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de Macêdo LP, de Castro Tavares R, Torres Braga M, Dos Santos LM, Donato G, Lima Júnior FASD, de Macêdo RP, Ugulino Netto A, Franke K, Vansant Oliveira Eugênio P, Batista Cezar-Junior A, Vilela Faquini I, Júnior Silva JL, de Carvalho Júnior EV, Almeida NS, Bandeira E Farias FA, Moraes Valença M, Rocha Cirne Azevedo-Filho H. The relationship between the level of vitamin D and ruptured intracranial aneurysms among patients with high sun exposure. Sci Rep 2024; 14:3555. [PMID: 38347057 PMCID: PMC10861505 DOI: 10.1038/s41598-024-53676-y] [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: 09/11/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
Non-traumatic subarachnoid hemorrhage (SAH) accounts for 3-5% of acute strokes. Intracranial aneurysm is the most common cause of non-traumatic SAH. Vitamin D influences the cardiovascular system, including the formation and rupture of cerebral aneurysms. To evaluate the serum vitamin D level in patients living in the tropical zone who suffered aneurysmal subarachnoid hemorrhage and its correlation with demographic and neurological characteristics. This is an analytical cross-sectional study to assess the serum level of vitamin D in a study population of 99 patients treated and diagnosed with aSAH in a public hospital in Recife-PE over a period of 12 months. In the study sample, composed of individuals with high sun exposure due to the lifestyle they lead in a tropical region, we observed hypovitaminosis D (85.9%), with a median of 19.9 ng/ml, although the majority of individuals are skin with high concentration of melanin (Fitzpatrick skin type IV and V). In addition, rates of sun exposure are high to all patients (Solar Index 9.03 P50). Most individuals were female (79.8%); there was no statistical difference in solar exposure/solar index between genders. As for the neurological repercussions, there was no statistical relevance in the clinical prognostic scales evaluated. As the sample was composed mainly of individuals whose economic activity is agriculture, the values of solar index found are vastly higher than those of other studies conducted in high latitude regions. In line with the literature review, some aspects were raised with the objective of justifying such findings that go from the base of the poor diet of these individuals, the increase of melanin in the skin and genetic alterations that directs us to possible mechanisms of natural photoprotection to high sun exposure. Thus, we had a vast majority (85%) of hypovitaminosis D, which in fact makes us wonder if there is any influence of calcitriol on vitamin D receptors in vascular walls and in the cardiovascular system as a whole, which influence bleeding events of this nature. As for the neurological repercussions, measured using assessment scales (Glasgow coma scale, WFNS scale, Hunt-Hess and Fisher's tomographic scale) there was no significant difference in the results. As it is only a descriptive study, the causal relationship of the facts cannot be established. However, in a population exposed to high sun exposure and affected by aneurysmal SAH, there is a significant rate of hypovitaminosis D, which supports the hypothesis that vitamin D plays a role in vascular pathologies, such as cerebral aneurysms and SAH.
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Affiliation(s)
- Lívio Pereira de Macêdo
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil.
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
- , Recife, Brasil.
| | | | | | | | - Glaudir Donato
- Medical Student, Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | | | | | | | - Kauê Franke
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | - Igor Vilela Faquini
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | - Nivaldo S Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | - Hildo Rocha Cirne Azevedo-Filho
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
- Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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de Macêdo LP, Baptista-André DC, Ugulino-Netto A, Franke K, Oliveira Eugênio PV, Cezar-Junior AB, Faquini IV, de Carvalho-Júnior EV, Almeida NS, Azevedo-Filho HRC. Management of a ruptured posterior inferior cerebellar artery (PICA) aneurysm with end-to-end in situ bypass: Case report. J Cerebrovasc Endovasc Neurosurg 2023:jcen.2023.E2023.05.006. [PMID: 38151969 DOI: 10.7461/jcen.2023.e2023.05.006] [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: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 12/29/2023] Open
Abstract
Dissecting posterior inferior cerebellar artery (PICA) aneurysms are uncommon lesions. Their anatomy and the location of the dissection are variable, however, they usually occurs at the origin of the PICA. Dissecting PICA aneurysms generally have non-vascular morphology involving an entire segment of the artery and cannot be cut. Nevertheless, the detection of these vascular lesions has increased latterly, so it is necessary to recognize it and take the appropriate management modalities for these injuries. In this report, we describe a case of a 73-year-old male patient, who presented a history of severe headache, associated with neck stiffness, nausea, vomiting, dizziness, hypoactivity, mental confusion, and walking difficulty. Radiographic investigation with brain computed tomography (CT) showed mild bleeding in a pre-medullary and pre-pontine cistern, and cerebral angiogram showed a dissecting PICA aneurysm. Despite being a challenging treatment, microsurgery management was the chosen modality. It was performed an end-to-end anastomosis between the p2/p3 segments, showing to be effective with good clinical and radiographic outcomes. We discussed an unusual case, reviewing the current literature on clinical presentations, the angiographic characteristics of the dissecting aneurysms of PICA, and evaluating the clinical and angiographic results of patients undergoing microsurgical treatment.
