Hugo Dória-Netto - Academia.edu (original) (raw)

Papers by Hugo Dória-Netto

The pterional access, popularized by Yasargil in 1976, is, to date, the most widely used surgical... more The pterional access, popularized by Yasargil in 1976, is, to date, the most widely used surgical route in neurosurgery 1,2. This access allows for transylvian and lateral subfrontal views. As well as a straight downward view of the anterolateral aspect of the basilar bifurcation 3,4. Drake introduced the subtemporal approach during the 1970's 5,6. The subtemporal approach offers a lateral view of the interpenducular fossa by retracting the temporal lobe superiorly. The temporopolar approach was first described by Sano in 1980 7. The subtemporal approach offers a lateral view of the interpenducular fossa by retracting the temporal lobe supe riorly. The temporopolar approach consists in pulling back the temporal pole, creating and enlarging an anterolateral view of the interpeduncular fossa. The addition of transylvian and subfrontal views to the subtemporal and temporopolar views is of great importance when a neurosurgeon needs to expose the interpeduncular cistern region or the entire temporal lobe, including the me dial portion. By microsurgical dissection of the Sylvian fis sure, third cranial nerve, crural and ambiens we are able to expose the entire temporal lobe. The pretemporal approach, described by de Oliveira, combines the advantages of all these approaches in one craniotomy 810. This approach exposes the entire temporal lobe in order to offer the transylvian and late ral subfrontal views, from the pterional craniotomy, along with the subtemporal and temporopolar views to access the interpeduncular fossa. Our team has performed eighty pretemporal cranioto mies from 2002 to 2012 at a private medical service. These were done to deal with forty six tumors, eighteen aneurysms, twelve arteriovenous malformations, two cavernous heman gioma and two dural arteriovenous fistula. DescriPtion of PretemPoral craniotomy Positioning The patient should be placed supine, with the shoulder at the edge of the surgical table in a neutral position, and head and neck remain suspended after removal of the head sup port. The head should be secured by a threepin skull fixa tion device (Mayfield or Sugita model), and must be main tained above the level of the right atrium to facilitate venous

World Neurosurgery, Apr 1, 2022

Arteriovenous malformations (AVMs) are complex, heterogeneous and uncommon neurovascular disorder... more Arteriovenous malformations (AVMs) are complex, heterogeneous and uncommon neurovascular disorders, frequently manifested in young adults. Parenchymal AVMs are thought to be congenital but this dogma 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 is variable and depends on its location, size, ability to take flow from adjacent areas and mainly on the occurrence of bleeding.4 AVMs can be treated by one or a combination of different treatment modalities. According to the "Expert Consensus on the Management of Brain Arteriovenous Malformations" in Spetzler-Martin Grade 2 AVMs, neurosurgery may be the best option.5 But the treatment of these lesions when located in eloquent areas, especially in the central lobe, is controversial. Awake craniotomy (AC) allows identification of eloquent gyrus and can potentially facilitate resection with preservation of functions. An alternative is stereotactic radiosurgery (SRS) but qualitative comparative analysis had revealed higher obliteration rate with awake AVM excision as compared to SRS.6 AC was the earliest surgical procedure known, and it has become fashionable again. In the past it was used for the surgical management of intractable epilepsy, but nowadays, its indications are increasing, and it is a widely recognized technique for the resection of mass lesions involving the eloquent cortex, and for deep brain stimulation.7 But its application for resection of vascular lesions, including AVMs, is still limited. In this 3-dimensional operative 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.

Advances in Cerebral Aneurysm Treatment [Working Title]

Intracranial aneurysms (IAs) found in the subarachnoid compartment of the internal carotid artery... more Intracranial aneurysms (IAs) found in the subarachnoid compartment of the internal carotid artery are at risk of rupturing and producing hemorrhage into this space, producing all the known serious pathological manifestations of subarachnoid hemorrhage. On the other hand, those who are exclusively in the intracavernous segment have this negligible risk. It is in this context that a peculiar class of IAs fits, the paraclinoid aneurysms, which are characterized by their complex anatomical relationships with the optic apparatus, anterior clinoid process, the first supraclinoidal arterial branches of the carotid artery, the oculomotor nerve and the segment mainly said clinoid, which is delimited by the proximal and distal dural rings. It is of crucial importance, and challenging, to determine the location of paraclinoid aneurysms and their exact relationship with the cavernous sinus, given the need to establish an adequate line of treatment for each case. Through preoperative studies of ...

Surgical Neurology International, Mar 31, 2022

is is an open-access article distributed under the terms of the Creative Commons Attribution-Non... more is is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

World Neurosurgery, 2021

Arteriovenous malformations (AVMs) are congenital neurovascular disorders frequently manifested i... more Arteriovenous malformations (AVMs) are congenital neurovascular disorders frequently manifested in young adults. The clinical presentation is variable and depends on its location, its size and its ability to steal flow from adjacent areas, but it mainly depends on the occurrence of bleeding. (1) The treatment of these lesions when located in eloquent areas, especially around the central sulcus, is controversial. Surgical resection of an AVM in the central lobe may cause postoperative sensorimotor deficits, since this anatomical region includes the pre- and postcentral gyri on the lateral surface and the paracentral lobule on the medial surface. (2) AVMs can be successfully treated by surgery, but this treatment may pose unacceptable risks to the patient if the AVM involves an eloquent cortex. We consider that surgical removal of many of these lesions is feasible, when preoperative planning is performed (3), when it is based on deep anatomical knowledge and particularly on a refined microsurgical technique. (1) In this 3-dimensional operative video, we present a case of a cerebral AVM of the Central Sulcus in which we achieved complete resection with microsurgical treatment without any neurological sequelae for the patient.

