Publications by authors named "Benedicto Oscar Colli"

56 Publications

Surgical management of embolized jugular foramen paragangliomas without facial nerve transposition: Experience of a public tertiary hospital in Brazil.

Surg Neurol Int 2021 30;12:482. Epub 2021 Sep 30.

Department of Surgery and Anatomy, Division of Neurosurgery, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

Background: Jugular foramen paragangliomas (JFP) treatment represents a challenge for surgeons due to its close relationship with facial nerve (FN), lower cranial nerves (LCN), and internal carotid artery. Due to its hypervascularization, preoperative tumor embolization has been indicated.

Methods: Retrospective analysis of the clinical evolution of 26 patients with JFP class C/D previously embolized treated through infratemporal/cervical access without FN transposition.

Results: Total and subtotal resections were 50% each, regrowth/recurrence were 25%, and 23%, respectively, and mortality was 3.9%. Postoperatively, 68.4% of patients had FN House and Brackmann (HB) Grades I/II. New FN deficits were 15.4% post embolization and 30.7% postoperatively. Previous FN deficits worsened in 46.1%. Tumor involved the FN in 30.8% and in 62.5% of them these nerves were resected and grafted (60% of them had HB III). Lateral fall, ear murmur, and vertigo improved in all patients. Tinnitus improved in 77.8% and one patient developed tinnitus after surgery. Hearing loss did not improve, eight partial hearing loss remained unchanged and four worsened. New postoperative LCN deficits were 64.3%. Postoperative KPS between 80 and 100 dropped 8.3%. Two patients with secretory paragangliomas with arterial hypertension difficult to control had better postoperative blood pressure control.

Conclusion: Although still with significant morbidity due to FN and LCN injuries, the treatment of patients with JFP Fisch C/D has good long-term results. Surgical techniques without FN transposition have less intraoperative nerve damage, lower rates of total resection, and higher recurrence. Preoperative embolization of JFP reduces the intraoperative blood loss but can cause FN deficit.
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http://dx.doi.org/10.25259/SNI_651_2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571183PMC
September 2021

Glomus jugulare in a pediatric patient: case report and literature review.

Childs Nerv Syst 2022 Feb 26;38(2):269-277. Epub 2021 Oct 26.

Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, 14049-900, Brazil.

Purpose: The jugular and tympanic glomus are rare neoplasms in the general population, being even more uncommon in the pediatric population. There is considerable morbidity associated with both disease and treatment. Treatment is essentially surgical, carried out in recent years in a multidisciplinary manner using preoperative embolization associated with microsurgery and eventually adjuvant radiotherapy. The outcome depends on the location of the lesion and its proximity to noble structures in addition to multidisciplinary monitoring in the postoperative period.

Methods: In this article, a literature review was carried out in the PubMed database, finding reports from 17 patients diagnosed with the disease. Only articles in English were considered.

Results: Moreover, we reported a case of a 14-year-old patient diagnosed with jugulotympanic glomus who underwent radical surgical treatment of the lesion.

Conclusion: This is a rare case of jugulotympanic glomus in a pediatric patient, who underwent surgical treatment associated with multidisciplinary therapy, with a favorable postoperative outcome.
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http://dx.doi.org/10.1007/s00381-021-05397-0DOI Listing
February 2022

Epidemiological features of meningiomas: a single Brazilian center's experience with 993 cases.

Arq Neuropsiquiatr 2021 08;79(8):705-715

Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia, Ribeirão Preto SP, Brazil.

Background: Meningiomas are the most frequent primary central nervous system (CNS) tumors. Their geographical and ethnic characteristics need to be known, in order to enable rational treatment.

Objective: To investigate clinical and epidemiological aspects in a series of patients with meningiomas.

Methods: Retrospective analysis on the demographic profile, location and histopathology of 993 patients with meningiomas (768 operated and 225 not operated).

Results: Meningiomas represented 43.8% of the primary CNS tumors; 6.8% were multiple tumors (14.7% with neurofibromatosis 2) and 0.6% were radiation-induced tumors. The mean ages were 53.0 and 63.9 years for operated and non-operated patients and the female/male ratios were 3.2:1 and 6.3:1. Diagnosis was made later among females. The peak incidences were in the 6th and 7th decades respectively for operated and non-operated patients. The incidence was low at early ages and higher among patients aged 70+ years. The meningiomas were intracranial in 96.5% and most were WHO grade I (88.9%) and transitional. In the spinal canal (3.5%), they occurred mainly in the dorsal region (all grade I; mostly transitional). The racial distribution was 1.0% in Asian-Brazilians, 87% in Caucasians and 12% in African-Brazilians. 83.4% and 51.6% of the patients were estimated to be recurrence-free at 10 and 20 years, and the mortality rate was 3%.

Conclusions: Most of the demographic data were similar to what has been observed in other western centers. Differences were higher incidence of meningiomas, female and older predominance in non-operated patients, predominance in Caucasian, and higher association with neurofibromatosis 2.
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http://dx.doi.org/10.1590/0004-282X-ANP-2020-0441DOI Listing
August 2021

Adult giant cerebellar cavernous malformations: case report and review of the literature.

Br J Neurosurg 2021 Aug 18:1-6. Epub 2021 Aug 18.

Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.

