Ricardo Dolci - Academia.edu (original) (raw)

Papers by Ricardo Dolci

Research paper thumbnail of Development of an experimental model for the study of nasosinusal and skull base arterial system using iodinated contrast and latex in specimens's vessels

The FASEB Journal, 2018

BACKGROUND: Cadaver dissection remains one of the most reliable and safest ways to study anatomy,... more BACKGROUND: Cadaver dissection remains one of the most reliable and safest ways to study anatomy, whereas computed tomography angiography (CTA) is an essential technology for enabling students to become familiar with human anatomy and surgical planning. Thus, the convergence of both radiologic and anatomic information is important for surgical success, especially in regions of complex anatomy such as the nasosinusal and skull base regions. Here we propose an experimental model in formalinized cadaver heads consisting of intravascular injection of colored latex and iodinated contrast mixture, followed by CTA scans of the nasosinusal and skull base arterial and venous systems before dissection.-METHODS: Six cadaver heads that had been preserved for >5 years in 10% formaldehyde were immersed for 72 hours in a solution containing a dimethyldiethanol mono/dialkyloyl ester quaternary ammonium salt. In 5 of these heads, a mixture composed of latex, tissue ink, and iodinated contrast (Ultravist 300) was injected into the vascular system. CTA scans were performed sequentially after the injection, followed by endonasal and macroscopic dissections.-RESULTS: There was good radiologic and macroscopic vessel uptake in 4 specimens, allowing a detailed anatomic study.-CONCLUSIONS: An experimental model was made feasible by injecting iodinated contrast and colored latex into formalinized cadavers for CTA evaluation of the nasosinusal and skull base arterial and venous systems before performing dissections.

Research paper thumbnail of Closure of skull base defects after endonasal endoscopic resection of planum sphenoidale and tuberculum sellae meningiomas

Asian Journal of Neurosurgery, 2020

Background: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor r... more Background: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage. Objective: The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas. Methods: A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects. Results: Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (f...

Research paper thumbnail of Relationship Between the Bilateral Removal of the Middle Nasal Turbinate and the Olfactory Function in Endoscopic Skull Base Surgery

World Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Technique for Latex Injection and Reuse of Human Heads Preserved in Formaldehyde

Journal of Neurological Surgery Part B: Skull Base, 2018

Background Understanding the anatomy of the skull base is paramount for every skull base surgeon,... more Background Understanding the anatomy of the skull base is paramount for every skull base surgeon, particularly in light of the expanded endoscopic endonasal approaches, and of the refined surgical technique used in both medial and lateral approaches. A comprehensive knowledge of anatomy is the cornerstone for a safe surgery, maximizing resection and minimizing complications. The best study method is the careful dissection of fresh human cadaveric heads in a well-equipped anatomy laboratory. In this study, we describe our protocol for preparing cadaveric specimens without vascular injection, which had been preserved in a formaldehyde solution after treating them with a dimethyldioctadecylammonium chloride/distearyl dimethyl ammonium chloride solution (commercial fabric softener) and injecting the vascular system with latex. Method Six cadaveric specimens underwent our treatment and subsequent injection of the vascular system and dissection. Results All specimens showed a good penetra...

Research paper thumbnail of Endoscopic Endonasal Approach for Interpeduncular Fossa Tumors: New Pituitary Transposition Technique Using Anatomic Cadaveric Dissection

XXXII Congresso Brasileiro de Neurocirurgia, 2018

Research paper thumbnail of Periodic olfactory assessment in patients undergoing skull base surgery with preservation of the olfactory strip

The Laryngoscope, Jan 27, 2017

Others have reported olfactory disturbances following endoscopic approaches to the skull base. Ho... more Others have reported olfactory disturbances following endoscopic approaches to the skull base. However, there is a lack of consensus on the extent and duration of dysfunction. This study aimed to compare our results with previously published work and to validate the olfactory strip-sparing approach. Prospective study to assess olfaction in 50 patients scheduled to undergo resection of skull base tumors via extended endoscopic approaches. Patients were divided into two groups. Group I had a nasoseptal flap (NSF), and group II included patients in whom rescue flaps were performed bilaterally. Olfactory outcomes were assessed using repeated University of Pennsylvania Smell Identification Test at baseline, 6 weeks, 3 months, and 6 months following surgery. Ultimately, 42 patients (seven group I and 35 group II) were available for assessment. Scores for group I were lower than at baseline at 6 weeks postoperatively (30.71 ± 5.5 vs. 24.5 ± 5.4; P = .05). However, by the third postoperativ...