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Affiliation(s)
| | | | | | - Kauê Franke
- Department of Neurosurgery, Hospital da Restauração, Recife, Brazil
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Vieira E, Netto AU, Cezar AB, Faquini I, Almeida NS, Azevedo-Filho HRC. Blood Blister-Like Aneurysms of the Internal Carotid Artery. Adv Tech Stand Neurosurg 2023; 48:371-383. [PMID: 37770692 DOI: 10.1007/978-3-031-36785-4_14] [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: 09/30/2023]
Abstract
Internal carotid artery blood blister-like aneurysms are challenging lesions that arise from the artery trunk at non-branching sites. They have been recognized since 1969 and are distinct from typical saccular aneurysms. Usually, these aneurysms are broad-based, with no clearly identifiable neck and have extremely friable and fragile walls, thus with a great propensity to cause subarachnoid hemorrhage and to rupture during treatment. Apparently, blister-like aneurysms are formed through an acquired defect of the inner layers (tunica intima and media) of the internal carotid artery wall, probably due to hemodynamic stress in the carotid siphon.Several surgical and endovascular techniques have been described for the treatment of these aneurysms, however, there is still no consensus on the best technique or method, exposing how challenging the treatment of internal carotid artery blister-like aneurysms is, for both neurosurgeons and neurointerventionists. In this chapter, we review the main aspects of the pathogenesis, diagnosis, and therapeutics and report our experience in the microsurgical treatment of these formidable lesions.
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Affiliation(s)
- Eduardo Vieira
- Department of Neurological Surgery, Hospital Da Restauração, Recife, Brazil
| | - Arlindo U Netto
- Department of Neurological Surgery, Hospital Da Restauração, Recife, Brazil
| | - Auricelio B Cezar
- Department of Neurological Surgery, Hospital Da Restauração, Recife, Brazil
| | - Igor Faquini
- Department of Neurological Surgery, Hospital Da Restauração, Recife, Brazil
| | - Nivaldo S Almeida
- Department of Neurological Surgery, Hospital Da Restauração, Recife, Brazil
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Macêdo LPD, Netto AU, Franke K, Eugenio PVO, Freitas LRDM, Costa VRX, Carvalho Júnior EVD, Faquini IV, Almeida NS, Azevedo-Filho HRC. Spontaneous Anal Extrusion of Ventriculoperitoneal Shunt Catheter: Case Report. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022. [DOI: 10.1055/s-0042-1748848] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background Ventriculoperitoneal shunt (VPS) has become the standard treatment for congenital hydrocephalus. In the neurosurgical practice, it is a common procedure which usually results in low rates of complication. However, some serious complications can occur, including infections, intestinal perforation, and even death.
Case Description A 19-year-old, female, asymptomatic patient, with a history of appendectomy and revision of the VPS 6 years before, presented spontaneous transanal extrusion of the catheter. Abdominal radiographs and tomography scans showed perforation of the descending colon without peritonitis, with expulsion of the distal tip of the catheter through the anus. The patient underwent removal of the proximal part of the VPS and installation of an external ventricular drain (EVD). On the second postoperative day, there was spontaneous elimination of the distal portion of the catheter, dispensing any additional surgical procedures. With antimicrobial prophylaxis and the contralateral VPS performed, the patient evolved without further complications until discharge. Diverging from cases reported in the literature, the patient in question did not present any abdominal manifestations.