Cavernous malformations are vascular malformations that can occur anywhere in the central nervous system (CNS). Giant cavernous malformations (GCM) are extremely rare in adults, especially in the posterior fossa. Herein, we described a 48-year-old male who presented with vertigo and postural instability for three months. Neuroimaging revealed a 131.15 cm heterogeneous midline upper cerebellar lesion. After a suboccipital craniotomy, a gross total resection (GTR) was accomplished. Histopathologic examination revealed a huge cavernous malformation. Only 27 GCM adult cases were reported in the English-based literature. Only two patients had cerebellar lesions and, to the best of our knowledge, this is the first case of cerebellar vermis GCM. We concluded that cerebellar GCM (CGCM) in adults are exceedingly rare and indolent lesions. These lesions can radiologically and clinically mimic neoplastic lesions that have to be considered in the differential diagnosis. GTR is the mainstay of treatment and, whenever possible, should be attempted.
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http://dx.doi.org/10.1080/02688697.2021.1961685DOI Listing
August 2021

Treatment of distal unruptured intracranial aneurysms using a surface-modified flow diverter under prasugrel monotherapy: a pilot safety trial.

J Neurointerv Surg 2021 Jul 25;13(7):647-651. Epub 2021 Feb 25.

Division of Interventional Neuroradiology, Department of Medical Imaging, Hematology and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil

Background: Flow diverters (FDs) are effective in the treatment of carotid aneurysms. Compared with carotid aneurysms, the treatment of distal intracranial aneurysms with FDs has been associated with a relatively high incidence of complications. Low thrombogenic modified-surface FDs may reduce ischemic complications and allow for the use of a single antiplatelet medication. The aim of this study was to assess the safety and efficacy of the p48 MW HPC Flow Modulation Device (Phenox GmbH, Bochum, Germany) to treat distal intracranial aneurysms used in combination with prasugrel monotherapy.

Methods: This was a single-center, prospective, pivotal, open, single-arm study. Patients were included in this study from December 2019 to September 2020. The primary endpoints were the incidence of any neurologic deficit after treatment until 1 month of follow-up, defined as National Institutes of Health Stroke Scale (NIHSS) ≥1, and the incidence of acute ischemic lesions in magnetic resonance imagin (MRI) images 48 hours after treatment. The secondary endpoint was the rate of complete occlusion of the aneurysms at the 1-month follow-up.

Results: Twenty-one patients harboring 27 distal aneurysms of the anterior circulation were included. Mean age was 57.8 (SD 9.7) years, and 16 patients were female (80%). No patient had neurologic symptoms at the 1-month follow-up. Four patients (20%) had asymptomatic acute brain ischemic lesions on MRI. Complete aneurysm occlusion occurred in 9/27 (33.3%) aneurysms at the 1-month follow-up.

Conclusion: In this pilot safety trial, treatment of distal intracranial aneurysms with p48 MW HPC under monotherapy with prasugrel appeared to be safe.
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http://dx.doi.org/10.1136/neurintsurg-2020-017262DOI Listing
July 2021

Endovascular Treatment of Tentorial Dural Arteriovenous Fistulas Using the Transarterial Approach as a First-Line Strategy.

Oper Neurosurg (Hagerstown) 2021 04;20(5):484-492

Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.

Background: In recent decades, endovascular approaches have become the standard treatment for most tentorial dural arteriovenous fistulas (TDAVFs). Although endovascular treatment (EVT) is associated with better clinical outcomes, the angiographic occlusion rates are lower than those of surgical or combined approaches.

Objective: To evaluate the efficacy and safety of EVT for TDAVFs using the transarterial approach (TAA) as a first-line strategy.

Methods: Clinical and radiological data from 45 consecutive patients with TDAVFs who underwent EVT at 2 centers were retrospectively reviewed. Patient demographics and clinical and angiographic data were registered. Postprocedural and 6-mo follow-up angiographic and clinical results were evaluated. Univariable and multivariable logistic regression were performed to identify angiographic occlusion predictors after the first session and predictors of clinical complications.

Results: An isolated TAA was used for 40 TDAVFs (88.9%). A total of 37 (82.2%) TDAVFs were completely occluded after a single EVT session, and 44 TDAVFs (97.8%) were completely occluded after the last procedure. The presence of fewer than 5 arterial feeders was a predictor for total occlusion after the first treatment session (odds ratio [OR], 18.9; 95% CI 2.06-173.57; P = .01). Six-month angiographic control was performed in 42 patients, and all TDAVFs were occluded. Good long-term neurological outcomes were observed in 41 patients (91.1%). Clinical complications occurred in 7 (15.6%) patients. They were related to the number of accessed arteries to perform TAA (odds ratio, 2.53; 95% CI 1.10-5.86; P = .03). The procedure-related mortality rate was 2.2%.

Conclusion: TAA is a safe and effective treatment for TDAVFs.
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http://dx.doi.org/10.1093/ons/opaa477DOI Listing
April 2021

Association between draining vein diameters and intracranial arteriovenous malformation hemorrhage: a multicentric retrospective study.

Neuroradiology 2020 Nov 30;62(11):1497-1505. Epub 2020 Jun 30.

Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, 14048-090, Brazil.

Purpose: Intracranial arteriovenous malformations (AVMs) cause hemorrhage, and the role of draining vein diameters in rupture risk is controversial. The aims of the present study were to investigate the variables related with intracranial AVM rupture and to examine the association of draining vein diameters and AVM hemorrhage.