Research paper thumbnail of Optic Canal Decompression: A Comparison Of Two Surgical Techniques

World neurosurgery, Jan 17, 2017

Research paper thumbnail of Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Arquivos de neuro-psiquiatria, 2017

The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for... more The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensio...

Research paper thumbnail of Salivary gland endoscopy in children: A systematic review

Revista da Associacao Medica Brasileira (1992), 2016

To review studies on sialendoscopy (SE) of the salivary glands in children focusing mainly on the... more To review studies on sialendoscopy (SE) of the salivary glands in children focusing mainly on the indications, endoscopic findings, and effectiveness of the procedure. The electronic databases searched were Pubmed, Scielo, and Cochrane. The search was conducted by two researchers independently, following inclusion and exclusion criteria. A third author analyzed sources of conflict. In the first stage they were discarded by reading the articles title that had no relation to the purpose of the study and then evaluated the abstracts of each study. In these two initial phases 37 articles were excluded. Articles not excluded by the selection criteria have been retrieved and assessed in full. Seven articles had their data extracted and were compared. The literature search parameters listed allowed the recovery of 44 articles. After applying the exclusion criteria, seven studies were included in this review representing 207 patients undergoing with ages ranging from 1 to 16 years. All stud...

Research paper thumbnail of Anatomical nuances of the internal carotid artery in relation to the quadrangular space

Journal of Neurosurgery, 2017

OBJECTIVEThe aim of this study was to evaluate the anatomical variations of the internal carotid ... more OBJECTIVEThe aim of this study was to evaluate the anatomical variations of the internal carotid artery (ICA) in relation to the quadrangular space (QS) and to propose a classification system based on the results.METHODSA total of 44 human cadaveric specimens were dissected endonasally under direct endoscopic visualization. During the dissection, the anatomical variations of the ICA and their relationship with the QS were noted.RESULTSThe space between the paraclival ICAs (i.e., intercarotid space) can be classified as 1 of 3 different shapes (i.e., trapezoid, square, or hourglass) based on the trajectory of the ICAs. The ICA trajectories also directly influence the volumetric area of the QS. Based on its geometry, the QS was classified as one of the following: 1) Type A has the smallest QS area and is associated with a trapezoid intercarotid space, 2) Type B corresponds to the expected QS area (not minimized or enlarged) and is associated with a square intercarotid space, and 3) Ty...

Research paper thumbnail of The Endoscopic Endonasal Approach for Removal of Petroclival Chondrosarcomas

Neurosurgery Clinics of North America, 2015

Skull base chondrosarcomas are locally aggressive and arise from the petroclival synchondrosis to... more Skull base chondrosarcomas are locally aggressive and arise from the petroclival synchondrosis to involve multiple surrounding regions. Despite local aggressiveness, they often "respect" the dura, displacing rather than transgressing it like other skull base malignancies. Although the dura is often intact at the end of tumor resection, elevating a vascularized nasoseptal flap is still a key portion of the procedure to protect the exposed internal carotid artery (ICA). A standard wide transsphenoidal approach is coupled with other modules of the expanded endoscopic endonasal approaches, according to tumor characteristics. From its main component in the petroclival synchondrosis, the tumor may be "followed" into the cavernous sinus, Meckel's cave, the middle and posterior cranial fossae, and the craniovertebral junction. Removal of the posterior wall of the maxillary sinus grants access to the pterygopalatine fossa; locating the vidian nerve within it and tracing its path posteriorly will lead to the foramen lacerum and the transition between the petrous and paraclival portions of the ICA.