Conclusion Intestinal perforation by VPS may be asymptomatic until anal extrusion occurs. However, the early approach should avoid infections, which are associated with increased mortality. Removing only the proximal catheter, together with antimicrobial prophylaxis, can be an effective, safe and less invasive alternative to manage this complication of VPS.
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Affiliation(s)
| | | | - Kauê Franke
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | | | | | | | | | - Igor Vilela Faquini
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
| | - Nivaldo S. Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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Carneiro-Filho GDS, de Macêdo LP, Andrade LI, Alves-Sá BF, Sousa LAM, de Medeiros Quirino SC, Chaves JR, Bezerra-Júnior DL, Almeida NS, Azevedo-Filho HRC. Upper Cervical Spine Injuries: Profile and Management of 120 Cases. Int J Spine Surg 2022; 16:1001-1008. [PMID: 35831063 PMCID: PMC9807045 DOI: 10.14444/8321] [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: 01/13/2023] Open
Abstract
OBJECTIVES To identify the profile and management of patients with upper cervical spine injury. METHODS Retrospective cohort study of patients with upper cervical spine injuries managed at Hospital da Restauração between 2014 and 2020. RESULTS It presents the profile of 145 injuries recorded by location and classification among the 120 patients, and the management performed. Men are more affected than women, almost half of the patients (42.5%) were aged 16 to 29 years. Neurological deficit was present in 18 cases (15%). Twenty cases presented injury involving the level C1. Most injuries (109 [90.8%]) occurred at the C2 level, the most frequent of which were as follows: isolated type II odontoid fracture (29.2%), miscellaneous fracture of C2 (20%), and isolated hangman's fracture (13.3%). The most used management in type II odontoid fracture was C1-C2 posterior arthrodesis (17/42) followed by odontoid osteosynthesis (12/42). Regarding isolated hangman's fracture, conservative management was performed in 37.5% (6/16), and the technical approach most performed was anterior C2-C3 discectomy and interbody fusion (5/16). CONCLUSIONS Upper cervical spine injury has a higher prevalence in young men and is most often caused by traffic accidents. The main level affected is C2, and type II odontoid fracture is the most frequent subtype. C1 injury is related to conservative treatment, while C2 or combined C1-C2 injury is related to surgical approach. The management of these injuries is mainly performed with surgical treatment, with C1-C2 posterior arthrodesis and anterior odontoid osteosynthesis representing most of the approaches.
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Affiliation(s)
| | - Lívio Pereira de Macêdo
- Hospital da Restauração, Recife, Pernambuco, Brazil, Lívio Pereira de Macêdo, Hospital da Restauração Recife, Rua João Fernandes Vieira, 544, Boa Vista, Recife, PE, Brazil;
| | | | | | | | | | | | | | - Nivaldo S. Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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Vieira E, Guimarães TC, Pontes ECA, Silva ACV, Carneiro MC, Netto AU, Pereira L, Cezar AB, Faquini I, Almeida NS, Griz MFL, Azevedo-Filho HRC. Initial experience in the microsurgical treatment of ruptured brain aneurysms in the endovascular era: characteristics and safety of the learning curve in the first 300 consecutively treated patients. Acta Neurochir (Wien) 2022; 164:973-984. [PMID: 35239013 DOI: 10.1007/s00701-022-05165-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Currently, there is an increasing tendency to refer only complex aneurysms for microsurgery. The formation of new neurosurgeons dedicated to open vascular neurosurgery becomes challenging in a situation in which complex aneurysms must be dealt with early in the career, raising questions about the safety of the learning curve. METHODS We analyzed the characteristics and surgical results of the first 300 consecutively treated patients after subarachnoid hemorrhage by a single neurosurgeon. The incidence of surgical complications and clinical outcomes during the learning curve were analyzed, looking for critical periods regarding patient safety. Microsurgical operative times were also studied. RESULTS A high frequency of wide-necked aneurysms was observed (70.3%), and, as a result, large (> 10 mm), MCA and paraclinoid aneurysms were overrepresented. A statistically significant correlation between surgical experience and clinical outcomes was observed, with progressive surgical experience resulting in a lower incidence of unfavorable outcomes. We also observed a higher frequency of major surgical complications, unfavorable clinical outcomes, and lower complete occlusion rates among the first 40 patients. Microsurgical operative times progressively and significantly decreased during the learning curve. CONCLUSIONS We observed a high prevalence of wide-necked aneurysms. Young neurosurgeons must be trained and prepared to deal with these aneurysms early in their careers. Although we observed a decrease in unfavorable results with cumulative surgical experience, the first 40 cases were associated with higher rates of major surgical complications, worse clinical outcomes, and lower complete occlusion rates, indicating that this period may be more critical to patient safety.
