Vinicius Guirado | Universidade de São Paulo (original) (raw)

Papers by Vinicius Guirado

Research paper thumbnail of Biological markers and severe head trauma. Where are we?

Arq Bras Neurocir, Mar 1, 2012

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the ... more Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world. Despite the signi cant advances in neuroradiology and cerebral monitoring it is still dif cult to measure the degree of primary brain injury and continuing secondary damage with Glasgow Coma Scale score or the initial computed tomography. Predicting prognosis of TBI patients in early stages has a vital importance and is dif cult in some instances. The present review shows that there has been an increasing interest in biochemical markers for traumatic brain injury during the last years. The potential correlation of markers with injury and outcome measures in severe head injury is promising.

Research paper thumbnail of Survival score scales of patients operated with spinal metastases: retrospective application in a Brazilian population

Arquivos de neuro-psiquiatria, Jan 24, 2015

Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting the... more Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting these patient's survival is a key factor to select the proper treatment modality, but the three most used score scales to predict their survival (Tokuhashi revised score, Tomita score and Bauer modified score) were designed in single institutions and their reliability to predict correctly the patient's survival were first tested only in those specific populations. This prognostication issue is addressed in this article, evaluating retrospectively the survival of 17 patients with SEM from a Brazilian general hospital with these score scales. Our results show that the actual survival of those patients were worse than the predicted of all three score scales, suggesting that differences between the different populations might have affected their reliability and alert that their usage as a major factor to select the most appropriate treatment have to be done with caution.

Research paper thumbnail of Occipital Condyle Fracture 1

Research paper thumbnail of Biological markers and head trauma. Where we are?

Research paper thumbnail of Noninvasive evaluation of intracranial hypertension? Is there a gold standard?

Computed tomography is essential in head injuried patients for the detection of structural damage... more Computed tomography is essential in head injuried patients for the detection of structural damage to the brain. However, the ability of CT scanning to predict the presence or absence of intracranial hypertension has been debated in the literature. Since the optic nerve is part of the central nervous system and in case of raised pressure in the cerebrospinal fluid its sheath inflates. Based in this hypothesis the authors reviewed the role of the optic nerve sheat diameter in diagnosis intracranial hypertension after traumatic brain injury. This non-invasive method is useful to predict the risk of intracranial hypertension and select patients to ICP monitoring, especially in those with normal CT scans.

Research paper thumbnail of Occipital Condyle Fractures in Traumatic Brain Injury—A Review

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2015

Research paper thumbnail of Differential Diagnosis of Calcifications Within the Spinal Canal

PURPOSE/AIM To review spinal canal anatomy, including its contents and important adjacent structu... more PURPOSE/AIM To review spinal canal anatomy, including its contents and important adjacent structures that may calcify To review the range of diagnostic possibilites that manifest as calcifications within the spinal canal, using different imaging methods (conventional radiology, CT and MRI) CONTENT ORGANIZATION Anatomy of the spinal canal and adjacent structures Clinical cases and illustrative images, including calcifications of normal vertebral structures (herniated disk, dura mater, flavum and posterior longitudinal ligaments), traumatic causes, tumors (meningeomas), pseudotumors (synovial cyst), crystal deposition diseases and other rare etiologies like aracoiditis ossificans Brief discussion and review of imaging findings, with emphasis on differential diagnosis SUMMARY The viewer should be able to: Identify calcifications within the spinal canal using different imagin methods Suggest a diagnosis or narrow differential after analyzing specific characteristics

Research paper thumbnail of 130 Prospective Randomized Study Comparing Clinical, Functional and Aesthetics Results of Classical Pterional and Minipterional Craniotomies

Neurosurgery, 2014

ABSTRACT To compare the clinical, functional and aesthetic results of 2 surgical techniques, pter... more ABSTRACT To compare the clinical, functional and aesthetic results of 2 surgical techniques, pterional (PT) and minipterional (MPT) craniotomies, for microsurgical clipping of anterior circulation aneurysms.