Research paper thumbnail of Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas

Neurosurgery Clinics of North America, 2015

Tuberculum sellae meningiomas are challenging lesions; their critical location and often insidiou... more Tuberculum sellae meningiomas are challenging lesions; their critical location and often insidious growth rate enables significant distortion of the superjacent optic apparatus before the patient notices any visual impairment. This article describes the technical nuances, selection criteria and complication avoidance strategies for the endonasal resection of tuberculum sellae meningiomas. A stepwise description of the surgical technique is presented; indications, adjuvant technologies, pitfalls and the relevant anatomy are also reviewed. Tuberculum sellae meningiomas may be safely and effectively resected through the endonasal route; invasion of the optic canals does not represent a limitation.

Research paper thumbnail of Development of an Experimental Model for Studying the Nasosinusal and Skull Base Arterial and Venous Systems Using Iodinated Contrast and Latex in Cadavers

World Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Evaluation of olfactory function in patients undergoing endoscopic skull base surgery with nasoseptal flap

Brazilian Journal of Otorhinolaryngology, 2020

Introduction: Endoscopic transnasal access to the skull base, both for treatment and reconstructi... more Introduction: Endoscopic transnasal access to the skull base, both for treatment and reconstruction, can cause olfactory morbidity. Knowing the main consequences of this intervention is essential to have objective criteria for decision-making regarding the appropriate surgical technique. Objectives: The aim of this study is to determine the impact on olfactory function of the endonasal endoscopic access to the skull base with the creation of the nasoseptal flap. Methods: A prospective research was carried out in which 22 patients who underwent endoscopic transnasal surgery at the skull base, with the creation of a nasoseptal flap. The Connecticut Chemosensory Clinical Research Center test was applied before and at the 1 st , 3 rd and 6 th postoperative months. Results: The results showed that only in the first month of follow-up the mean patient classification was statistically worse than at the other evaluation moments (p < 0.05), but there was no mean difference in the Connecticut score classification between the other moments (p > 0.05); that is, patients showed worsening in the 1 st month and returned to the preoperative mean after the 3 rd month of follow-up.

Research paper thumbnail of Endoscopic Double Flap Technique for Reconstruction of Large Anterior Skull Base Defects: Technical Note

Journal of Neurological Surgery Part B: Skull Base

Research paper thumbnail of Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base

Brazilian Journal of Otorhinolaryngology, 2016

The large increase in the number of transnasal endoscopic skull base surgeries is a consequence o... more The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination. To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations. The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation. The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.

Research paper thumbnail of An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery

International archives of otorhinolaryngology, 2018

The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be ... more The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be well understood prior to the expanded endoscopic surgery (EES) at the skull base via the endonasal transsphenoidal approach. A feared complication is injury to the internal carotid artery (ICA). To evaluate the anatomic variations of the SS and its relationship to the ICA using computed tomography (CT). Cross-sectional retrospective study. Analysis of 90 patients' CT scans on axial, coronal and sagittal planes with 1 mm slices, evaluating lateral and posterior extensions of pneumatization of the SS, deviation of the sphenoid septum, presence of septations and their relationship to the parasellar and paraclival segments of the internal carotid artery (psICA and pcICA, respectively). The association between the protrusions of the psICA and the pcICA was statistically significant ( < 0.001), as was the association between the lateral extension of pneumatization of the SS and the ...

Research paper thumbnail of Endoscopic endonasal drainage of cerebral abscess: case report and revision of literature

Brain abscess following rhinosinusitis is uncommon in clinical practice today, as result of impro... more Brain abscess following rhinosinusitis is uncommon in clinical practice today, as result of improvement in diagnosis as well as the increased use and efficacy of antibiotic treatment of rhinosinusitis. The role of expanded endoscopic endonasal approaches in treating skull base pathologies has significantly increased over the last decade, along with greater knowledge of the ventral anatomy of this region, offering a new method of brain abscess treatment. We present the case of 24-year-old, male with brain abscess secondary to acute sinusitis that was drained with an endoscopic endonasal approach. We discuss the pathogenesis, diagnostic and appropriate treatment available in literature.

