves G, Padilha Miranda T, Koppe GL, Demartini Z. Endovascular Treatment of a Dural Arteriovenous Fistula after Cerebral Sinovenous Thrombosis in a Child. Pediatr Neurosurg 2019; 54:66-70. [PMID: 30481758 DOI: 10.1159/000494563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dural arteriovenous fistula (DAVF) is rare in children. Development theories postulate a response to cerebral sinovenous thrombosis (CSVT) or to venous hypertension. The symptoms are highly nonspecific and depend on lesion location. Standard treatment of thrombosis is based on antithrombotic therapy, while the main therapy for DAVF is embolization. CASE REPORT An 8-year-old boy presented with headache was diagnosed with CSVT and treated with anticoagulant. He developed tinnitus, mental confusion, and lowering of consciousness. Magnetic resonance imaging showed a DAVF draining through a single stenotic venous sinus. Successful endovascular treatment was performed with arterial embolization of multiple feeders and stent and balloon sinus angioplasty. CONCLUSION Risk factors associated with sinus thrombosis must be always investigated; endovascular treatment is safe and reasonable in a clinical deterioration scenario.
Collapse
Affiliation(s)
- Luana Antunes Maranha Gatto
- Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Brazil,
| | | | | | - Tayna Padilha Miranda
- Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Brazil
| | | | - Zeferino Demartini
- Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Brazil
| |
Collapse
|
11
|
Albuquerque Sousa LH, Maranha Gatto LA, Demartini Junior Z, Koppe GL. Scalp Cirsoid Aneurysm: An Updated Systematic Literature Review and an Illustrative Case Report. World Neurosurg 2018; 119:416-427. [DOI: 10.1016/j.wneu.2018.08.098] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/16/2022]
|
12
|
Antunes Maranha Gatto L, Naves de Lima Alves G, do Monte Rodrigues Seabra D, Koppe GL, Demartini Z. Single-session percutaneous embolization with onyx and coils of sinus pericranii. Surg Neurol Int 2018; 9:114. [PMID: 29963324 PMCID: PMC6000716 DOI: 10.4103/sni.sni_456_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 12/02/2017] [Accepted: 02/15/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sinus pericranii (SP) is a rare vascular malformation consisting of an abnormal communication between the extra- and the intracranial venous system. It occurs due to the adhesion of vessels without a muscular layer or a hemangioma on the outer surface of the skull through diploic vessels, communicating with an intracranial venous sinus. CASE DESCRIPTION A 10-month-old female presented with a pulsatile mass on the posterior parietal region. Investigation with brain vascular examinations showed a venous malformation communicating with the superior sagittal sinus under the scalp, without arterial feeder or nidus. An endovascular embolization with coils and a percutaneous embolization with Onyx ® were performed. The final venography showed complete exclusion of the lesion, which was gradually being absorbed. CONCLUSION This is the first case of an SP successfully treated in a single session by embolization with coils and onyx.
Collapse
Affiliation(s)
- Luana Antunes Maranha Gatto
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Guilherme Naves de Lima Alves
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Diego do Monte Rodrigues Seabra
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Gelson Luis Koppe
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Zeferino Demartini
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| |
Collapse
|
13
|
Abstract
Sneddon syndrome (SS) is a rare progressive non-inflammatory thrombotic vasculopathy affecting small/medium-sized blood vessels of unknown origin. It is strongly associated with the presence of antiphospholipid antibodies (AA). The presence of livedo reticularis and cerebrovascular disease are hallmark features. The condition is far more common in young women. We report a case of SS in a 43 year-old male with a two-year history of progressive cognitive impairment consistent with dementia syndrome, and major personality changes, besides livedo reticularis and cerebral angiographic pattern of vasculitis. AA were borderline. The recognition of skin blemishes that precede strokes should raise the hypothesis of SS. AA are elevated in more than half of cases, but their role in the pathogenesis or association of positive antibodies and SS remains unclear. Dementia syndrome in young patients should be extensively investigated to rule out reversible situations. Typical skin findings, MRI and angiography may aid diagnosis.
Collapse
Affiliation(s)
| | - Raul Martins
- Radiologist of CETAC - Diagnóstico por Imagem, Curitiba, PR, Brazil
| | - Gelson Luis Koppe
- Interventional Neuroradiologist of Hospital das Nações, Curitiba, PR, Brazil
| | - Zeferino Demartini
- Neurosurgeon and Interventional Neuroradiologist of Hospital das Nações, Curitiba, PR, Brazil
| | | |
Collapse
|
14
|
Demartini Z, Gatto LAM, da Rocha TC, Maeda AK, Valerio A, Koppe GL, Francisco AN. Is the Mayfield Head Holder Obligatory for Intracranial Aneurysm Clipping? Pediatr Neurosurg 2018; 53:360-363. [PMID: 30145594 DOI: 10.1159/000491825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/04/2018] [Indexed: 11/19/2022]
Abstract
Intracranial aneurysm surgery is commonly performed using pinned head holders, which pose a higher risk for the pediatric population. Several authors recommend avoiding the use of this device when it is not strictly necessary, and this is currently possible considering advances in anesthesiology and monitoring. As the literature on microsurgery without skull clamp use is scant, we report the case of a 15-year-old boy presenting with a subarachnoid hemorrhage after rupture of a middle cerebral artery aneurysm. Surgical treatment was performed with the head resting on a gel cushion horseshoe; aneurysm clipping was achieved without wakefulness or awareness and the patient had a good recovery.
