Leodante da Costa - Academia.edu (original) (raw)

Papers by Leodante da Costa

Journal of NeuroInterventional Surgery, Feb 18, 2012

Canadian Journal of Neurological Sciences, Jun 26, 2016

Neurosurgery, Aug 1, 2012

ABSTRACT : Vertebral compression fracture (VCF) is increasingly being observed post-spine SBRT. A... more ABSTRACT : Vertebral compression fracture (VCF) is increasingly being observed post-spine SBRT. A recent SINS classification was developed to segregate patients into the unstable, potentially unstable and stable risk categories but has yet to be clinically validated. The aim of this study was to determine the risk of VCF post-spine SBRT, and identify if SINS in addition to SBRT specific clinical and dosimetric factors were predictive for VCF. : We retrospectively scored 167 spinal segments in 100 patients treated with spine SBRT according to SINS specific criteria. In addition, we evaluated the presence of paraspinal extension, prior-radiation, dose per fraction (=20Gy vs. <20 Gy), age and histology. The median total dose was 24 Gy (range, 8-35Gy), and number of fractions three (range, 1- 5 fractions). Baseline spine magnetic resonance imaging (MRI) and computed tomography (CT) at baseline were compared to subsequent imaging at two to three monthly intervals. Post-operative patients and patients who recurred prior to any VCF were excluded. : Patients were classified by SINS as stable (57%) or potentially unstable (43%) at baseline. The median follow-up was 7.4 months (range, 0.4-37.3 months). Nineteen fractures (11%) were identified, and 12 (63%) were de novo and seven (37%) were fractures that had progressed (FP). The mean and median time to fracture post-SBRT was 3.3 and 2 months, respectively (range, 0.5-21.6 month). The one-year fracture-free probability (FFP) was 87.3%. Multivariate analysis confirmed that alignment (P = 0.0003, HR 0.09), lytic lesion (P 0.007, HR 0.082), primary histologic type, and dose per fraction >20Gy (P 0.004, HR 8.2) were the only significant predictors of VCF. : Presence of deformity and lytic tumor were the only predictive factors of VCF based on the original SINS criteria. Patients treated with =20 Gy in a single fraction and spinal metastases from liver and lung primaries were also at a higher risk of VCF.

International Journal of Radiation Oncology Biology Physics, Nov 1, 2018

Purpose/Objective(s): Laryngeal squamous cell carcinoma (LSCC) is the most common type of larynge... more Purpose/Objective(s): Laryngeal squamous cell carcinoma (LSCC) is the most common type of laryngeal carcinoma and the incidence has increased in recent years across the world. There is therefore an urgent need to develop novel potential therapeutic targets. Matrix metalloproteinases (MMPs) have been found to play a role in the process of tumor invasion and metastasis, in particular MMP2 and MMP3. However, their expression and mechanism of action in LSCC remains largely unknown. In this study, we examined the expression of MMP2 and MMP3 in tissue samples from LSCC patients. Materials/Methods: A total of 10 patients with pathologically-confirmed LSCC and 10 normal LSCC tissue samples adjacent to a LSCC were collected from patients undergoing curative-intent surgery at the Eye and ENT Hospital, Fudan University, China. Human LSCC cell lines, Hep-2 and LSC-1, were purchased from the Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences. We examined MMP2 and MMP3 expression in archived LSCC tissues using RT-PCR and western blot analysis. we overexpressed MMP2 and MMP3 in two LSCC cell lines, Hep-2 and LSC-1 and use CCK8 and transwell assay to test the ability of Proliferation and migration. Then we performed RT-PCR to detect the expression of E-cadherin and N-cadherin mRNA in LSCC cells lines, which revealed that both were reduced following the overexpression of MMP2 and MMP3. We knocked down MMP2 and MMP3 in Hep-2 and LSC-1 cells using a short hairpin RNA (sh-MMP2 and sh-MMP3), with scrambled shRNA as the control. We measured the expression of EMT markers, E-cadherin and N-cadherin, using RT-PCR and western blot analysis after inhibition of MMP2 and MMP3. Results: The study showed that expression of both MMPs was upregulated compared to control samples. We also found that upregulation of both MMP2 and MMP3 promoted LSCC cell proliferation and migration. Further investigation demonstrated that the expression of the epithelial marker, E-cadherin, is reduced and that of the mesenchymal marker, Ncadherin, is increased in LSCC cells following MMP2 or MMP3 upregulation, suggesting activation of epithelialemesenchymal transition. We employed a knockdown system utilizing RNA interference to add further support to this theory. Conclusion: These results suggest that MMP2 and MMP3 are critical for the growth and metastasis of LSCC, and that a drug that targets MMP2 and MMP3 may constitute a novel pharmacological approach to the treatment of this condition.