Research paper thumbnail of Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships

Head & Neck, 2016

The quadrangular space permits an anterior entry into Meckel&amp;amp;amp;amp;#39;s cave while... more The quadrangular space permits an anterior entry into Meckel&amp;amp;amp;amp;#39;s cave while obviating the need for cerebral or cranial nerve retraction. This avenue is intimately associated with the cavernous sinus; thus, from this ventral perspective, it is feasible to visualize the anteromedial, anterolateral, and Parkinson triangles. Twenty middle cranial fossae were dissected endonasally under direct endoscopic visualization. Measurements of the surface area of the quadrangular space and the ventrally accessible cavernous sinus triangles were performed using 3 coordinates under image-guided navigation. The surface area of the quadrangular space was 16.36 mm(2) (±2.89 mm(2) ). The anterolateral triangle was the largest (47.27 ± 5.37 mm(2) ), whereas Parkinson&amp;amp;amp;amp;#39;s was the smallest (22.46 ± 5.54 mm(2) ); the anteromedial triangle presented an average surface area 36.07 mm(2) (±4.15 mm(2) ). The trajectory of the internal carotid artery (ICA) significantly impacts the quadrangular space area and may be a potential parameter for defining the feasibility of this corridor. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

Research paper thumbnail of Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae

Journal of Neurological Surgery Part B: Skull Base, 2015

Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical ... more Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.

Research paper thumbnail of Development of an experimental model for the study of nasosinusal and skull base arterial system using iodinated contrast and latex in specimens's vessels

The FASEB Journal, 2018

BACKGROUND: Cadaver dissection remains one of the most reliable and safest ways to study anatomy,... more BACKGROUND: Cadaver dissection remains one of the most reliable and safest ways to study anatomy, whereas computed tomography angiography (CTA) is an essential technology for enabling students to become familiar with human anatomy and surgical planning. Thus, the convergence of both radiologic and anatomic information is important for surgical success, especially in regions of complex anatomy such as the nasosinusal and skull base regions. Here we propose an experimental model in formalinized cadaver heads consisting of intravascular injection of colored latex and iodinated contrast mixture, followed by CTA scans of the nasosinusal and skull base arterial and venous systems before dissection.-METHODS: Six cadaver heads that had been preserved for >5 years in 10% formaldehyde were immersed for 72 hours in a solution containing a dimethyldiethanol mono/dialkyloyl ester quaternary ammonium salt. In 5 of these heads, a mixture composed of latex, tissue ink, and iodinated contrast (Ultravist 300) was injected into the vascular system. CTA scans were performed sequentially after the injection, followed by endonasal and macroscopic dissections.-RESULTS: There was good radiologic and macroscopic vessel uptake in 4 specimens, allowing a detailed anatomic study.-CONCLUSIONS: An experimental model was made feasible by injecting iodinated contrast and colored latex into formalinized cadavers for CTA evaluation of the nasosinusal and skull base arterial and venous systems before performing dissections.

Research paper thumbnail of Closure of skull base defects after endonasal endoscopic resection of planum sphenoidale and tuberculum sellae meningiomas

Asian Journal of Neurosurgery, 2020

Background: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor r... more Background: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage. Objective: The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas. Methods: A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects. Results: Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (f...

Research paper thumbnail of Relationship Between the Bilateral Removal of the Middle Nasal Turbinate and the Olfactory Function in Endoscopic Skull Base Surgery

World Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Technique for Latex Injection and Reuse of Human Heads Preserved in Formaldehyde

Journal of Neurological Surgery Part B: Skull Base, 2018

Background Understanding the anatomy of the skull base is paramount for every skull base surgeon,... more Background Understanding the anatomy of the skull base is paramount for every skull base surgeon, particularly in light of the expanded endoscopic endonasal approaches, and of the refined surgical technique used in both medial and lateral approaches. A comprehensive knowledge of anatomy is the cornerstone for a safe surgery, maximizing resection and minimizing complications. The best study method is the careful dissection of fresh human cadaveric heads in a well-equipped anatomy laboratory. In this study, we describe our protocol for preparing cadaveric specimens without vascular injection, which had been preserved in a formaldehyde solution after treating them with a dimethyldioctadecylammonium chloride/distearyl dimethyl ammonium chloride solution (commercial fabric softener) and injecting the vascular system with latex. Method Six cadaveric specimens underwent our treatment and subsequent injection of the vascular system and dissection. Results All specimens showed a good penetra...