Collapse
Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Cajuru University Hospital, Pontifical Catholic University of Parana, Curitiba, Brazil.,Department of Neurosurgery, Hospital Pequeno Principe, Curitiba, Brazil
| | - Luana Antunes Maranha Gatto
- Department of Neurosurgery, Cajuru University Hospital, Pontifical Catholic University of Parana, Curitiba, Brazil
| | | | | | - Adriana Valerio
- Department of Anesthesiology, Hospital Pequeno Principe, Curitiba, Brazil
| | - Gelson Luis Koppe
- Department of Neurosurgery, Hospital Pequeno Principe and Hospital Vita Curitiba, Curitiba, Brazil
| | | |
Collapse
|
15
|
Gatto LAM, Koppe GL, Demartini Z, Zétola VDHF. Physicians are not well informed about the new guidelines for the treatment of acute stroke. Arq Neuropsiquiatr 2017; 75:718-721. [PMID: 29166463 DOI: 10.1590/0004-282x20170122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Treatment of cerebrovascular disease has advanced rapidly in the last two decades. Recent data has added challenges to the treatment of ischemic stroke in the acute phase. OBJECTIVE To evaluate the knowledge of physicians about the treatment of ischemic stroke in the acute phase. METHODS An online questionnaire was submitted to all physicians enrolled in the Regional Council of Medicine in Brazil. RESULTS 456 physicians from different specialties answered the questions. Most of them did not know that mechanical endovascular thrombectomy is often considered as the gold standard treatment in cases of ischemic stroke in the acute phase; and 85% of them did not realize that thrombectomy together with intravenous thrombolysis was possible. The maximum time to act in an acute event also presented many divergences, even with regard to the infusion of rtPA. The lack of structure, medication and absence of a neurologist were considered the main barriers to treatment. CONCLUSION Physicians are not well informed about the new guidelines for the treatment of acute stroke. Most physicians incorrectly answered most of the questions on the questionnaire.
Collapse
Affiliation(s)
- Luana Antunes Maranha Gatto
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurocirurgia, Curitiba PR, Brasil.,Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurorradiologia Intervencionista, Curitiba PR, Brasil
| | - Gelson Luis Koppe
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurorradiologia Intervencionista, Curitiba PR, Brasil
| | - Zeferino Demartini
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurocirurgia, Curitiba PR, Brasil.,Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurorradiologia Intervencionista, Curitiba PR, Brasil
| | | |
Collapse
|
16
|
Gatto LAM, Saurin F, Koppe GL, Demartini Z. Facial palsy after embolization of dural arteriovenous fistula: A case report and literature review. Surg Neurol Int 2017; 8:270. [PMID: 29204306 PMCID: PMC5691552 DOI: 10.4103/sni.sni_428_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/27/2016] [Accepted: 05/26/2017] [Indexed: 11/04/2022] Open
Abstract
Background Dural arteriovenous fistulas (DAVF) are unusual intracranial vascular malformations consisting of anomalous connections between meningeal arteries and dural sinuses or the veins that pass through them. They have variable clinical presentation and prognosis, which depend on their location and venous hemodynamics. Treatment is based on the closure of the abnormal connections, which is usually conducted via arterial and/or transvenous endovascular techniques. Case Description We present a male patient who complained of headaches and left-sided pulsatile tinnitus due to DAVF from the external carotid artery branches draining directly into the ipsilateral sigmoid sinus. Embolization with Onyx® was successful, obtaining angiographic occlusion and symptom remission. However, on postoperative day 4, the patient presented with left facial palsy and spontaneous regression. Conclusion Although embolization is an effective and safe procedure, complications may occur. Reflux of the embolic agent to the vasa nervorum of the cranial nerve may lead to ischemic neuropathy. Here, we reported a case of embolized DAVF presenting with a postoperative peripheral facial palsy where the two embolized pedicles were branches of the middle meningeal and occipital arteries involved in the vascularization of the extratemporal segment of the facial nerve. We discuss the etiopathogenic, anatomical, and pathophysiological aspects of this complication.