Research paper thumbnail of Associacao do Valor Preditivo do New Injury Severity Score (Niss) Com A Escala de Resultados de Glasgow em Pacientes Com Lesao Axonial Difusa

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2012

Research paper thumbnail of Fatores prognósticos associados ao tratamento cirúrgico da mielorradiculopatia espondilótica cervical

Coluna/Columna, 2012

Objetivo: Identificar os fatores clínicos dos indivíduos, fatores sociais, ambientais e dos exame... more Objetivo: Identificar os fatores clínicos dos indivíduos, fatores sociais, ambientais e dos exames de imagem que se correlacionam ao resultado final de melhora neurológica em pacientes submetidos ao tratamento cirúrgico da mielopatia espondilótica cervical. Métodos: A avaliação clínica foi quantificada pela escala deficitária da JOA. Analisamos 200 casos de mielorradiculopatia cervical, operados no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A média de segmento foi de 06 anos e 08 meses. A análise radiológica foi baseada nos critérios de instabilidade de White e scala de Kellgren. Resultados: Em 80% houve melhora, 14% estabilização e em 6% piora do quadro neurológico. A piora neurológica não foi associada com nenhum fator clínico, ambiental ou de imagem. A melhora neurológica foi diretamente proporcional a menor idade na cirurgia, ausência de co-morbidade, sinal de Hoffman, atrofia muscular, hipersinal medular na RNM, menor período de evolução pré-operatório, melhor status neurológico pré-operatório e inversamente proporcional ao diâmetro AP do canal medular e multiplicidade de compressões. Identificou-se associação com o tabagismo. Mais de 70 anos, evolução superior a 24 meses, atrofia muscular, pontuação JOA igual ou inferior a sete pontos e diâmetro AP do canal inferior ou igual a seis mm não foram associado à melhora.

Research paper thumbnail of Improvement of verbal fluency in patients with diffuse brain injury over time

Neuropsychiatric disease and treatment, 2014

Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic b... more Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic brain injury (TBI), is considered one of the most prevalent forms of primary neuronal injury in patients with severe TBI. Cognitive deficits induced by DAI can persist over time, especially following moderate or severe injuries. The aim of the present study was to compare verbal fluency (VF) performance at 6 and 12 months after the trauma in a same group of patients with DAI. Eighteen patients with moderate to severe DAI and 17 healthy volunteers were enrolled. All DAI participants had sustained a TBI at least 6 months prior to the start of the study, were between 18 and 50 years of age, and had at least 4 years of education. The VF test was administered within an extensive neuropsychological test battery. We evaluated the same patients at 6 months (DAI1 group) and 12 months (DAI2 group) and compared the results of neuropsychological tests with a control group of healthy volunteers who we...

Research paper thumbnail of Quality of life in adult intradural primary spinal tumors: 36-Item Short Form Health Survey correlation with McCormick and Aminoff-Logue scales

Journal of Neurosurgery: Spine, 2013

The most appropriate method to determine the quality of life of patients with intradural primary ... more The most appropriate method to determine the quality of life of patients with intradural primary spinal tumors (IPSTs) is not still well established. Clinical data in 234 patients who underwent surgery for intradural spinal disease were collected prospectively. The 36-Item Short Form Health Survey (SF-36), a generic score scale, was administered to 148 patients with IPSTs to demonstrate if the survey can be used to effectively evaluate these patients. Forty-eight patients were excluded because they did not complete the protocol. The study was finally conducted with 100 patients (45 male and 55 female) with IPSTs, and the results were compared with those of 2 other scales: the McCormick scale and the Aminoff-Logue scale. Construct validity was demonstrated by confirming the hypothesized relationship between the scores of the SF-36 and the McCormick scale (p = 0.003), the Aminoff-Logue gait subscale (p = 0.025), the Aminoff-Logue micturition subscale (p = 0.013), and the Aminoff-Logue defecation subscale (p = 0.004). Reliability was demonstrated for all 8 SF-36 domain scales and the Physical Component Summary and the Mental Component Summary of the SF-36, where in each the Cronbach alpha satisfied the Nunnally criterion of > 0.85. The authors' results demonstrated that SF-36 provides valid and reliable data for patients with IPSTs and that the survey can be used appropriately to evaluate these patients.

Research paper thumbnail of Prospective randomized study comparing the clinical outcomes between inferior vena cava Greenfield and TrapEase filters

Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter, 2010

Although anticoagulation remains the mainstay of treatment for deep venous thrombosis, the use of... more Although anticoagulation remains the mainstay of treatment for deep venous thrombosis, the use of inferior vena cava (IVC) filters when anticoagulation has failed or when contraindicated remains a safe and effective treatment. Greenfield (Boston Scientific, Natick, Mass) and TrapEase (Cordis, Bridgewater, NJ) filters are arguably among the most popular filtration devices. The Greenfield filter (12F introducer) has been in use for >30 years and has been well studied. The TrapEase filter (6F introducer) has been used since 2000, with a limited number of studies. Good guidelines to help determine which filter to use in any given situation are lacking; therefore, this randomized study prospectively compared the clinical outcomes (access-site thrombosis, filter thrombosis, and symptomatic pulmonary embolism [PE]) between these filters.