Methods: Two hundred three patients were included in this study, of which 117 (57%) had unruptured AVMs, and 86 (43%) had ruptured AVMs.

Results: In an adjusted (multivariate) analysis, the variables significantly associated with AVM hemorrhagic presentation were age (OR per year increase 0.97, 95%CI 0.95-0.99, p = 0.007), a deep nidus compared with superficial nidus (OR 3.21, 95%CI 1.13-9.06, p = 0.028), the nidus diameter (OR per each mm increase 0.95, 95%CI 0.92-0.97, p < 0.001), a single draining vein compared with multiple draining veins (OR 2.14, 95%CI 1.02-4.50, p = 0.044), the draining vein diameter (OR per mm increase 1.52, 95%CI 1.26-1.83, p < 0.001), and a draining vein diameter ≥ 5 mm compared with < 5 mm (OR 5.80, 95%CI 2.70-12.47, p < 0.001).

Conclusion: In this study, after adjusted analysis, the variables associated with intracranial AVM hemorrhagic presentation were a young age, a small nidus diameter, a deeply located nidus, a single draining vein, and large draining vein diameters. A draining vein diameter cutoff ≥ 5 mm was positively associated with the risk of AVM rupture. A large and prospective study is now necessary to confirm if draining vein diameter is a risk factor for AVM hemorrhage.
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http://dx.doi.org/10.1007/s00234-020-02484-yDOI Listing
November 2020

De Novo Intracranial Arteriovenous Malformation-Case Report and Literature Review.

World Neurosurg 2020 06 27;138:349-351. Epub 2020 Mar 27.

Division of Interventional Neuroradiology, Department of Radiology, Hematology and Oncology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

Background: Intracranial arteriovenous malformations (AVMs) have been considered congenital. We present and discuss a case of a child who had no evidence of an AVM at 6 years of age when presenting with parenchymatous hemorrhage due to cavernous angioma and who developed the lesion during 10 years of follow-up.

Case Description: A 6-year-old female presented with parenchymatous hemorrhage and was diagnosed with cavernous angioma of the right occipital lobe. She was treated with lesion removal and remained asymptomatic during the initial follow-up. At age 16, she presented to the emergency department with a new-onset headache. A new magnetic resonance imaging scan was performed and revealed an AVM in the right temporal lobe, which was confirmed with digital subtraction angiography. The AVM had not been present 10 years earlier, as seen on the previous digital subtraction angiography and magnetic resonance imaging examinations.

Conclusions: On the basis of recent findings of de novo AVMs and on the current theory of a postnatal origin of AVMs, we propose that AVMs cannot always be considered congenital and that several factors can contribute to their pathogenesis.
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http://dx.doi.org/10.1016/j.wneu.2020.03.109DOI Listing
June 2020

Analysis of Caspase-9 protein and microRNAs miR-21, miR-126 and miR-155 related to the apoptosis mechanism in the cerebellum of rats submitted to focal cerebral ischemia associated with an alcoholism model.

Arq Neuropsiquiatr 2019 24;77(10):689-695. Epub 2019 Oct 24.

Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Ribeirão Preto SP, Brasil.

Objective: This study aimed to analyze the cerebellum of rats submitted to an experimental focal cerebral ischemia, by middle cerebral artery occlusion for 90 minutes, followed by reperfusion for 48 hours, associated with an alcoholism model.

Methods: Fifty adult Wistar rats were used, subdivided into five experimental groups: control group (C): animals submitted to anesthesia only; sham group (S): animals submitted to complete simulation of the surgical procedure; ischemic group (I): animals submitted to focal cerebral ischemia for 90 minutes followed by reperfusion for 48 hours; alcoholic group (A): animals that received daily absolute ethanol diluted 20% in water for four weeks; and, ischemic and alcoholic group (I + A): animals receiving the same treatment as group A and, after four weeks, submitted to focal cerebral ischemia for 90 minutes, followed by reperfusion for 48 hours. The cerebellum samples were collected and immunohistochemical analysis of Caspase-9 protein and serum analysis by RT-PCR of microRNAs miR-21, miR-126 and miR155 were performed.

Results: The expression of Caspase-9 was higher in groups I, A and I + A. In the microRNAs analyses, miR-126 was higher in groups A and I + A, miR-155 was higher in groups I and I + A.

Conclusions: We conclude that apoptosis occurs in the cerebellar cortex, even if it is distant from the ischemic focus, and that microRNAs 126 and 155 show a correlation with cellular apoptosis in ischemic rats and those submitted to the chronic alcohol model.
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http://dx.doi.org/10.1590/0004-282X20190126DOI Listing
July 2020

Morphological and immunohistochemical analysis of proteins CASPASE 3 and XIAP in rats subjected to cerebral ischemia and chronic alcoholism.

Acta Cir Bras 2018 Aug;33(8):652-663

Assistant Professor, Department of Surgery and Anatomy, Medical School, USP, Ribeirao Preto-SP, Brazil. Design of the study, manuscript writing.

Purpose: To evaluate histopathological and ultrastructural changes and expression of proteins related to apoptosis CASPASE 3 and XIAP after experimental induction of temporary focal cerebral ischemia (90 minutes) due to obstruction of the middle cerebral artery in alcoholism model.