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Affiliation(s)
- Eduardo Vieira
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil.
| | - Thiago C Guimarães
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Erton C A Pontes
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Ana C V Silva
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | | | - Arlindo U Netto
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Lívio Pereira
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Auricélio B Cezar
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Igor Faquini
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Nivaldo S Almeida
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
| | - Maria F L Griz
- Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil
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Pereira de Macêdo L, Ugulino Netto A, Franke K, Vansant Oliveira Eugenio P, Ribeiro de Moraes Freitas L, Antônio Serra de Lima Júnior F, Romeiro de Paula JV, Nery Bernardino S, Morais de Souza FH, S. Almeida N, Rocha Cirne Azevedo-Filho H. C7 contribution to the ulnar nerve. roneuro 2021. [DOI: 10.33962/roneuro-2021-035] [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] [Indexed: 11/11/2022] Open
Abstract
Introduction. Classic anatomical literature frequently describes C7 contribution to ulnar nerve (UN) formation as a casual event. However, surgical practice and dissections frequently reveal a recurrent presence of a lateral cord component of the UN. This study aimed to seek through literature to establish the frequency and degree of this contribution.
Methodology. We ran a literature review searching on Pubmed, MEDLINE, Embase and Web of Science databases for ulnar nerve anatomy and described discursively the results.
Results and discussion. We found 9 articles that described quantitatively and qualitatively the contribution of C7 on the formation of the UN. The prevalence described ranged from 2 to 100%, depending on the methodology used and population characteristics. When present, studies described a contribution from 9,9% to 30,4%, sending even more fibres than T1 root on average.
Conclusion. The C7 root can be considered a frequent and important component of the ulnar nerve, explaining UN territory repercussions on C7 radiculopathies. This knowledge is important on surgical approaches, maybe avoiding iatrogenic lesions and negative outcomes.
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Abstract
Decompressive craniectomy (DC) is an urgent neurosurgical procedure, effective in the reduction of intracranial pressure (ICP) in patients with elevated ICP and in complications of brain infarction that do not respond to clinical treatment; traumatic brain injury (TBI); intracerebral haemorrhage (ICH) and aneurysmal intracerebral haemorrhage. Symptomatic hydrocephalus is present in 2 to 29% of patients who undergo craniectomy. They may require a ventriculoperitoneal shunt (VPS). The literature does not yet show standard management of cranioplasty in patients who have previously undergone a shunt, showing evidence of sinking skin flap syndrome. This case shows parenchymal expansion after VPS occlusion and cranioplasty in the patient’s profile. The 23-year-old male patient, right-handed, went to the hospital in January 2017 due to severe traumatic brain injury following multiple traumas. The patient underwent urgent DC surgery for the management of elevated ICP. The patient developed hydrocephalus. hydrocephalus. It was decided to perform the VPS implant. After 2 years, and with quite a sunken flap, the patient was submitted to cranioplasty procedure after shunt occlusion was performed. The patient left the hospital receiving outpatient care with no more complaints. In spite of the favourable outcome, new studies are fundamental to decide upon the best approach.