Research paper thumbnail of Endoscopic Endonasal Approach for Interpeduncular Fossa Tumors: New Pituitary Transposition Technique Using Anatomic Cadaveric Dissection

XXXII Congresso Brasileiro de Neurocirurgia, 2018

Research paper thumbnail of Periodic olfactory assessment in patients undergoing skull base surgery with preservation of the olfactory strip

The Laryngoscope, Jan 27, 2017

Others have reported olfactory disturbances following endoscopic approaches to the skull base. Ho... more Others have reported olfactory disturbances following endoscopic approaches to the skull base. However, there is a lack of consensus on the extent and duration of dysfunction. This study aimed to compare our results with previously published work and to validate the olfactory strip-sparing approach. Prospective study to assess olfaction in 50 patients scheduled to undergo resection of skull base tumors via extended endoscopic approaches. Patients were divided into two groups. Group I had a nasoseptal flap (NSF), and group II included patients in whom rescue flaps were performed bilaterally. Olfactory outcomes were assessed using repeated University of Pennsylvania Smell Identification Test at baseline, 6 weeks, 3 months, and 6 months following surgery. Ultimately, 42 patients (seven group I and 35 group II) were available for assessment. Scores for group I were lower than at baseline at 6 weeks postoperatively (30.71 ± 5.5 vs. 24.5 ± 5.4; P = .05). However, by the third postoperativ...

Research paper thumbnail of Optic Canal Decompression: A Comparison Of Two Surgical Techniques

World neurosurgery, Jan 17, 2017

Research paper thumbnail of Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Arquivos de neuro-psiquiatria, 2017

The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for... more The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensio...

Research paper thumbnail of Salivary gland endoscopy in children: A systematic review

Revista da Associacao Medica Brasileira (1992), 2016

To review studies on sialendoscopy (SE) of the salivary glands in children focusing mainly on the... more To review studies on sialendoscopy (SE) of the salivary glands in children focusing mainly on the indications, endoscopic findings, and effectiveness of the procedure. The electronic databases searched were Pubmed, Scielo, and Cochrane. The search was conducted by two researchers independently, following inclusion and exclusion criteria. A third author analyzed sources of conflict. In the first stage they were discarded by reading the articles title that had no relation to the purpose of the study and then evaluated the abstracts of each study. In these two initial phases 37 articles were excluded. Articles not excluded by the selection criteria have been retrieved and assessed in full. Seven articles had their data extracted and were compared. The literature search parameters listed allowed the recovery of 44 articles. After applying the exclusion criteria, seven studies were included in this review representing 207 patients undergoing with ages ranging from 1 to 16 years. All stud...

Research paper thumbnail of Anatomical nuances of the internal carotid artery in relation to the quadrangular space

Journal of Neurosurgery, 2017

OBJECTIVEThe aim of this study was to evaluate the anatomical variations of the internal carotid ... more OBJECTIVEThe aim of this study was to evaluate the anatomical variations of the internal carotid artery (ICA) in relation to the quadrangular space (QS) and to propose a classification system based on the results.METHODSA total of 44 human cadaveric specimens were dissected endonasally under direct endoscopic visualization. During the dissection, the anatomical variations of the ICA and their relationship with the QS were noted.RESULTSThe space between the paraclival ICAs (i.e., intercarotid space) can be classified as 1 of 3 different shapes (i.e., trapezoid, square, or hourglass) based on the trajectory of the ICAs. The ICA trajectories also directly influence the volumetric area of the QS. Based on its geometry, the QS was classified as one of the following: 1) Type A has the smallest QS area and is associated with a trapezoid intercarotid space, 2) Type B corresponds to the expected QS area (not minimized or enlarged) and is associated with a square intercarotid space, and 3) Ty...