Methods: Forty adult Wistar rats were used, subdivided into 5 experimental groups: control group (C); Sham group (S); Ischemic group (I); Alcoholic group (A); and Ischemic and Alcoholized group (I+A): animals submitted to the same treatment of group A and after four weeks were submitted to focal cerebral ischemia during 90 minutes, followed by reperfusion of 48 hours. Were processed for histopathological analysis and immunohistochemistry (for the protein expression of CASPASE -3 and XIAP).

Results: Greater histopathological changes were observed in the animals of groups I and I+A in the three areas analyzed. The neuronal loss was higher in the medial striatum region of the animals of groups I and I + A. The protein expression of CASPASE -3 was higher than that of XIAP in the groups I and I + A for both proteins.

Conclusion: The expression of XIAP was slightly higher where the histopathological changes and expression of CASPASE -3 was less evident.
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http://dx.doi.org/10.1590/s0102-865020180080000001DOI Listing
August 2018

Pediatric neurocysticercosis.

Childs Nerv Syst 2018 10 9;34(10):1957-1965. Epub 2018 Jul 9.

Division of Pediatric Neurosurgery, National Institute of Women, Children and Adolescents Health Fernandes Figueira - Oswaldo Cruz Foundation (IFF - Fiocruz), Rio de Janeiro, RJ, Brazil.

Background: Neurocysticercosis (NCC) is an infestation of the nervous system caused by encysted larvae of Taenia solium. NCC is an important acquired cause of epilepsy and other neurological manifestations especially in endemic areas. NCC in children has pleomorphic manifestations depending on the location, number, viability of the cysts, and host response. Even with advancing knowledge of the disease manifestations, many aspects related to diagnosis and treatment, particularly in children, still remain controversial and pose challenges to clinical practice. There is no gold standard test to diagnose NCC and the management recommendations are still emerging. This review provides an overview of diagnosis of NCC in children and its management with special focus on current challenges and future prospects.

Discussion: In developing countries, NCC is important not only because of its frequency but also because of high morbidity and mortality rates associated, especially in cases in which it progresses to increased intracranial pressure. Because of its pleomorphic presentation, NCC should be considered in the differential diagnosis of a number of neurological conditions. Treatment with cysticidal therapy leads to reduction in seizure frequency and a faster resolution of lesions.

Conclusions: We have summarized the current approaches to diagnosis and treatment of NCC, recent advances in understanding the biology of NCC, and how one can take advantage of these new insights to formulate the next generation of clinical trials.
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http://dx.doi.org/10.1007/s00381-018-3889-4DOI Listing
October 2018

Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes.

J Neurointerv Surg 2018 May 19;10(5):461-462. Epub 2017 Aug 19.

Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.

Introduction: Transvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown.

Objective: To assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF.

Methods: A retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used-coils or liquids-were compared between two groups of patients.

Results: Complete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms.

Conclusion: In this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.
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http://dx.doi.org/10.1136/neurintsurg-2017-013318DOI Listing
May 2018

Extending the indications for transvenous approach embolization for superficial brain arteriovenous malformations.

J Neurointerv Surg 2017 Nov 9;9(11):1053-1059. Epub 2017 Jun 9.

Division of Interventional Neuroradiology, Department of Internal Medicine, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.

Introduction: Transarterial embolization is the standard endovascular treatment strategy for intracranial arteriovenous malformations (AVMs). The transvenous approach has been indicated for the embolization of deep AVMs meeting a set of strict eligibility criteria. The present study aims to assess the safety and efficacy of the transvenous approach for superficial AVMs.

Methods: A retrospective series of 12 patients presenting with cortical AVMs were treated by endovascular embolization using a transvenous approach with a curative intent.

Results: Nine patients (75%) had ruptured AVMs at admission. The mean nidus size was 1.9 cm, six patients (50%) had a nidus in eloquent areas and the median Spetzler-Martin grade was 2. The rate of immediate angiographic occlusion of the AVMs was 91.6% (11/12). One patient in whom immediate angiographic occlusion was not achieved showed spontaneous occlusion at the 6-month follow-up. No procedural or clinical complications were observed. The mean and median modified Rankin scale (mRS) scores at discharge were 1.7 and 2 (range 0-3, SD=0.96), and the mean and median mRS scores at 6 months were 1.6 and 2 (0-3, 1.16). Nine patients (75%) were independent (mRS ≤2) at discharge and 11 patients (91.6%) were independent (mRS ≤2) at the 6-month follow-up.

Conclusions: The curative transvenous embolization of superficial intracranial AVMs is feasible and appears safe and effective when strict anatomical selection is respected. This technique extends the current indications for transvenous embolization of intracranial AVMs and may improve cure rates while reducing embolization-related complications.
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http://dx.doi.org/10.1136/neurintsurg-2017-013113DOI Listing
November 2017

High expression of anti-apoptotic genes in grade I and II meningiomas.

Arq Neuropsiquiatr 2017 04;75(4):209-215

Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Ribeirão Preto SP, Brasil.

Objective: To evaluate the expression of c-FLIP, XIAP, Bcl-2, caspase 3, 8 and 9, cytochrome c, APAF 1 and Smac/DIABLO genes related to apoptosis pathways.

Methods: The gene expression was evaluated in 30 meningiomas (WHO grades I and II) and in 10 normal samples (from arachnoid tissue) through PCR-RT.