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Batista Cezar-Junior A, Faquini IV, Frank K, Euripedes Almondes S Lemos L, de Carvalho EV, Almeida NS, Azevedo-Filho HRC. Limited dorsal myeloschisis with a contiguous stalk to human tail-like cutaneous appendage, associated with a lipoma of conus medullaris: A case report. Int J Surg Case Rep 2020; 71:303-306. [PMID: 32480343 PMCID: PMC7264008 DOI: 10.1016/j.ijscr.2020.05.021] [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: 04/19/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Limited dorsal myeloschisis (LDM) is a recently described pathological entity, characterized by a defect of the closed focal neural tube and a fibroneural pedicle connecting the cutaneous lesion to the spinal cord. PRESENTATION OF THE CASE This case describes a 9-month-old child with a human tail and an underlying spinal dysraphism. This was represented by LDM stalk associated with a medullary lipoma, in connection with the dorsal cutaneous appendage. We also report the therapeutic proposal for this case and its clinical outcome. DISCUSSION LDM is a distinctive clinicopathological presentation of a spinal dysraphism, associated with numerous anomalies, such as lipomyelomeningocele, tethered cord, lipoma, congenital heart disease and teratoma. In this case, surgical treatment for LDM consists of surgical resection of the appendage, untethering of the spinal cord and resection of conus medullaris lipoma in the same procedure. CONCLUSION In this case report, we share the experience of a referral service in pediatric neurosurgery regarding clinical and radiological diagnosis, and the successful treatment of this rare type of congenital malformation. Therefore, clinicians should be aware of possible morphological variations of the skin lesion associated with LDM.
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Affiliation(s)
| | - Igor Vilela Faquini
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, Brazil.
| | - Kauê Frank
- Neurosurgery Department of the Hospital da Restauração Gov. Paulo Guerra, Recife, Brazil.
| | | | | | - Nivaldo S Almeida
- Neurosurgery Department of the Hospital da Restauração Gov. Paulo Guerra, Recife, Brazil.
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Vieira E, Faquini IV, Silva JL, Griz MFL, Cezar AB, Almeida NS, Azevedo-Filho HRC. Subarachnoid neurocysticercosis and an intracranial infectious aneurysm: case report. Neurosurg Focus 2019; 47:E16. [DOI: 10.3171/2019.5.focus19280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
Infectious intracranial aneurysms (IIAs) represent 2%–6% of all intracranial aneurysms and, classically, have been associated with bacterial or fungal agents. The authors report the case of a 42-year-old woman who presented with a typical history of subarachnoid hemorrhage. Digital subtraction angiography (DSA) showed an aneurysmal dilatation on the frontal M2 segment of the left middle cerebral artery (MCA). The patient was treated surgically, and multiple cysts were found in the left carotid and sylvian cisterns, associated with a dense inflammatory exudate that involved the MCA. The cysts were removed, and a fusiform aneurysmal dilatation was identified. The lesion was not amenable to direct clipping, so the authors wrapped it. Histopathological analysis of the removed cysts revealed the typical pattern of subarachnoid neurocysticercosis. The patient received cysticidal therapy with albendazole and corticosteroids, and she recovered uneventfully. Follow-up DSA performed 6 months after surgery showed complete resolution of the aneurysm. The authors performed a review of the literature and believe that there is sufficient evidence to affirm that the subarachnoid form of neurocysticercosis may lead to the development of an IIA and that Taenia solium should be listed among the possible etiological agents of IIAs, along with bacterial and fungal agents.
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Maricevich JPBR, Cezar-Junior AB, de Oliveira-Junior EX, Veras E Silva JAM, da Silva JVL, Nunes AA, Almeida NS, Azevedo-Filho HRC. Functional and aesthetic evaluation after cranial reconstruction with polymethyl methacrylate prostheses using low-cost 3D printing templates in patients with cranial defects secondary to decompressive craniectomies: A prospective study. Surg Neurol Int 2019; 10:1. [PMID: 30775055 PMCID: PMC6357537 DOI: 10.4103/sni.sni_149_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/19/2018] [Accepted: 11/17/2018] [Indexed: 11/09/2022] Open
Abstract
Background: Cranial reconstruction surgery is a procedure used as an attempt to reestablish the cranial bone anatomy. This study evaluates the symptomatic and aesthetic improvement of patients with cranial defects secondary to decompressive craniectomies after cranial reconstruction with customized polymethyl methacrylate (PMMA) prostheses. Secondly, we aim to divide our experience in the production of these prostheses with a low-cost method. Methods: A prospective study was carried out with patients submitted to cranioplasty at the Hospital da Restauração between 2014 and 2017. A total of 63 cranioplasties were performed using customized PMMA prosthesis produced by 3D impression molds. All patients underwent a functional and aesthetic evaluation questionnaire in the preoperative period and in the sixth postoperative month. Results: Sixty-three patients underwent cranioplasty with a mean age of 33 years, ranging from 13 to 58 years, 55 males and 8 females. The mean area of the defect was 147 cm2. The mean postoperative follow-up of the patients was 21 months, ranging from 6 to 33 months. Fifty-five patients attended the 6-month postoperative consultation. All patients presented symptomatic improvement after reconstruction of the skull. The infection rate was 3.2%, 4.8% of extrusion, 1.6% of prosthesis fracture, 7.9% of extradural hematoma, 17.4% of reoperation, 5% of wound dehiscence, and 4.8% of removal of the prosthesis. Conclusion: Cranioplasty, with a customized PMMA prosthesis, improved the symptoms and aesthetic appearance of all operated patients. The use of prototypes to customize cranial prostheses facilitated the operative technique and allowed the recovery of a cranial contour very close to normal.