Research paper thumbnail of Multiple epidural haematomas after meningioma surgery

British Journal of Neurosurgery, 2011

Intracranial meningioma removal carries a higher risk of post-operative haemorrhage compared with... more Intracranial meningioma removal carries a higher risk of post-operative haemorrhage compared with other intracranial neoplasm surgeries. We report a patient who developed three intracranial haematomas following a frontal meningioma removal.

Research paper thumbnail of Intramedullary granuloma suggestive of tuberculoma

Arquivos de Neuro-Psiquiatria, 2011

DISCUSSION The common location of intramedullary tuberculoma is the thoracic cord and less common... more DISCUSSION The common location of intramedullary tuberculoma is the thoracic cord and less commonly in the cervical and lumbar regions. The best imaging modality for diagnosis is magnetic resonance image 4. The ideal treatment remains controversial, and many ...

Research paper thumbnail of Spinal melanotic schwannomas

Arquivos de Neuro-Psiquiatria, 2012

Research paper thumbnail of Evaluation of surgical techniques for treatment of cervical spondylotic myeloradiculopathy

Objetivo: Avaliar a eficácia do tratamento cirúrgico da mielorradiculopatia espondilótica cervica... more Objetivo: Avaliar a eficácia do tratamento cirúrgico da mielorradiculopatia espondilótica cervical na produção de melhora neurológica pós-operatória, aferida em pontos pela escala da JOA e taxa de recuperação e as complicações do tratamento. Métodos: Análise dos prontuários e os exames de imagem de 200 indivíduos submetidos a tratamento cirúrgico da mielorradiculopatia cervical no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A avaliação clínica foi quantificada pela escala da JOA, com média de segmento de 06 anos e 08 meses. Resultados: Evidenciou-se melhora neurológica pós-operatória nas vias anterior e posterior, exceto nas laminectomias sem fusão, onde houve piora neurológica tardia. A via anterior mostrou um significante maior índice de complicações, relacionados a déficit de fusão intervertebral, deslocamento de enxerto, síndrome de disco adjacente, disfonia, disfagia, o mau posicionamento de enxerto e placas, lesão de raiz nervosa e significativo maior índice de re-intervenção cirúrgica. Na via posterior maior ocorrência de instabilidade em cifose pós-operatória na laminectomia, não sendo observada na laminoplastia, esta última com índices semelhantes aos encontrados na via anterior. Não houve melhora da dor axial nas laminoplastias e houve piora nas laminectomias, enquanto que nas discectomias e corpectomias houve significativa melhora do sintoma. Conclusão: As vias anterior e posterior foram eficazes em produzir melhora neurológica, exceto as laminectomias sem fusão. A via anterior produziu mais complicações, mas trata melhor a dor.

Research paper thumbnail of Adjacent segment disease (Transitional Syndrome) in cervical spine: clinical and radiological results

ABSTRACT OBJECTIVE: the objective of this study was to identify the occurrence of adjacent disc s... more ABSTRACT OBJECTIVE: the objective of this study was to identify the occurrence of adjacent disc syndrome secondary to intervertebral fusion in the cervical segment, and the predictors of outcome. METHODS: the medical records and imaging studies of 209 patients undergoing surgical treatment of cervical degenerative disease, with 169 cases treated through anterior approach and 40 cases through the posterior approach, at the HC-FMUSP from March 1993 to January 2007. Clinical evaluation was quantified by the scale of Japanese Orthopaedic Association (JOA), with an average follow-up of 80 months. The radiological analysis was based on the criteria of instability by White and Panjabi in all cases. The degeneration was measured by the scale of Kellgren before and after surgery. RESULTS: overall, the syndrome of adjacent disc was diagnosed in 30 cases (17.75%), with a mean time interval of incidence of 28.5 months after the merger, or 2.9 cases per year. There was an increase in degenerative changes in X-rays at levels adjacent to anterior fusion in 41.42% and 52.5% for the posterior without fusion, evaluated by the scale of Kellgren, the degeneration rate of 6.7% per annum, with no correlation with clinical changes. CONCLUSIONS: changes in physiological sagittal alignment of the spine and their severity predispose to the development of the syndrome. There was no incidence of the syndrome in cases of pseudoarthrosis or methacrylate, therefore, where there was a merger. The use of decompression and fusion, anterior, is associated with the possibility of developing a new framework for myeloradiculopathy in the postoperative period. Merger at a level that involve the fifth or sixth cervical vertebra, fixation with plates and pre-existing radiographic evidence of disc degeneration adjacent were factors of high risk for its emergence.