Results: The results showed higher expression of anti-apoptotic genes in meningiomas when compared to the control group, which had a low expression of pro-apoptotic genes.

Conclusion: There is a possible block in the activation of caspases through the intrinsic apoptosis pathway in meningiomas. c-FLIP modulates caspase 8 and, by inhibiting its activation due to the lack of connection with the receiver, there is a block to the FAS activation of apoptosis by its extrinsic pathway.
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http://dx.doi.org/10.1590/0004-282X20170027DOI Listing
April 2017

Expression of NMDA receptor and microRNA-219 in rats submitted to cerebral ischemia associated with alcoholism.

Arq Neuropsiquiatr 2017 Jan;75(1):30-35

Universidade de São Paulo, Departamento de Cirurgia e Anatomia, Ribeirão Preto SP, Brasil.

Objective:: To evaluate the microRNA-219 and NMDA expression in brain tissue and blood of animals subjected to cerebral ischemia associated with alcoholism.

Methods:: Fifty Wistar rats were divided into groups: control, sham, ischemic, alcoholic, and ischemic plus alcoholic. The expression of microRNA-219 and NMDA were analyzed by real-time PCR.

Results:: When compared to the control group, the microRNA-219 in brain tissue was less expressed in the ischemic, alcoholic, and ischemic plus alcoholic groups. In the blood, this microRNA had lower expression in alcoholic and ischemic plus alcoholic groups. In the brain tissue the NMDA gene expression was greater in the ischemic, alcoholic, and ischemic plus alcoholic groups.

Conclusion:: A possible modulation of NMDA by microRNA-219 was observed with an inverse correlation between them.
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http://dx.doi.org/10.1590/0004-282X20160188DOI Listing
January 2017

Morphological and immunohistochemical analysis of apoptosis in the cerebellum of rats subjected to focal cerebral ischemia with or without alcoholism model.

Acta Cir Bras 2016 Sep;31(9):629-637

Associate Professor, Department of Surgery and Anatomy, School of Medicine of Ribeirao Preto, USP, Brazil. Conception, design, intellectual and scientific content of the study; manuscript writing, critical revision; supervision of all phases of the study.

Purpose: : To evaluated histopathological changes, morphometric and expression of proteins CASPASE-3, BCL-2 and XIAP related to apoptosis in the cerebellum after induction of temporary focal cerebral ischemia followed by reperfusion, with or without a model of chronic alcoholism.

Methods: : Fifty Wistar rats were used and divided into: control group (C), sham group (S), ischemic group (I), alcoholic group (A), and ischemic and alcoholic group (IA). The cerebellum samples collected were stained for histopathological and morphometric analysis and immunohistochemistry study.

Results: : Histopathological changes were observed a greater degree in animals in groups A and IA. The morphometric study showed no difference in the amount of cells in the granular layer of the cerebellum between the groups. The expression of CASPASE-3 was higher than BCL-2 and XIAP in the groups A and IA.

Conclusion: : We observed correlation between histopathological changes and the occurrence of apoptosis in cerebellar cortex.
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http://dx.doi.org/10.1590/S0102-865020160090000009DOI Listing
September 2016

Validation of a New Minimally Invasive Intracranial Pressure Monitoring Method by Direct Comparison with an Invasive Technique.

Acta Neurochir Suppl 2016 ;122:97-100

University of São Paulo, Sao Paulo, Brazil.

In this chapter we present in vivo experiments with a new minimally invasive method of monitoring intracranial pressure (ICP). Strain gauge deformation sensors are externally glued onto the exposed skull. The signal from these sensors is amplified, filtered, and sent to a computer with appropriate software for analysis and data storage. Saline infusions into the spinal channel of rats were performed to produce ICP changes, and minimally invasive ICP and direct Codman intraparenchymal ICP were simultaneously acquired in six animals. The similarity between the invasive and minimally invasive methods in response to ICP increase was assessed using Pearson's correlation coefficient. It demonstrated good agreement between the two measures < r > = 0.8 ± 0.2, with a range of 0.31-0.99.
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http://dx.doi.org/10.1007/978-3-319-22533-3_19DOI Listing
July 2017

Validation of a New Noninvasive Intracranial Pressure Monitoring Method by Direct Comparison with an Invasive Technique.

Acta Neurochir Suppl 2016 ;122:93-6

University of São Paulo, São Paulo, Brazil.

The search for a completely noninvasive intracranial pressure (ICPni) monitoring technique capable of real-time digitalized monitoring is the Holy Grail of brain research. If available, it may facilitate many fundamental questions within the range of ample applications in neurosurgery, neurosciences and translational medicine, from pharmaceutical clinical trials, exercise physiology, and space applications. In this work we compare invasive measurements with noninvasive measurements obtained using the proposed new noninvasive method. Saline was infused into the spinal channel of seven rats to produce ICP changes and the simultaneous acquisition of both methods was performed. The similarity in the invasive and noninvasive methods of ICP monitoring was calculated using Pearson's correlation coefficients (r). Good agreement between measures < r > = 0.8 ± 0.2 with a range 0.28-0.96 was shown.
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http://dx.doi.org/10.1007/978-3-319-22533-3_18DOI Listing
July 2017

Modified pressure cooker technique: An easier way to control onyx reflux.

J Neuroradiol 2016 Jun 2;43(3):218-22. Epub 2016 Mar 2.