Research paper thumbnail of The Endoscopic Endonasal Approach for Removal of Petroclival Chondrosarcomas

Neurosurgery Clinics of North America, 2015

Skull base chondrosarcomas are locally aggressive and arise from the petroclival synchondrosis to... more Skull base chondrosarcomas are locally aggressive and arise from the petroclival synchondrosis to involve multiple surrounding regions. Despite local aggressiveness, they often "respect" the dura, displacing rather than transgressing it like other skull base malignancies. Although the dura is often intact at the end of tumor resection, elevating a vascularized nasoseptal flap is still a key portion of the procedure to protect the exposed internal carotid artery (ICA). A standard wide transsphenoidal approach is coupled with other modules of the expanded endoscopic endonasal approaches, according to tumor characteristics. From its main component in the petroclival synchondrosis, the tumor may be "followed" into the cavernous sinus, Meckel's cave, the middle and posterior cranial fossae, and the craniovertebral junction. Removal of the posterior wall of the maxillary sinus grants access to the pterygopalatine fossa; locating the vidian nerve within it and tracing its path posteriorly will lead to the foramen lacerum and the transition between the petrous and paraclival portions of the ICA.

Research paper thumbnail of Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas

Neurosurgery Clinics of North America, 2015

Tuberculum sellae meningiomas are challenging lesions; their critical location and often insidiou... more Tuberculum sellae meningiomas are challenging lesions; their critical location and often insidious growth rate enables significant distortion of the superjacent optic apparatus before the patient notices any visual impairment. This article describes the technical nuances, selection criteria and complication avoidance strategies for the endonasal resection of tuberculum sellae meningiomas. A stepwise description of the surgical technique is presented; indications, adjuvant technologies, pitfalls and the relevant anatomy are also reviewed. Tuberculum sellae meningiomas may be safely and effectively resected through the endonasal route; invasion of the optic canals does not represent a limitation.

Research paper thumbnail of Development of an Experimental Model for Studying the Nasosinusal and Skull Base Arterial and Venous Systems Using Iodinated Contrast and Latex in Cadavers

World Neurosurgery, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Evaluation of olfactory function in patients undergoing endoscopic skull base surgery with nasoseptal flap

Brazilian Journal of Otorhinolaryngology, 2020

Introduction: Endoscopic transnasal access to the skull base, both for treatment and reconstructi... more Introduction: Endoscopic transnasal access to the skull base, both for treatment and reconstruction, can cause olfactory morbidity. Knowing the main consequences of this intervention is essential to have objective criteria for decision-making regarding the appropriate surgical technique. Objectives: The aim of this study is to determine the impact on olfactory function of the endonasal endoscopic access to the skull base with the creation of the nasoseptal flap. Methods: A prospective research was carried out in which 22 patients who underwent endoscopic transnasal surgery at the skull base, with the creation of a nasoseptal flap. The Connecticut Chemosensory Clinical Research Center test was applied before and at the 1 st , 3 rd and 6 th postoperative months. Results: The results showed that only in the first month of follow-up the mean patient classification was statistically worse than at the other evaluation moments (p < 0.05), but there was no mean difference in the Connecticut score classification between the other moments (p > 0.05); that is, patients showed worsening in the 1 st month and returned to the preoperative mean after the 3 rd month of follow-up.

Research paper thumbnail of Endoscopic Double Flap Technique for Reconstruction of Large Anterior Skull Base Defects: Technical Note

Journal of Neurological Surgery Part B: Skull Base

Research paper thumbnail of Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base