Canadian Journal of Neurological Sciences, Nov 1, 2009

Dural arteriovenous fistulae (DAVF) are abnormal arteriovenous shunts that occur in the dura. Cli... more Dural arteriovenous fistulae (DAVF) are abnormal arteriovenous shunts that occur in the dura. Clinical manifestation is related to the pattern of venous drainage and can include ocular symptoms, bruit, congestive venous encephalopathy and intracranial hemorrhage. Approximately 50% of dural arteriovenous fistulae occur in the posterior fossa, and typically involve the transverse and sigmoid sinuses. Involvement of the tentorium or marginal sinus is less common. Borden et al have classified cranial DAVF as follows: Type I DAVFs are those that drain directly into the dural venous sinus or meningeal vein. Type II DAVFs are those that drain into the venous sinus with retrograde drainage into subarachnoid (superficial) veins. Type III DAVFs are those that drain into the ABSTRACT: Objective: Dural arteriovenous fistulae (DAVF) of the hypoglossal canal region are rare lesions. We describe three cases of DAVF of the hypoglossal canal presenting with ocular symptoms and discuss the endovascular management options. Methods: Three consecutive patients with DAVF of the hypoglossal canal region presented with proptosis, chemosis and disturbances of extra-ocular mobility. Each patient was treated using a different endovascular approach, based on variations of the vascular access. Results: The cases and treatments are reviewed, with a literature review on the subject. Endovascular treatment, transvenous or trans-arterial was curative in all cases. Conclusion: DAVF of the hypoglossal canal region can present with ocular manifestations very similar to DAVF of the cavernous sinus or carotid-cavernous fistulas. Endovascular treatment is usually feasible and effective, but an understanding of the vascular anatomy and pathophysiology of the disease are of utmost importance when planning the approach. RÉSUMÉ: Traitement endovasculaire des fistules artérioveineuses du canal de l'hypoglosse avec symptômes orbitaires. Objectif : Les fistules artérioveineuses durales (FAVD) de la région du canal de l'hypoglosse sont rares. Nous décrivons trois cas de FAVD du canal de l'hypoglosse dont les symptômes initiaux étaient des symptômes oculaires et nous discutons des options endovasculaires de traitement. Méthodes : Trois patients consécutifs atteints de FAVD de la région du canal de l'hypoglosse ont consulté pour exophtalmie, chémosis et troubles de la motricité extra-oculaire. Chaque patient a été traité au moyen d'une approche endovasculaire différente à cause de variations individuelles de l'accès vasculaire. Résultats : Les cas et les traitements ont été révisés et nous avons procédé à une revue de littérature sur ce sujet. Le traitement endovasculaire, transveineux ou transartériel, s'est avéré curatif dans tous les cas. Conclusion : Les FAVD de la région du canal de l'hypoglosse peuvent provoquer des manifestations oculaires comme symptômes initiaux qui sont très semblables à celles des FAVD du sinus caverneux ou des fistules carotidiennes-caverneuses. Le traitement endovasculaire est habituellement faisable et efficace, mais une compréhension de l'anatomie vasculaire et de la physiopathologie de la maladie sont cruciales pour déterminer l'approche à privilégier.

Frontiers in Neurology, May 11, 2016

Objective: Increased awareness around neurocognitive deficits after mild traumatic brain injury (... more Objective: Increased awareness around neurocognitive deficits after mild traumatic brain injury (mTBI) has progressed the search for objective, diagnostic, and monitoring tools, yet imaging biomarkers for mTBI and recovery are not established in clinical use. It has been suggested that mTBI impairs cerebrovascular reactivity (CVR) to CO2, which could be related to post-concussive syndrome (PCS). We investigate CVR evolution after mTBI using blood-oxygen-level dependent (BOLD) magnetic resonance imaging (MRI) and possible correlation with PCS. Methods: A prospective cohort of 25 mTBI patients and 18 matched controls underwent BOLD MRI CVR measurements. A subset of 19 mTBI patients underwent follow-up testing. Visits took place at a mean of 63 and 180 days after injury. Symptoms were assessed with the Sport Concussion Assessment Tool 2 (SCAT2). Symptoms, CVR and brain volume [gray matter (GM), white matter (WM), and whole brain (WB)], age, and sex, were examined between groups and longitudinally within traumatic brain injury (TBI) patients. results: Traumatic brain injury participants were 72% males, mean age being 42.7 years. Control participants were 61% with mean age of 38.7 years. SCAT2 scores tended to improve among those mTBI patients with follow-up visits (p = 0.07); however, they did not tend to recover to scores of the healthy controls. Brain volumes were not statistically different between groups at the first visit (WM p = 0.71; GM p = 0.36). In mTBI patients, there was a reduction in GM volume between visits 1 and 2 (p = 0.0046). Although mean CVR indexes were similar (WM p = 0.27; GM p = 0.36; and WB p = 0.35), the correlation between SCAT2 and CVR was negative in controls