Division of neurosurgery, medical school of Ribeirão Preto, university of São Paulo, Ribeirão Preto, SP, Brazil.

The use of onyx enabled the treatment of various intracranial vascular diseases more effectively than cyanoacrylate. The pressure cooker technique allowed definitive control of reflux and was made possible via detachable microcatheters. We present a variation of this technique called the modified pressure cooker to make reflux control easier and more reproducible and thus simplifying the procedure. We also extended the application of the technique to other diseases beyond arteriovenous malformations including dural arteriovenous fistulas and hypervascular tumors.
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http://dx.doi.org/10.1016/j.neurad.2016.01.146DOI Listing
June 2016

Straight sinus: ultrastructural analysis aimed at surgical tumor resection.

J Neurosurg 2016 08 8;125(2):494-507. Epub 2016 Jan 8.

Division of Neurosurgery and.

OBJECTIVE Accurate knowledge of the anatomy of the straight sinus (SS) is relevant for surgical purposes. During one surgical procedure involving the removal of part of the SS wall, the authors observed that the venous blood flow was maintained in the SS, possibly through a vein-like structure within the dural sinus or dural multiple layers. This observation and its divergence from descriptions of the histological features of the SS walls motivated the present study. The authors aimed to investigate whether it is possible to dissect the SS walls while keeping the lumen intact, and to describe the histological and ultrastructural composition of the SS wall. METHODS A total of 22 cadaveric specimens were used. The SS was divided into three portions: anterior, middle, and posterior. The characteristics of the SS walls were analyzed, and the feasibility of dissecting them while keeping the SS lumen intact was assessed. The thickness and the number of collagen fibers and other tissues in the SS walls were compared with the same variables in other venous sinuses. Masson's trichrome and Verhoeff's stains were used to assess collagen and elastic fibers, respectively. The data were analyzed using Zeiss image analysis software (KS400). RESULTS A vein-like structure independent of the SS walls was found in at least one of the portions of the SS in 8 of 22 samples (36.36%). The inferior wall could be delaminated in at least one portion in 21 of 22 samples (95.45%), whereas the lateral walls could seldom be delaminated. The inferior wall of the SS was thicker (p < 0.05) and exhibited less collagen and greater amounts of other tissues-including elastic fibers, connective tissue, blood vessels, and nerve fibers (p < 0.05)-compared with the lateral walls. Transmission electron microscopy revealed the presence of muscle fibers at a level deeper than that of the subendothelial connective tissue in the inferior wall of the SS, extending from its junction with the great cerebral vein to the confluence of sinuses. CONCLUSIONS The presence of a structure within the SS that can maintain the venous blood flow despite the dural wall might be considered an anatomical variation. The greater thickness of the inferior wall of the SS compared with the lateral walls is mainly due to the presence of larger amounts of tissues other than collagen. Delamination of the inferior wall of the SS was mostly possible in its inferior wall, but an attempt to delaminate the lateral walls is not recommended. Ultrastructural assessment corroborated a recent report of the presence of muscle fibers in the inferior wall of the SS.
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http://dx.doi.org/10.3171/2015.6.JNS15584DOI Listing
August 2016

Atypical and anaplastic meningiomas in a public hospital in São Paulo State, Brazil.

Arq Neuropsiquiatr 2015 Sep;73(9):770-8

Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.

Unlabelled: Atypical/anaplastic (World Health Organization (WHO) grades II and III) are less common and have poorer outcomes than benign meningiomas. This study aimed to analyze the outcome of patients with these tumors.

Method: Overall/recurrence-free survivals (RFS) and the Karnofsky Performance Scale of 52 patients with grades II (42) and III (9) meningiomas surgically treated were analyzed (uni/multivariate analysis).

Results: Total/subtotal resections were 60.8%/35.3%. Patients <60 years-old and grade II tumors had longer survival. Grade II tumors, total resection and de novo meningioma had better RFS (univariate analysis). Patients >60 years-old, de novo meningioma and radiotherapy had longer survival and patients <60 years-old and with grade II tumors had longer RFS (multivariate analysis). Recurrence rate was 51% (39.2% Grade II and 66.7% Grade III). Operative mortality was 1.9%.

Conclusion: Age <60 years-old, grade II tumors and de novo meningiomas were the main predictors for better prognosis among patients with grades II and III meningiomas.
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http://dx.doi.org/10.1590/0004-282X20150106DOI Listing
September 2015

Morphometric and Functional Analysis of Axonal Regeneration after End-to-end and End-to-side Neurorrhaphy in Rats.

Plast Reconstr Surg Glob Open 2015 Mar 7;3(3):e326. Epub 2015 Apr 7.

Division of Plastic Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil; and Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.

Background: End-to-side neurorrhaphy is controversial in the literature and has sparked debate over its degree of recovery. In this study, nerve regeneration was assessed in rats after end-to-side neurorrhaphy by morphometric analysis, electromyography, electron microscopy, and retrograde horseradish peroxidase (HRP) and Fluoro-Gold (FG; Fluorochrome Inc., Denver, Colo.) transport and then compared to end-to-end neurorrhaphy and sham operation.