Research paper thumbnail of Transient Lesion in the Splenium of the Corpus Callosum in Acute Uncomplicated Falciparum Malaria

American Journal of Tropical Medicine and Hygiene, 2014

Research paper thumbnail of Management of supratentorial epidural hematoma in children: report on 49 patients

Arquivos de Neuro-Psiquiatria, 2010

Traumatic head injury is a common cause of mortality and acquired neurological impairment in chil... more Traumatic head injury is a common cause of mortality and acquired neurological impairment in children. However, pediatric epidural hematomas (EDHs) are not common and few series have studied the evolution of these patients. In this study, we present the results from a sample of patients with EDH with long-term follow-up. Method: Between January 2006 and December 2008, 49 patients with traumatic EDH were treated at our unit. Clinical course, radiological findings and outcomes were evaluated. Neurological status was assessed using the Glasgow Coma Scale (GCS). The patients' ages ranged from one day to 16 years. The mean follow-up was six months. Results: On admission, most of the patients presented mild trauma and 57% had a GCS of 13-15. The most common symptom was irritability. The most frequent mechanisms of injury were: falling from a height in 29 cases and motor vehicle accidents in 16 cases. Three of these patients presented GCS 3, but only one died. We found a late neurological deficit in nine patients. Conclusion: These lesions may occur following mild head trauma and in alert children with nonfocal neurological examinations. However, in children presenting irritability with subgaleal hematomas and a history of loss of consciousness, skull computed tomography must be performed.

Research paper thumbnail of Biological markers and severe head trauma. Where are we?

Arq Bras Neurocir, Mar 1, 2012

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the ... more Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem throughout the world. Despite the signi cant advances in neuroradiology and cerebral monitoring it is still dif cult to measure the degree of primary brain injury and continuing secondary damage with Glasgow Coma Scale score or the initial computed tomography. Predicting prognosis of TBI patients in early stages has a vital importance and is dif cult in some instances. The present review shows that there has been an increasing interest in biochemical markers for traumatic brain injury during the last years. The potential correlation of markers with injury and outcome measures in severe head injury is promising.

Research paper thumbnail of Survival score scales of patients operated with spinal metastases: retrospective application in a Brazilian population

Arquivos de neuro-psiquiatria, Jan 24, 2015

Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting the... more Spinal cord epidural metastasis (SEM) is a common complication of systemic cancer. Predicting these patient's survival is a key factor to select the proper treatment modality, but the three most used score scales to predict their survival (Tokuhashi revised score, Tomita score and Bauer modified score) were designed in single institutions and their reliability to predict correctly the patient's survival were first tested only in those specific populations. This prognostication issue is addressed in this article, evaluating retrospectively the survival of 17 patients with SEM from a Brazilian general hospital with these score scales. Our results show that the actual survival of those patients were worse than the predicted of all three score scales, suggesting that differences between the different populations might have affected their reliability and alert that their usage as a major factor to select the most appropriate treatment have to be done with caution.

Research paper thumbnail of Occipital Condyle Fracture 1

Research paper thumbnail of Biological markers and head trauma. Where we are?

Research paper thumbnail of Noninvasive evaluation of intracranial hypertension? Is there a gold standard?

Computed tomography is essential in head injuried patients for the detection of structural damage... more Computed tomography is essential in head injuried patients for the detection of structural damage to the brain. However, the ability of CT scanning to predict the presence or absence of intracranial hypertension has been debated in the literature. Since the optic nerve is part of the central nervous system and in case of raised pressure in the cerebrospinal fluid its sheath inflates. Based in this hypothesis the authors reviewed the role of the optic nerve sheat diameter in diagnosis intracranial hypertension after traumatic brain injury. This non-invasive method is useful to predict the risk of intracranial hypertension and select patients to ICP monitoring, especially in those with normal CT scans.