Journal of Neurosurgery: Case Lessons

BACKGROUND This report describes the use of hyperbaric oxygen therapy for the acute management of... more BACKGROUND This report describes the use of hyperbaric oxygen therapy for the acute management of an intraoperative air embolism encountered during a neurosurgical procedure. Furthermore, the authors highlight the concomitant diagnosis of tension pneumocephalus requiring evacuation prior to hyperbaric therapy. OBSERVATIONS A 68-year-old male developed acute ST-segment elevation and hypotension during elective disconnection of a posterior fossa dural arteriovenous fistula. The semi-sitting position had been used to minimize cerebellar retraction, raising the concern for acute air embolism. Intraoperative transesophageal echocardiography was utilized to establish the diagnosis of air embolism. The patient was stabilized on vasopressor therapy, and immediate postoperative computed tomography revealed air bubbles in the left atrium along with tension pneumocephalus. He underwent urgent evacuation for the tension pneumocephalus followed by hyperbaric oxygen therapy to manage the hemodyna...

Infection Control & Hospital Epidemiology

Objective:To evaluate the utility of autologous bone-flap swab cultures performed at the time of ... more Objective:To evaluate the utility of autologous bone-flap swab cultures performed at the time of cranioplasty in predicting postcranioplasty surgical site infection (SSI).Design:Retrospective cohort study.Participants:Patients undergoing craniectomy (with bone-flap storage in tissue bank), followed by delayed autologous bone-flap replacement cranioplasty between January 1, 2010, and November 30, 2020.Setting:Tertiary-care academic hospital.Methods:We framed the bone-flap swab culture taken at the time of cranioplasty as a diagnostic test for predicting postcranioplasty SSI. We calculated, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios.Results:Among 282 unique eligible cases, 16 (5.6%) developed SSI after cranioplasty. A high percentage of bone-flap swab cultures were positive at the time of craniectomy (66.7%) and cranioplasty (59.5%). Most organisms from bone-flap swab cultures were Cutibacterium acnes or coagulase-neg...

Journal of Stroke and Cerebrovascular Diseases

OBJECTIVES Ischemic stroke has been estimated to occur in up to 26% of patients with blunt cerebr... more OBJECTIVES Ischemic stroke has been estimated to occur in up to 26% of patients with blunt cerebrovascular injury (BCVI). Antithrombotic therapy (AT) may be used for stroke prevention, but the role of endovascular treatment (ET) remains unclear. We systematically reviewed the literature on AT and ET for the treatment of patients with BCVIs. MATERIALS AND METHODS PubMed, EMBASE, Web of Science, and Cochrane were searched upon the PRISMA guidelines to include studies reporting the use of ET in BCVI patients. Post-ET neurologic outcomes, radiographic responses, and complication rates were assessed. A fixed-effect model meta-analysis was performed to compare treatment-related post-BCVI ischemic stroke rates between AT and ET protocols. RESULTS We included 16 studies comprising 352 patients undergoing ET for BCVI. Mean post-ET rates of good neurologic outcomes and radiologic responses were 86.9% (range, 63.6-100%) and 94.0% (range 57.1-100%), respectively. Mean post-ET complication rate was 5.2% (range, 0-66.7%). Seven studies compared the roles of AT (delivered in 805 patients) and ET (performed in 235 patients) for preventing the onset of post-BCVI ischemic strokes. No significant difference in rates of post-BCVI ischemic stroke was found between patients receiving AT vs patients undergoing ET (OR 0.71, 95% CI: 0.35-1.42, p = 0.402). CONCLUSION AT and ET may be comparable in preventing the occurrence of ischemic stroke following BCVIs. AT may be preferred as the less-invasive first-line therapy, but ET showed favorable rates of post-treatment clinical and radiologic outcomes, coupled with low rates of treatment-related complications.