Methods: Thirty-seven animals were operated on and divided randomly into 4 groups: group 1, sham; group 2, end-to-end neurorrhaphy; group 3, end-to-side neurorrhaphy with an epineural window; and group 4, end-to-side neurorrhaphy without an epineural window. Three months after surgery, HRP was injected into the peroneal muscles. After 48 hours, nerve segments and lumbar spine segments were collected. Electromyography data were compared between groups, and FG uptake was compared in 20 other animals. Analysis of variance with Tukey-Kramer correction was used for group comparison.

Results: The fiber count after end-to-end neurorrhaphy was higher than after end-to-side neurorrhaphy with an epineural window (q = 5.243 and P < 0.01) or without an epineural window (q = 4.951 and P < 0.01). HRP labeling showed a difference between group 2 and end-to-side neurorrhaphy with an epineural window (q = 5.291 and P < 0.01) and without an epineural window (q = 5.617 and P < 0.01). There was also a difference in mean area labeled with FG. Furthermore, the amplitudes of the action potentials were significantly higher in groups 1 and 2.

Conclusions: There was nerve regeneration in all groups studied. However, the end-to-end neurorrhaphy group had better reinnervation than the end-to-side neurorrhaphy groups.
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http://dx.doi.org/10.1097/GOX.0000000000000280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387148PMC
March 2015

Imaging diagnosis of dural and direct cavernous carotid fistulae.

Radiol Bras 2014 Jul-Aug;47(4):251-5

Professor Responsible for the Unit of Interventional Radiology and Therapeutic Neuroradiology - Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil.

Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae.
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http://dx.doi.org/10.1590/0100-3984.2013.1799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4337128PMC
March 2015

Rare case of neurinoma of the facial nerve.

Braz J Otorhinolaryngol 2015 Mar-Apr;81(2):226-7. Epub 2015 Jan 15.

Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.

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http://dx.doi.org/10.1016/j.bjorl.2014.12.008DOI Listing
May 2016

Foramen magnum meningiomas: surgical treatment in a single public institution in a developing country.

Arq Neuropsiquiatr 2014 Jul;72(7):528-37

Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirao Preto, SP, Brazil.

Objective: To analyze the clinical outcome of patients with foramen magnum (FM) meningiomas.

Method: Thirteen patients (11 Feminine / 2 Masculine with FM meningiomas operated on through lateral suboccipital approach were studied. Clinical outcome were analyzed using survival (SC) and recurrence-free survival curves (RFSC).

Results: All tumors were World Health Organization grade I. Total, subtotal and partial resections were acchieved in 69.2%, 23.1% and 7.7%, respectively, and SC was better for males and RFSC for females. Tumor location, extent of resection and involvement of vertebral artery/lower cranial nerves did not influence SC and RFSC. Recurrence rate was 7.7%. Operative mortality was 0. Main complications were transient (38.5%) and permanent (7.7%) lower cranial nerve deficits, cerebrospinal fluid fistula (30.8%), and transient and permanent respiratory difficulties in 7.7% each.

Conclusions: FM meningiomas can be adequately treated in public hospitals in developing countries if a multidisciplinary team is available for managing postoperative lower cranial nerve deficits.
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http://dx.doi.org/10.1590/0004-282x20140101DOI Listing
July 2014

Sciatic nerve regeneration in rats by a nerve conduit engineering with a membrane derived from natural latex.

Acta Cir Bras 2012 Dec;27(12):885-91

Department of Biochemistry and Immunology, School of Medicine of Ribeirao Preto, USP, SP, Brazil.

Purpose: To evaluate the capacity of natural latex membrane to accelerate and improve the regeneration quality of the of rat sciatic nerves.

Methods: Forty male adult Wistar rats were used, anesthetized and operated to cut the sciatic nerve and receive an autograft or a conduit made with a membrane derived from natural latex (Hevea brasiliensis). Four or eight weeks after surgery, to investigate motor nerve recovery, we analyzed the neurological function by walking pattern (footprints analysis and computerized treadmill), electrophysiological evaluation and histological analysis of regenerated nerve (autologous nerve graft or tissue cables between the nerve stumps), and anterior tibial and gastrocnemius muscles.

Results: All functional and morphological analysis showed that the rats transplanted with latex conduit had a better neurological recovery than those operated with autologous nerve: quality of footprints, performance on treadmill (p<0.01), electrophysiological response (p<0.05), and quality of histological aspects on neural regeneration.

Conclusion: The data reported showed behavioral and functional recovery in rats implanted with latex conduit for sciatic nerve repair, supporting a complete morphological and physiological regeneration of the nerve.
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http://dx.doi.org/10.1590/s0102-86502012001200010DOI Listing
December 2012

Pre, intra and post-ischemic hypothermic neuroprotection in temporary focal cerebral ischemia in rats: morphometric analysis.

Arq Neuropsiquiatr 2012 Aug;70(8):609-16

Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Objective: To evaluate the neuroprotection of mild hypothermia, applied in different moments, in temporary focal cerebral ischemia in rats.

Methods: Rats was divided into Control (C), Sham (S), Ischemic-control(IC), Pre-ischemic Hypothermia (IH1), Intra-ischemic Hypothermia (IH2), and Post-ischemic Hypothermia (IH3) groups. Morphometry was performed using the KS400 software (Carl Zeiss®) in coronal sections stained by Luxol Fast Blue. Ischemic areas and volumes were obtained.