Research paper thumbnail of Occipital Condyle Fractures in Traumatic Brain Injury—A Review

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2015

Research paper thumbnail of Differential Diagnosis of Calcifications Within the Spinal Canal

PURPOSE/AIM To review spinal canal anatomy, including its contents and important adjacent structu... more PURPOSE/AIM To review spinal canal anatomy, including its contents and important adjacent structures that may calcify To review the range of diagnostic possibilites that manifest as calcifications within the spinal canal, using different imaging methods (conventional radiology, CT and MRI) CONTENT ORGANIZATION Anatomy of the spinal canal and adjacent structures Clinical cases and illustrative images, including calcifications of normal vertebral structures (herniated disk, dura mater, flavum and posterior longitudinal ligaments), traumatic causes, tumors (meningeomas), pseudotumors (synovial cyst), crystal deposition diseases and other rare etiologies like aracoiditis ossificans Brief discussion and review of imaging findings, with emphasis on differential diagnosis SUMMARY The viewer should be able to: Identify calcifications within the spinal canal using different imagin methods Suggest a diagnosis or narrow differential after analyzing specific characteristics

Research paper thumbnail of 130 Prospective Randomized Study Comparing Clinical, Functional and Aesthetics Results of Classical Pterional and Minipterional Craniotomies

Neurosurgery, 2014

ABSTRACT To compare the clinical, functional and aesthetic results of 2 surgical techniques, pter... more ABSTRACT To compare the clinical, functional and aesthetic results of 2 surgical techniques, pterional (PT) and minipterional (MPT) craniotomies, for microsurgical clipping of anterior circulation aneurysms.

Research paper thumbnail of Associacao do Valor Preditivo do New Injury Severity Score (Niss) Com A Escala de Resultados de Glasgow em Pacientes Com Lesao Axonial Difusa

Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 2012

Research paper thumbnail of Fatores prognósticos associados ao tratamento cirúrgico da mielorradiculopatia espondilótica cervical

Coluna/Columna, 2012

Objetivo: Identificar os fatores clínicos dos indivíduos, fatores sociais, ambientais e dos exame... more Objetivo: Identificar os fatores clínicos dos indivíduos, fatores sociais, ambientais e dos exames de imagem que se correlacionam ao resultado final de melhora neurológica em pacientes submetidos ao tratamento cirúrgico da mielopatia espondilótica cervical. Métodos: A avaliação clínica foi quantificada pela escala deficitária da JOA. Analisamos 200 casos de mielorradiculopatia cervical, operados no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A média de segmento foi de 06 anos e 08 meses. A análise radiológica foi baseada nos critérios de instabilidade de White e scala de Kellgren. Resultados: Em 80% houve melhora, 14% estabilização e em 6% piora do quadro neurológico. A piora neurológica não foi associada com nenhum fator clínico, ambiental ou de imagem. A melhora neurológica foi diretamente proporcional a menor idade na cirurgia, ausência de co-morbidade, sinal de Hoffman, atrofia muscular, hipersinal medular na RNM, menor período de evolução pré-operatório, melhor status neurológico pré-operatório e inversamente proporcional ao diâmetro AP do canal medular e multiplicidade de compressões. Identificou-se associação com o tabagismo. Mais de 70 anos, evolução superior a 24 meses, atrofia muscular, pontuação JOA igual ou inferior a sete pontos e diâmetro AP do canal inferior ou igual a seis mm não foram associado à melhora.

Research paper thumbnail of Improvement of verbal fluency in patients with diffuse brain injury over time

Neuropsychiatric disease and treatment, 2014

Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic b... more Diffuse axonal injury (DAI), a common cause of neurological sequelae in patients with traumatic brain injury (TBI), is considered one of the most prevalent forms of primary neuronal injury in patients with severe TBI. Cognitive deficits induced by DAI can persist over time, especially following moderate or severe injuries. The aim of the present study was to compare verbal fluency (VF) performance at 6 and 12 months after the trauma in a same group of patients with DAI. Eighteen patients with moderate to severe DAI and 17 healthy volunteers were enrolled. All DAI participants had sustained a TBI at least 6 months prior to the start of the study, were between 18 and 50 years of age, and had at least 4 years of education. The VF test was administered within an extensive neuropsychological test battery. We evaluated the same patients at 6 months (DAI1 group) and 12 months (DAI2 group) and compared the results of neuropsychological tests with a control group of healthy volunteers who we...