Plastic & Reconstructive Surgery, 2021

Learning Objectives: After studying this article, the participant should be able to: 1. Define an... more Learning Objectives: After studying this article, the participant should be able to: 1. Define and classify different types of cranial defects 2. Compare both autologous and alloplastic options for reconstruction 3. Develop an optimal approach for cranial vault reconstruction in various clinical scenarios. Summary: Defects of the cranium result from various causes, including traumatic loss, neurosurgical intervention, skull tumors, and infection. Cranial vault reconstruction aims to restore both the structural integrity and surface morphology of the skull. To ensure a successful outcome, the choice of appropriate cranioplasty reconstruction will vary primarily based on the cause, location, and size of the defect. Other relevant factors that must be considered include adequacy of soft-tissue coverage, presence of infection, and previous or planned radiation therapy. This article presents an algorithm for the reconstruction of various cranial defects using both autologous and alloplastic techniques, with a comparison of their advantages and disadvantages.

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2021

Background: Ischemic stroke occurs following trauma-related blunt cerebrovascular injury (BCVI) i... more Background: Ischemic stroke occurs following trauma-related blunt cerebrovascular injury (BCVI) in up to 20% of cases. Preventative treatment includes antiplatelets, anticoagulants, and/or endovascular treatment (ET), but the optimal choice remains unclear. The objective of this study was to compare the ischemic stroke rate between these three treatments. Methods: Following PRISMA guidelines, we queried the OVID Medline, Embase, Web of Science, and Cochrane Library databases from September 2019 to inception to identify studies reporting treatment-stratified outcomes in BCVI patients. Meta-analysis was performed to compare outcomes between the treatment groups, using odds ratios. Retrospective review of our institutional experience with BCVI outcomes was performed and added to the meta-analysis. Results: Analysis of seven comparative studies of antiplatelets (n=334) versus anticoagulation (n=325) found no significant difference in ischemic stroke rate (OR 1.27, 95%CI 0.40-3.99), but ...

Journal of Craniofacial Surgery, 2020

Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid arterial system an... more Carotid-cavernous fistulas (CCFs) are abnormal connections between the carotid arterial system and the cavernous sinus. These acquired vascular malformations may result in severe orbital congestion and sight-threatening complications. The authors present their experience in gaining access to the superior ophthalmic vein to embolize indirect CCFs in three different patients. Surgical exposure and cannulation of the SOV were successful in all 3 cases. One patient developed an orbital compartment syndrome towards the end of the embolization process, after the irrigation cannula was inadvertently dislodged from the SOV. He required a lateral canthotomy and inferior cantholysis but did not suffer from any related sequelae. Signs and symptoms resolved gradually in all patients and cosmetic results were excellent. In our experience, the SOV offers a reliable access to indirect CCFs, but patients should be monitored closely during the embolization process to prevent ophthalmic complications.

Journal of Clinical Neuroscience, 2020

Introduction: Cranial dural arteriovenous fistulas (DAVFs) are rare vascular lesions that often h... more Introduction: Cranial dural arteriovenous fistulas (DAVFs) are rare vascular lesions that often harbour complex angio-architectural features. This subtype of DAVF may require multiple, multimodality, or hybrid treatments. In this paper we aim to identify specific angio-architectural features that are present in complex cranial DAVFs and we report our series with respect to treatment modalities and outcomes. Methods: Twenty-five cranial Borden type II and III cranial DAVFs were treated at our Institution from 2013 to 2017. We classified nine (36%) as complex based on specific angio-architectural features. Treatment strategies were based on fistula location, angiographic features and patient's presenting condition. Phone interviews were used to confirm outcome at 6 and 12 months. Results: Four patients (45%) presented with acute hydrocephalus, and 3 (33%) with intracranial hemorrhage. Multiple and combined treatment sessions were needed for all complex DAVFs. Five patients required 2 endovascular procedures each. One patient had 2 surgeries. The first line of treatment was endovascular in 6 cases (67%) and surgery in 3 (33%). Two treatment-related (22%) complications occurred. Complete disconnection was achieved in 5 out of 9 patients (55%). Two patients with an incomplete disconnection refused further treatment and were well at last follow up, with a partially treated fistula and persistent CVR. The other 3 patients concluded treatment after the end of our data collection period. At 1 year, 7/9 patients had stable or improved clinical symptoms, and 8/9 patients had GOS of 4 or 5. Conclusions: Complex cranial DAVF often require a multidisciplinary approach and multiple treatment sessions should be expected. Specific angio-architectural features that increase DAVF complexity include multiple arterial feeders, especially transosseous or pial, reflux into multiple cortical veins, sinus occlusion/ entrapment, venous aneurysms, segmental stenosis, medial or deep location, and association with the deep venous system.