Brazilian Journal of Otorhinolaryngology, 2016

The large increase in the number of transnasal endoscopic skull base surgeries is a consequence o... more The large increase in the number of transnasal endoscopic skull base surgeries is a consequence of greater knowledge of the anatomic region, the development of specific materials and instruments, and especially the use of the nasoseptal flap as a barrier between the sinus tract (contaminated cavity) and the subarachnoid space (sterile area), reducing the high risk of contamination. To assess the otorhinolaryngologic complications in patients undergoing endoscopic surgery of the skull base, in which a nasoseptal flap was used. This was a retrospective study that included patients who underwent endoscopic skull base surgery with creation of a nasoseptal flap, assessing for the presence of the following post-surgical complications: cerebrospinal fluid leak, meningitis, mucocele formation, nasal synechia, septal perforation (prior to posterior septectomy), internal nasal valve failure, epistaxis, and olfactory alterations. The study assessed 41 patients undergoing surgery. Of these, 35 had pituitary adenomas (macro- or micro-adenomas; sellar and suprasellar extension), three had meningiomas (two tuberculum sellae and one olfactory groove), two had craniopharyngiomas, and one had an intracranial abscess. The complications were cerebrospinal fluid leak (three patients; 7.3%), meningitis (three patients; 7.3%), nasal fossa synechia (eight patients; 19.5%), internal nasal valve failure (six patients; 14.6%), and complaints of worsening of the sense of smell (16 patients; 39%). The olfactory test showed anosmia or hyposmia in ten patients (24.3%). No patient had mucocele, epistaxis, or septal perforation. The use of the nasoseptal flap has revolutionized endoscopic skull base surgery, making the procedures more effective and with lower morbidity compared to the traditional route. However, although mainly transient nasal morbidities were observed, in some cases, permanent hyposmia and anosmia resulted. An improvement in this technique is therefore necessary to provide a better quality of life for the patient, reducing potential complications.

Research paper thumbnail of An Analysis of Anatomic Variations of the Sphenoid Sinus and Its Relationship to the Internal Carotid Artery

International archives of otorhinolaryngology, 2018

The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be ... more The sphenoid sinus (SS) has a high variability; its anatomical relations and variations must be well understood prior to the expanded endoscopic surgery (EES) at the skull base via the endonasal transsphenoidal approach. A feared complication is injury to the internal carotid artery (ICA). To evaluate the anatomic variations of the SS and its relationship to the ICA using computed tomography (CT). Cross-sectional retrospective study. Analysis of 90 patients' CT scans on axial, coronal and sagittal planes with 1 mm slices, evaluating lateral and posterior extensions of pneumatization of the SS, deviation of the sphenoid septum, presence of septations and their relationship to the parasellar and paraclival segments of the internal carotid artery (psICA and pcICA, respectively). The association between the protrusions of the psICA and the pcICA was statistically significant ( < 0.001), as was the association between the lateral extension of pneumatization of the SS and the ...

Research paper thumbnail of Endoscopic endonasal drainage of cerebral abscess: case report and revision of literature

Brain abscess following rhinosinusitis is uncommon in clinical practice today, as result of impro... more Brain abscess following rhinosinusitis is uncommon in clinical practice today, as result of improvement in diagnosis as well as the increased use and efficacy of antibiotic treatment of rhinosinusitis. The role of expanded endoscopic endonasal approaches in treating skull base pathologies has significantly increased over the last decade, along with greater knowledge of the ventral anatomy of this region, offering a new method of brain abscess treatment. We present the case of 24-year-old, male with brain abscess secondary to acute sinusitis that was drained with an endoscopic endonasal approach. We discuss the pathogenesis, diagnostic and appropriate treatment available in literature.

Research paper thumbnail of Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships

Head & Neck, 2016

The quadrangular space permits an anterior entry into Meckel&amp;amp;amp;amp;#39;s cave while... more The quadrangular space permits an anterior entry into Meckel&amp;amp;amp;amp;#39;s cave while obviating the need for cerebral or cranial nerve retraction. This avenue is intimately associated with the cavernous sinus; thus, from this ventral perspective, it is feasible to visualize the anteromedial, anterolateral, and Parkinson triangles. Twenty middle cranial fossae were dissected endonasally under direct endoscopic visualization. Measurements of the surface area of the quadrangular space and the ventrally accessible cavernous sinus triangles were performed using 3 coordinates under image-guided navigation. The surface area of the quadrangular space was 16.36 mm(2) (±2.89 mm(2) ). The anterolateral triangle was the largest (47.27 ± 5.37 mm(2) ), whereas Parkinson&amp;amp;amp;amp;#39;s was the smallest (22.46 ± 5.54 mm(2) ); the anteromedial triangle presented an average surface area 36.07 mm(2) (±4.15 mm(2) ). The trajectory of the internal carotid artery (ICA) significantly impacts the quadrangular space area and may be a potential parameter for defining the feasibility of this corridor. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

Research paper thumbnail of Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae

Journal of Neurological Surgery Part B: Skull Base, 2015

Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical ... more Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.