Research paper thumbnail of Quality of life in adult intradural primary spinal tumors: 36-Item Short Form Health Survey correlation with McCormick and Aminoff-Logue scales

Journal of Neurosurgery: Spine, 2013

The most appropriate method to determine the quality of life of patients with intradural primary ... more The most appropriate method to determine the quality of life of patients with intradural primary spinal tumors (IPSTs) is not still well established. Clinical data in 234 patients who underwent surgery for intradural spinal disease were collected prospectively. The 36-Item Short Form Health Survey (SF-36), a generic score scale, was administered to 148 patients with IPSTs to demonstrate if the survey can be used to effectively evaluate these patients. Forty-eight patients were excluded because they did not complete the protocol. The study was finally conducted with 100 patients (45 male and 55 female) with IPSTs, and the results were compared with those of 2 other scales: the McCormick scale and the Aminoff-Logue scale. Construct validity was demonstrated by confirming the hypothesized relationship between the scores of the SF-36 and the McCormick scale (p = 0.003), the Aminoff-Logue gait subscale (p = 0.025), the Aminoff-Logue micturition subscale (p = 0.013), and the Aminoff-Logue defecation subscale (p = 0.004). Reliability was demonstrated for all 8 SF-36 domain scales and the Physical Component Summary and the Mental Component Summary of the SF-36, where in each the Cronbach alpha satisfied the Nunnally criterion of > 0.85. The authors' results demonstrated that SF-36 provides valid and reliable data for patients with IPSTs and that the survey can be used appropriately to evaluate these patients.

Research paper thumbnail of Prospective randomized study comparing the clinical outcomes between inferior vena cava Greenfield and TrapEase filters

Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter, 2010

Although anticoagulation remains the mainstay of treatment for deep venous thrombosis, the use of... more Although anticoagulation remains the mainstay of treatment for deep venous thrombosis, the use of inferior vena cava (IVC) filters when anticoagulation has failed or when contraindicated remains a safe and effective treatment. Greenfield (Boston Scientific, Natick, Mass) and TrapEase (Cordis, Bridgewater, NJ) filters are arguably among the most popular filtration devices. The Greenfield filter (12F introducer) has been in use for >30 years and has been well studied. The TrapEase filter (6F introducer) has been used since 2000, with a limited number of studies. Good guidelines to help determine which filter to use in any given situation are lacking; therefore, this randomized study prospectively compared the clinical outcomes (access-site thrombosis, filter thrombosis, and symptomatic pulmonary embolism [PE]) between these filters.

Research paper thumbnail of Multiple epidural haematomas after meningioma surgery

British Journal of Neurosurgery, 2011

Intracranial meningioma removal carries a higher risk of post-operative haemorrhage compared with... more Intracranial meningioma removal carries a higher risk of post-operative haemorrhage compared with other intracranial neoplasm surgeries. We report a patient who developed three intracranial haematomas following a frontal meningioma removal.

Research paper thumbnail of Intramedullary granuloma suggestive of tuberculoma

Arquivos de Neuro-Psiquiatria, 2011

DISCUSSION The common location of intramedullary tuberculoma is the thoracic cord and less common... more DISCUSSION The common location of intramedullary tuberculoma is the thoracic cord and less commonly in the cervical and lumbar regions. The best imaging modality for diagnosis is magnetic resonance image 4. The ideal treatment remains controversial, and many ...

Research paper thumbnail of Spinal melanotic schwannomas

Arquivos de Neuro-Psiquiatria, 2012

Research paper thumbnail of Evaluation of surgical techniques for treatment of cervical spondylotic myeloradiculopathy