Collapse
Affiliation(s)
| | | | - Gelson Luis Koppe
- Head of Interventional Neuroradiology in HUC-PUC, Curitiba, Parana, Brazil
| | - Zeferino Demartini
- Department of Neurosurgeon and Interventional Neuroradiologist in HUC-PUC, Curitiba, Parana, Brazil
| |
Collapse
|
17
|
Gatto LAM, Mathias R, Tuma R, Abdalla R, de Aguiar PHP. Rare complication of ventriculoperitoneal shunt: Catheter protrusion to subcutaneous tissue - Case report. Surg Neurol Int 2016; 7:S1142-S1146. [PMID: 28194301 PMCID: PMC5299149 DOI: 10.4103/2152-7806.196926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/18/2016] [Accepted: 09/30/2016] [Indexed: 11/30/2022] Open
Abstract
Background: Ventriculoperitoneal (VP) shunt is a day-to-day procedure performed by a neurosurgeon. The most frequent associated complications are obstructive and infectious. Although rare, there are well-reported complications related to the poor positioning of the distal catheter, with perforation of organs and tissues. Still rarer are the complications related to the migration of this catheter. Case Description: We describe an atypical case of VP shunt postoperative by normal pressure hydrocephalus. After well-documented proper positioning of the distal catheter into the intraperitoneal cavity, it protruded into the subcutaneous space. Even on a new documented satisfactory abdominal tomography, this catheter migrated back again to the subcutaneous tissue. Conclusion: We did not find plausible explanation for this rare event.
Collapse
Affiliation(s)
- Luana Antunes Maranha Gatto
- Department of Neurosurgery and Interventional Neuroradiology, University Hospital Cajuru, Curitiba, PR, Brazil
| | - Roger Mathias
- Department of Neurosurgery of Bragança University, Division of Neurosurgery, Sirio LIbanês Hospital, São Paulo, SP, Brazil
| | - Rogério Tuma
- Divisions of Neurology, Sirio LIbanês Hospital, São Paulo, SP, Brazil
| | - Ricardo Abdalla
- Divisions of Surgery, Sirio LIbanês Hospital, São Paulo, SP, Brazil
| | | |
Collapse
|
18
|
Demartini Z, Liebert F, Gatto LAM, Jung TS, Rocha C, Santos AMB, Koppe GL. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation. Case Rep Ophthalmol 2015; 6:482-7. [PMID: 26955353 PMCID: PMC4777947 DOI: 10.1159/000443141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Indexed: 11/19/2022] Open
Abstract
Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.
Collapse
|
19
|
Nascimento FA, Gatto LAM, Silvado C, Mäder-Joaquim MJ, Moro MS, Araujo JC. Anterior temporal lobectomy versus selective amygdalohippocampectomy in patients with mesial temporal lobe epilepsy. Arq Neuro-Psiquiatr 2015; 74:35-43. [DOI: 10.1590/0004-282x20150188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To contribute our experience with surgical treatment of patients with mesial temporal lobe epilepsy (mTLE) undergoing anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SelAH). Method This is a retrospective observational study. The sample included patients with medically refractory mTLE due to unilateral mesial temporal sclerosis who underwent either ATL or SelAH, at Hospital de Clinicas – UFPR, from 2005 to 2012. We report seizure outcomes, using Engel classification, cognitive outcomes, using measurements of verbal and visuospatial memories, as well as operative complications. Result Sixty-seven patients (33 ATL, 34 SelAH) were studied; median follow-up was 64 months. There was no statistically significant difference in seizure or neuropsychological outcomes, although verbal memory was more negatively affected in ATL operations on patients’ dominant hemispheres. Higher number of major complications was observed in the ATL group (p = 0.004). Conclusion Seizure and neuropsychological outcomes did not differ. ATL appeared to be associated with higher risk of complications.
Collapse
|
20
|
Nascimento FA, Gatto LAM, Lages RO, Neto HM, Demartini Z, Koppe GL. Diffuse idiopathic skeletal hyperostosis: A review. Surg Neurol Int 2014; 5:S122-5. [PMID: 24843807 PMCID: PMC4023007 DOI: 10.4103/2152-7806.130675] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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: 11/30/2013] [Accepted: 12/09/2013] [Indexed: 11/29/2022] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic noninflammatory disease characterized by ossification of the entheses. Methods: This paper reviews the etiopathogenesis, epidemiology, clinical features, differential diagnosis, and treatment of DISH, based on current available literature. Results: Exact prevalence and incidence of DISH remains undetermined. Many external and genetic factors have been reported as being contributors to the pathogenesis of DISH. Current theories focus on the pathologic calcification of the anterior longitudinal ligament of the spine as the main physiopathological mechanism of disease. Clinical features are variable from monoarticular sinovitis to airway obstruction, and can be associated to systemic conditions. Comorbidities include obesity, hypertension, diabetes mellitus, hyperinsulinemia, dyslipidemia, and hyperuricemia according to a number of reports. Conclusions: DISH is a disease which involves the calcification of the anterior longitudinal ligament of the spine and can be associated with numerous clinical presentations and comorbidities.
Collapse
Affiliation(s)
| | - Luana Antunes Maranha Gatto
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Neurosurgeon, Fellow of Interventional Neuroradiology, Neurosurgery Resident, Curitiba, Paraná, Brazil
| | - Roberto Oliver Lages
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Brazil
| | | | - Zeferino Demartini
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Neurosurgeon and Interventional Neuroradiologist, Curitiba, Paraná Brazil
| | - Gelson Luis Koppe
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Interventional Neuroradiologist in Hospital Universitário Cajuru, Curitiba, Paraná, Brazil
| |
Collapse
|