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Affiliation(s)
| | | | | | | | - Jorge Vicente Lopes da Silva
- Information Technology Center Renato Archer (Ministry of Science and Technology of Brazil), Campinas, Sao Paulo, Brazil
| | - Amanda Amorin Nunes
- Process Engineering and Materials Engineering. Works at Information Technology Center Renato Archer (Ministry of Science and Technology of Brazil), Campinas, Sao Paulo, Brazil
| | - Nivaldo S Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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Vieira E, Guimarães TC, Faquini IV, Silva JL, Saboia T, Andrade RVCL, Gemir TL, Neri VC, Almeida NS, Azevedo-Filho HRC. Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty. J Neurosurg 2017; 129:1017-1023. [PMID: 29148904 DOI: 10.3171/2017.4.jns152954] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decompressive craniectomy (DC) is a widely used procedure in neurosurgery; however, few studies focus on the best surgical technique for the procedure. The authors' objective was to conduct a prospective randomized controlled trial comparing 2 techniques for performing DC: with watertight duraplasty and without watertight duraplasty (rapid-closure DC). METHODS The study population comprised patients ranging in age from 18 to 60 years who were admitted to the Neurotrauma Service of the Hospital da Restauração with a clinical indication for unilateral decompressive craniectomy. Patients were randomized by numbered envelopes into 2 groups: with watertight duraplasty (control group) and without watertight duraplasty (test group). After unilateral DC was completed, watertight duraplasty was performed in the control group, while in the test group, no watertight duraplasty was performed and the exposed parenchyma was covered with Surgicel and the remaining dura mater. Patients were then monitored daily from the date of surgery until hospital discharge or death. The primary end point was the incidence of surgical complications (CSF leak, wound infection, brain abscess, or subgaleal fluid collections). The following were analyzed as secondary end points: clinical outcome (analyzed using the Glasgow Outcome Scale [GOS]), surgical time, and hospital costs. RESULTS Fifty-eight patients were enrolled, 29 in each group. Three patients were excluded, leaving 27 in the test group and 28 in the control group. There were no significant differences between groups regarding age, Glasgow Coma Scale score at the time of surgery, GOS score, and number of postoperative follow-up days. There were 9 surgical complications (5 in the control group and 4 in the test group), with no significant differences between the groups. The mean surgical time in the control group was 132 minutes, while in the test group the average surgical time was 101 minutes, a difference of 31 minutes (p = 0.001). The mean reduction in total cost was $420.00 USD (a 23.4% reduction) per procedure in the test group. CONCLUSIONS Rapid-closure DC without watertight duraplasty is a safe procedure. It is not associated with a higher incidence of surgical complications (CSF leak, wound infection, brain abscess, or subgaleal fluid collections), and it decreased surgical time by 31 minutes on average. There was also a hospital cost reduction of $420.00 USD (23.4% reduction) per procedure. Clinical trial registration no.: NCT02594137 (clinicaltrials.gov).