Neurosurgical focus, 2017

The management of arteriovenous malformations (AVMs) of the corpus callosum and choroidal fissure... more The management of arteriovenous malformations (AVMs) of the corpus callosum and choroidal fissure is challenging because they commonly receive arterial feeders from the anterior and posterior circulation, and drain to deep veins. In this video the authors present the case of a 20-year-old man who presented with acute onset of headache, loss of consciousness, and nuchal rigidity. Computed tomography, MRI, and cerebral angiography performed in tandem revealed a ruptured, large, Grade IV AVM of the corpus callosum and choroidal fissure with two groups of arterial feeders: one from the pericallosal artery and the other from the medial and lateral posterior choroidal arteries. The treatment strategy included two stages. The first stage involved preoperative embolization of the arterial feeders from the posterior circulation, which promoted reduction of the nidus flow of the AVM. The second involved a microsurgical resection, using the interhemispheric approach, with the patient in the pr...

Journal of Neurosurgery, Aug 1, 2018

T he subcallosal area is the inferomedial portion of the frontal lobe located rostral to the corp... more T he subcallosal area is the inferomedial portion of the frontal lobe located rostral to the corpus callosum. Reaching the subcallosal region has been a challenge for neurosurgeons because of its deep location and close relationship with important vascular structures. Inferior routes, such as the fronto-orbitozygomatic transsylvian approach, or anterior routes, such as the infrafrontal interhemispheric approach, have been most commonly used to approach lesions in the subcallosal area. 2-5,8-10, 12, 14, 15,20 The hazard of anterior and inferior routes to the subcallosal region is possible damage to the branches of the anterior cerebral artery (ACA), particularly the hypothalamic and subcallosal branches. Injury to these arterial branches may result in memory impairment, amnestic-confabulatory syndrome, or hypothalamic problems. Additionally, a transventricular preforniceal approach, which is a route ABBREVIATIONS ACA = anterior cerebral artery; ACoA = anterior communicating artery.

Journal of Neurological Surgery Part B: Skull Base, 2012

Arquivos de Neuro-Psiquiatria, 2014

This article intends to describe in a didactical and practical manner the suboccipital far-latera... more This article intends to describe in a didactical and practical manner the suboccipital far-lateral craniotomy. This is then basically a descriptive text, divided according to the main stages involved in this procedure, and that describes with details how the authors currently perform this craniotomy.

Tratado de neurologia clínica e cirúrgica, Apr 13, 2022

The Intersection Between the Oculomotor Nerve and the Internal Carotid Artery to Distinguish Extracavernous and Intracavernous Paraclinoid Aneurysms Using Anatomic DissectionseA New 3T Magnetic Resonance Imaging Protocol Confirmed by Three-Dimensionally Printed Biomodels, 2022

The intersection between the ICA and the CNIII, which crosses it transversely in its entire diame... more The intersection between the ICA and the CNIII, which crosses it transversely in its entire diameter, is a reliable anatomic-radiologic landmark to correctly classify paraclinoid aneurysms. Through a new MRI protocol, it is possible to radiologically identify this intersection and to easily distinguish the intracavernous and extracavernous ICA paraclinoid aneurysms.

British Journal of Neurosurgery

OBJECTIVE This case study aims to present the Foreign Accent Syndrome (FAS) in a patient with Cer... more 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.

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2015

Introduction Gangliogliomas are tumors commonly found in the temporal lobe and related to seizure... more Introduction Gangliogliomas are tumors commonly found in the temporal lobe and related to seizures; their appearance in the pineal region is rarely described. This report characterizes the first case of anaplastic ganglioglioma of the pineal region. Case Report The authors describe the case of a 32-year-old woman that developed progressive headache. An MRI investigation revealed a pineal tumor. The patient tested negative for biomarkers and underwent surgery through supracerebellar infratentorial approach and achieved gross total resection of the tumor in a challenging location. Pathological analysis revealed a biphasic neoplasm with the following two distinct phenotypes in separate fields: an immature neuronal component with several atypical mitoses and a mature astrocytic component with bipolar cells, microcysts, and eosinophilic bodies. The Ki67/MIB1 proliferation index was 20-30% in localized hotspots. Based on the pathological findings, the tumor was defined as an anaplastic ganglioglioma World Health Organization (WHO) grade III. Discussion/Conclusion Gangliogliomas are classified as glioneural neoplasms based on the histologic findings described as a mixture of neoplastic astrocytes and neurons. Moreover, these tumors represent 0.4-1.3% of tumors of the central nervous system. Authors describe de novo anaplastic ganglioglioma as 1% of the largest series. Gross total resection and adjuvant treatment may play important role in patients' prognostic. In this case, due to the malignant anaplastic component of her tumor, the patient received treatment with temozolamide and radiotherapy after gross total resection of the lesion.

Arquivos de Neuro-Psiquiatria, 2012

This review intended to describe in a didactic and practical manner the frontotemporosphenoidal c... more This review intended to describe in a didactic and practical manner the frontotemporosphenoidal craniotomy, which is usually known as pterional craniotomy and constitute the cranial approach mostly utilized in the modern neurosurgery. This is, then, basically a descriptive text, divided according to the main stages involved in this procedure, and describes with details how the authors currently perform this craniotomy.