Results: Statistically, blue areas showed difference for C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.01; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH vs. IH2 (p=0.39; p=0.85; p=0.63). Red areas showed difference between C vs. IC, IC vs. IH1 and IC vs. IH2 (p=0.0001; p=0.009; p=0.03), and no difference between C vs. S, IC vs. IH3 and IH1 vs. IH2 (p=0.48; p=0.27; p=0.68). Average ischemic areas and ischemic volumes showed difference between IC vs. IH1 and IC vs. IH2 (p=0.0001 and p=0.0011), and no difference between IC vs. IH3 and IH1 vs. IH2 (p=0.57; p=0.79).

Conclusion: Pre-ischemic and intra-ischemic hypothermia were shown to be similarly neuroprotective, but this was not true for post-ischemic hypothermia.
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http://dx.doi.org/10.1590/s0004-282x2012000800010DOI Listing
August 2012

Results of microsurgical treatment of paraclinoid carotid aneurysms.

Neurosurg Rev 2013 Jan 17;36(1):99-114; discussion 114-5. Epub 2012 Aug 17.

Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.

The term "paraclinoid aneurysms", has been used for aneurysms of the internal carotid artery (ICA) between the cavernous sinus and the posterior communicating artery. Due to their complex anatomical relationship at the skull base and because they are frequently large/giant, their surgical treatment remains a challenge. Ninety-five patients harboring 106 paraclinoid aneurysms underwent surgery (1990-2010). Age, 11-72 years old. Sex, 74:21 female/male. Follow-up; 1-192 months (mean = 51.7 months). Eighty-six patients had single and 9 had multiple paraclinoid aneurysms. Sixty-six were ophthalmic, 14 were in the ICA superior wall, 13 in the inferior, 10 in the medial, and 3 in the ICA lateral wall. Eleven were giant, 29 were large, and 66 were small. Sixty-three patients had ruptured and 32 had unruptured aneurysms. Two patients with bilateral aneurysms had bilateral approaches, totaling 97 procedures. A total of 98.2% of aneurysms were clipped (complete exclusion in 93.8%). ICA occlusion occurred in 10 (5.6%). There was no patient rebleeding during the follow-up period. A good outcome was achieved in 76.8%, with better results for unruptured aneurysms, worse results for patients with vasospasm, and with no difference according to size. Thirty-six (37.9%) patients had transient/permanent postoperative neurological deficits (25.4% ruptured vs. 62.5% unruptured aneurysms). The most frequent deficits were visual impairment and third cranial nerve palsies. Operative mortality was 11.6%, all in patients presenting with ruptured aneurysms. Despite relatively high morbidity/mortality, especially for patients with ruptured aneurysms, microsurgical treatment of paraclinoid aneurysm has high efficacy, with better outcome for unruptured aneurysms and worse outcome for patients with vasospasm.
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http://dx.doi.org/10.1007/s10143-012-0415-0DOI Listing
January 2013

Giant intracranial aneurysms: morphology and clinical presentation.

Neurosurg Rev 2013 Jan 13;36(1):117-22; discussion 122. Epub 2012 Jul 13.

Department of Neurological Sciences, Medical School of São José do Rio Preto, São José do Rio Preto, SP, Brazil.

The purpose of this study was to correlate the morphology of giant intracranial aneurysms (GIA) with their clinical presentation. Eighty patients with GIA, 14 males and 66 females, were studied. Univariate and multivariate analyses were made to test the associations between morphological and clinical features. The main locations of the unruptured GIA included the carotid cavernous segment, and for the ruptured GIA, the most frequent were the carotid supraclinoid and middle cerebral arteries. There was a significant association among communicating arteries (CA) of "bad" quality and presence of thrombus and calcification (TC). The risk of rupture is 8 times higher in patients with CA of "bad" quality and 11 times higher in patients without TC. GIA are more frequent in the cavernous segment. There is a high rupture risk in the middle cerebral artery. CA of "bad" quality are associated with TC. The rupture risk is significantly higher in patients without TC.
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http://dx.doi.org/10.1007/s10143-012-0407-0DOI Listing
January 2013

Transseptumpellucidumrostrostomy: anatomical considerations and neuroendoscopic approach.

Acta Cir Bras 2011 ;26 Suppl 2:133-40

Department of Surgery and Anatomy, FMRP, USP, Ribeirao Preto, SP, Brazil.

Purpose: Verify the presence of the rostral lamina of the corpus callosum, and set parameters for neuroendoscopy.

Methods: Relationship of the floor of the frontal horn of lateral ventricle and the hypothalamic-septal region were studied after sagittal and axial sections of the brains. Measurements were compared using F and Student t tests. The correlations between anterior-posterior diameter of the interventricular foramen / anterior-posterior diameter of the fornix column, and between anterior-posterior diameter of the interventricular foramen / length of the rostral lamina were performed by Pearson index test.

Results: There was no statistically significant difference in measurements performed in both hemispheres (p<0.05). Positive correlations were observed between the anterior-posterior diameter of the interventricular foramen / anterior-posterior diameter of the fornix column (R = 0.35), and between the anterior-posterior diameter of the interventricular foramen / length of the rostral lamina (R = 0.23).

Conclusion: Rostral lamina was observed in all brains. It was possible to perform an endoscopic fenestration in the rostral lamina, communicating safely the lateral ventricle with a polygonal subcallosal cistern.
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http://dx.doi.org/10.1590/s0102-86502011000800025DOI Listing
June 2012
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