Neurology: Clinical Practice, 2019

Funding information and disclosures are provided at the end of the article. Full disclosure form ... more Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Acta Urológica Portuguesa, 2017

Introdução: As fístulas uro-rectais (FUR) constituem uma complicação devastadora do tratamento de... more Introdução: As fístulas uro-rectais (FUR) constituem uma complicação devastadora do tratamento de tumores pélvicos e um desafio cirúrgico para o cirurgião reconstrutivo. Contudo, apesar da sua crescente incidência associada a uma utilização cada vez mais frequente das diferentes modalidades não-cirúrgicas, especialmente de radioterapia, com ou sem cirurgia, para o tratamento de tumores pélvicos, a fístula urorectal permanece relativamente rara. Dada a elevada improbabilidade do encerramento espontâneo da fístula uro-rectal, a correcção cirúrgica torna-se necessária na quase totalidade dos casos. Apesar da existência de várias técnicas cirúrgicas, as taxas de falência/recorrência são habitualmente elevadas, particularmente em fístulas rádicas. Descrevemos neste estudo a nossa experiência limitada no tratamento de fístulas urorectais resultantes de tratamentos de tumores pélvicos (aparelho urinário inferior e recto). Métodos: Entre Outubro de 2008 e Fevereiro de 2015, foram identifica...

Neurosurgery, 2019

INTRODUCTION Studies evaluating endothelial injury after endovascular thrombectomy (EVT) have bee... more INTRODUCTION Studies evaluating endothelial injury after endovascular thrombectomy (EVT) have been done by means of retrieved human thrombus, magnetic resonance (MR) vessel-wall imaging, and animal histopathologic studies. These techniques have limitations, as MR imaging has insufficient spatial resolution to directly visualize endothelium, and histopathologic examinations are ex vivo and unable to provide real-time patterns of injury. The aim of the current study is intraluminal imaging after EVT using optical coherence tomography (OCT). We describe our animal model for thrombus preparation, vessel occlusion, mechanical thrombectomy, and subsequent endovascular OCT imaging. Furthermore, we describe the first human endovascular OCT imaging after EVT in 2 stroke patients. METHODS A total of 3 swine weighing 35 to 40 kg were selected for the animal model. Autologous venous whole blood drawn 48 h before the procedure was used to create thrombus. The bilateral superficial cervical arter...

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2012

Glioblastoma (GBM) is the most common intrinsic brain tumor in adults, accounting for 67% of prim... more Glioblastoma (GBM) is the most common intrinsic brain tumor in adults, accounting for 67% of primary brain tumors. Giant cell glioblastoma (GCG) is a rare variation of GBM, occurring in less than 5% of the cases. GCG has been demonstrated to affect younger patients and have a more indolent course than traditional GBM with longer survival rates. Age, surgical resection, and genetic features are likely related with better prognosis. The presence of a p53 mutation is found in 75% of GCG with this more indolent behavior. We present a case of a 72 years-old female who presented with an extremely aggressive GCG without p53 expression who had an unusually rapid neurological deterioration and tumor regrowth after surgical excision.

Scientific reports, Jan 5, 2018

Intraoperative image-guided surgical navigation for craniospinal procedures has significantly imp... more Intraoperative image-guided surgical navigation for craniospinal procedures has significantly improved accuracy by providing an avenue for the surgeon to visualize underlying internal structures corresponding to the exposed surface anatomy. Despite the obvious benefits of surgical navigation, surgeon adoption remains relatively low due to long setup and registration times, steep learning curves, and workflow disruptions. We introduce an experimental navigation system utilizing optical topographical imaging (OTI) to acquire the 3D surface anatomy of the surgical cavity, enabling visualization of internal structures relative to exposed surface anatomy from registered preoperative images. Our OTI approach includes near instantaneous and accurate optical measurement of >250,000 surface points, computed at >52,000 points-per-second for considerably faster patient registration than commercially available benchmark systems without compromising spatial accuracy. Our experience of 171 ...

The Lancet. Neurology, 2018

General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient ... more General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endo...