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14
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Nobre EF, Farias GA, Almeida NS. Polaritons in uniaxial materials propagating in hollow cylinders. J Opt Soc Am A Opt Image Sci Vis 2000; 17:173-179. [PMID: 10641853 DOI: 10.1364/josaa.17.000173] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The properties of polaritons propagating in hollow dielectric and magnetic cylinders embedded in an optically inert medium are studied. We pay special attention to those solutions of Maxwell's equations that give the behavior of the nonradiative modes (confined and localized) propagating in an optically active cylindrical medium. The dispersion relation of surface (localized) modes is obtained. Numerical results are presented for cylinders constituted by magnetic and dielectric materials, such as the uniaxial Heisenberg antiferromagnet MnF2 and the dielectric TiO2.
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Affiliation(s)
- E F Nobre
- Departamento de Física, Universidade Federal do Ceará, Fortaleza, Brasil
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Almeida NS, Mills DL. Eddy currents and spin excitations in conducting ferromagnetic films. Phys Rev B Condens Matter 1996; 53:12232-12241. [PMID: 9982855 DOI: 10.1103/physrevb.53.12232] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Almeida NS, Mills DL. Phase diagram of magnetic multilayers: The role of biquadratic exchange. Phys Rev B Condens Matter 1995; 52:13504-13510. [PMID: 9980546 DOI: 10.1103/physrevb.52.13504] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Almeida NS, Mills DL, Teitelman M. Temperature variation of the interfilm exchange in magnetic multilayers: the influence of spin wave interactions. Phys Rev Lett 1995; 75:733-736. [PMID: 10060100 DOI: 10.1103/physrevlett.75.733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Almeida NS, Carriço AS. Nonlinear response of antiferromagnetic films to radiation at oblique incidence. Phys Rev B Condens Matter 1993; 48:9835-9838. [PMID: 10007237 DOI: 10.1103/physrevb.48.9835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Almeida NS, Farias GA, Oliveira NT, Vasconcelos EF. Influence of a dc field on polaritons confined in magnetic wires. Phys Rev B Condens Matter 1993; 48:9839-9842. [PMID: 10007238 DOI: 10.1103/physrevb.48.9839] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Vasconcelos EF, Oliveira NT, Farias GA, Almeida NS. Polaritons confined in magnetic wires. Phys Rev B Condens Matter 1991; 44:12621-12623. [PMID: 9999433 DOI: 10.1103/physrevb.44.12621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Almeida NS, Tilley DR. Susceptibility and surface magnetostatic modes for the spiral and cone states of rare-earth magnets. Phys Rev B Condens Matter 1991; 43:11145-11153. [PMID: 9996851 DOI: 10.1103/physrevb.43.11145] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Almeida NS, Mills DL. Erratum: Effective-medium theory of long-wavelength spin waves in magnetic superlattices. Phys Rev B Condens Matter 1989; 39:12339. [PMID: 9949145 DOI: 10.1103/physrevb.39.12339.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Almeida NS, Mills DL. Effective-medium theory of long-wavelength spin waves in magnetic superlattices. Phys Rev B Condens Matter 1988; 38:6698-6710. [PMID: 9945348 DOI: 10.1103/physrevb.38.6698] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Mauger A, Almeida NS, Mills DL. Magnetic polarons and electronic structure in semimagnetic superlattices: Application to CdTe/Cd1-xMnx. Phys Rev B Condens Matter 1988; 38:1296-1310. [PMID: 9946390 DOI: 10.1103/physrevb.38.1296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kahn L, Almeida NS, Mills DL. Nonlinear optical response of superlattices: Multistability and soliton trains. Phys Rev B Condens Matter 1988; 37:8072-8081. [PMID: 9944138 DOI: 10.1103/physrevb.37.8072] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Almeida NS, Mills DL. Dynamical response of antiferromagnets in an oblique magnetic field: Application to surface magnons. Phys Rev B Condens Matter 1988; 37:3400-3408. [PMID: 9944932 DOI: 10.1103/physrevb.37.3400] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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DeLucia R, Planeta CDS, Almeida NS. [Consumption of drugs, alcoholic beverages and cigarettes by workers of Cubatão]. AMB Rev Assoc Med Bras 1987; 33:215-8. [PMID: 3504291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Almeida NS, Tsallis C. Equation of state for the infinite cluster and backbone in the anisotropic square lattice. Phys Rev B Condens Matter 1985; 32:4725-4731. [PMID: 9937654 DOI: 10.1103/physrevb.32.4725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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