Objetivo: Avaliar a eficácia do tratamento cirúrgico da mielorradiculopatia espondilótica cervica... more Objetivo: Avaliar a eficácia do tratamento cirúrgico da mielorradiculopatia espondilótica cervical na produção de melhora neurológica pós-operatória, aferida em pontos pela escala da JOA e taxa de recuperação e as complicações do tratamento. Métodos: Análise dos prontuários e os exames de imagem de 200 indivíduos submetidos a tratamento cirúrgico da mielorradiculopatia cervical no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A avaliação clínica foi quantificada pela escala da JOA, com média de segmento de 06 anos e 08 meses. Resultados: Evidenciou-se melhora neurológica pós-operatória nas vias anterior e posterior, exceto nas laminectomias sem fusão, onde houve piora neurológica tardia. A via anterior mostrou um significante maior índice de complicações, relacionados a déficit de fusão intervertebral, deslocamento de enxerto, síndrome de disco adjacente, disfonia, disfagia, o mau posicionamento de enxerto e placas, lesão de raiz nervosa e significativo maior índice de re-intervenção cirúrgica. Na via posterior maior ocorrência de instabilidade em cifose pós-operatória na laminectomia, não sendo observada na laminoplastia, esta última com índices semelhantes aos encontrados na via anterior. Não houve melhora da dor axial nas laminoplastias e houve piora nas laminectomias, enquanto que nas discectomias e corpectomias houve significativa melhora do sintoma. Conclusão: As vias anterior e posterior foram eficazes em produzir melhora neurológica, exceto as laminectomias sem fusão. A via anterior produziu mais complicações, mas trata melhor a dor.

Research paper thumbnail of Adjacent segment disease (Transitional Syndrome) in cervical spine: clinical and radiological results

ABSTRACT OBJECTIVE: the objective of this study was to identify the occurrence of adjacent disc s... more ABSTRACT OBJECTIVE: the objective of this study was to identify the occurrence of adjacent disc syndrome secondary to intervertebral fusion in the cervical segment, and the predictors of outcome. METHODS: the medical records and imaging studies of 209 patients undergoing surgical treatment of cervical degenerative disease, with 169 cases treated through anterior approach and 40 cases through the posterior approach, at the HC-FMUSP from March 1993 to January 2007. Clinical evaluation was quantified by the scale of Japanese Orthopaedic Association (JOA), with an average follow-up of 80 months. The radiological analysis was based on the criteria of instability by White and Panjabi in all cases. The degeneration was measured by the scale of Kellgren before and after surgery. RESULTS: overall, the syndrome of adjacent disc was diagnosed in 30 cases (17.75%), with a mean time interval of incidence of 28.5 months after the merger, or 2.9 cases per year. There was an increase in degenerative changes in X-rays at levels adjacent to anterior fusion in 41.42% and 52.5% for the posterior without fusion, evaluated by the scale of Kellgren, the degeneration rate of 6.7% per annum, with no correlation with clinical changes. CONCLUSIONS: changes in physiological sagittal alignment of the spine and their severity predispose to the development of the syndrome. There was no incidence of the syndrome in cases of pseudoarthrosis or methacrylate, therefore, where there was a merger. The use of decompression and fusion, anterior, is associated with the possibility of developing a new framework for myeloradiculopathy in the postoperative period. Merger at a level that involve the fifth or sixth cervical vertebra, fixation with plates and pre-existing radiographic evidence of disc degeneration adjacent were factors of high risk for its emergence.

Research paper thumbnail of Transient Lesion in the Splenium of the Corpus Callosum in Acute Uncomplicated Falciparum Malaria

American Journal of Tropical Medicine and Hygiene, 2014

Research paper thumbnail of Management of supratentorial epidural hematoma in children: report on 49 patients

Arquivos de Neuro-Psiquiatria, 2010

Traumatic head injury is a common cause of mortality and acquired neurological impairment in chil... more Traumatic head injury is a common cause of mortality and acquired neurological impairment in children. However, pediatric epidural hematomas (EDHs) are not common and few series have studied the evolution of these patients. In this study, we present the results from a sample of patients with EDH with long-term follow-up. Method: Between January 2006 and December 2008, 49 patients with traumatic EDH were treated at our unit. Clinical course, radiological findings and outcomes were evaluated. Neurological status was assessed using the Glasgow Coma Scale (GCS). The patients' ages ranged from one day to 16 years. The mean follow-up was six months. Results: On admission, most of the patients presented mild trauma and 57% had a GCS of 13-15. The most common symptom was irritability. The most frequent mechanisms of injury were: falling from a height in 29 cases and motor vehicle accidents in 16 cases. Three of these patients presented GCS 3, but only one died. We found a late neurological deficit in nine patients. Conclusion: These lesions may occur following mild head trauma and in alert children with nonfocal neurological examinations. However, in children presenting irritability with subgaleal hematomas and a history of loss of consciousness, skull computed tomography must be performed.