Publications by authors named "Giselle Coelho"

16 Publications

  • Page 1 of 1

Spinal cord tumor leading to urinary retention resulting from infection in a child.

Urol Case Rep 2021 Jan 5;34:101479. Epub 2020 Nov 5.

Department of Pediatric Surgery, Hospital Santa Marcelina, Brazil.

is an endemic disease in Brazil. It rarely affects the central nervous system, particularly in children. We report the case of a child that presented with an acute spinal cord compression condition, resulting from a mass that proved to be a granuloma caused by a infection. Proper treatment had no effect on the regression of urological symptoms and the child had to undergo a Mitrofanoff principle.
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http://dx.doi.org/10.1016/j.eucr.2020.101479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658661PMC
January 2021

In Reply to the Letter to the Editor Regarding "Development and Evaluation of a Pediatric Mixed Reality Model for Neuroendoscopic Surgical Training".

World Neurosurg 2020 08;140:446-447

Pediatric Neurosurgery-Center/CENEPE, São Paulo, Brazil; Fetal and Perinatal Medicine Group-Samaritano Hospital, São Paulo, Brazil.

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http://dx.doi.org/10.1016/j.wneu.2020.06.116DOI Listing
August 2020

A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele.

Neurosurg Rev 2020 Aug 8. Epub 2020 Aug 8.

University of São Paulo (USP), São Paulo, Brazil.

Congenital transsphenoidal encephalocele (CTE) surgical correction is a challenging procedure. Although rare, this anomaly, characterized with neural herniation elements, including the pituitary gland or optic pathway through the sphenoid bone with anatomical alteration, can be presented in many different ways and should be individually analyzed. Significant advances in medical technology and the 3D models may simulate the complex anatomical relations of the human body. Nowadays, medical education relies on the availability of standardized materials that can reliably emulate human anatomy. Therefore, realistic anatomical models have become an alternative for cadavers or animal specimens. In this technical note, the authors present a new technique to create personalized models that combine 3D printing, molding, and casting to create an anatomically and tactilely realistic model based on magnetic resonance and computerized tomography images. Produced from different silicon types, the model recreated the anatomic alterations precisely, allowing a multidisciplinary team to determine the adequate surgical approach for this patient. We describe a case of congenital transsphenoidal encephalocele of a 3-year-old boy, whose surgical correction was planned using a hybrid model. The technical description of the model is given in detail. This new hybrid model allowed a detailed discussion of the surgical approach aspects by having tissues of different consistencies and resistances and a very high prediction rate. This approach may allow a reduction in surgery time and possible complications after operative procedures.
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http://dx.doi.org/10.1007/s10143-020-01361-9DOI Listing
August 2020

Development and Evaluation of Pediatric Mixed-Reality Model for Neuroendoscopic Surgical Training.

World Neurosurg 2020 07 6;139:e189-e202. Epub 2020 Apr 6.

Pediatric Neurosurgery, Center/CENEPE-Beneficência Portuguesa Hospital, São Paulo, Brazil; Fetal and Perinatal Medicine Group, Samaritano Hospital, São Paulo, Brazil.

Objective: Neurosurgical training requires several years of supervised procedures and represents a long and challenging process. The development of surgical simulation platforms is essential to reducing the risk of potentially intraoperative severe errors arising from inexperience. To present and perform a phase I validation process of a mixed reality simulation (realistic and virtual simulators combined) for neuroendoscopic surgical training.

Methods: Tridimensional videos were developed by the 3DS Max program. Physical simulators were made with a synthetic thermoretractile and thermosensible rubber, which, when combined with different polymers, produces >30 different textures that simulate consistencies and mechanical resistance of human tissues. Questionnaires regarding the role of virtual and realistic simulators were applied to experienced neurosurgeons to assess the applicability of the mixed-reality simulation for neuroendoscopic surgical training.

Results: The model was considered as a potential tool for training new residents in neuroendoscopic surgery. It was also adequate for practical application with inexperienced surgeons. According to the overall score, 83% of the surgeons believed that the realistic physical simulator presents distortions when compared with the real anatomic structure, afterwards the model improved 66% tridimensional reconstruction and 66% reported that the virtual simulator allowed a multiangular perspective ability.

Conclusions: This model provides a highly effective way of working with 3-dimensional data and significantly enhances the learning of surgical anatomy and operative strategies. The combination of virtual and realistic tools may safely improve and abbreviate the surgical learning curve.
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http://dx.doi.org/10.1016/j.wneu.2020.03.170DOI Listing
July 2020

Augmented reality and physical hybrid model simulation for preoperative planning of metopic craniosynostosis surgery.

Neurosurg Focus 2020 03;48(3):E19

3University of São Paulo, USP; and.

Objective: The main objective of neurosurgery is to establish safe and reliable surgical techniques. Medical technology has advanced during the 21st century, enabling the development of increasingly sophisticated tools for preoperative study that can be used by surgeons before performing surgery on an actual patient. Laser-printed models are a robust tool for improving surgical performance, planning an operative approach, and developing the skills and strategy to deal with uncommon and high-risk intraoperative difficulties. Practice with these models enhances the surgeon's understanding of 3D anatomy but has some limitations with regard to tactile perception. In this study, the authors aimed to develop a preoperative planning method that combines a hybrid model with augmented reality (AR) to enhance preparation for and planning of a specific surgical procedure, correction of metopic craniosynostosis, also known as trigonocephaly.

Methods: With the use of imaging data of an actual case patient who underwent surgical correction of metopic craniosynostosis, a physical hybrid model (for hands-on applications) and an AR app for a mobile device were created. The hybrid customized model was developed by using analysis of diagnostic CT imaging of a case patient with metopic craniosynostosis. Created from many different types of silicone, the physical model simulates anatomical conditions, allowing a multidisciplinary team to deal with different situations and to precisely determine the appropriate surgical approach. A real-time AR interface with the physical model was developed by using an AR app that enhances the anatomic aspects of the patient's skull. This method was used by 38 experienced surgeons (craniofacial plastic surgeons and neurosurgeons), who then responded to a questionnaire that evaluated the realism and utility of the hybrid AR simulation used in this method as a beneficial educational tool for teaching and preoperative planning in performing surgical metopic craniosynostosis correction.

Results: The authors developed a practice model for planning the surgical cranial remodeling used in the correction of metopic craniosynostosis. In the hybrid AR model, all aspects of the surgical procedure previously performed on the case patient were simulated: subcutaneous and subperiosteal dissection, skin incision, and skull remodeling with absorbable miniplates. The pre- and postoperative procedures were also carried out, which emphasizes the role of the AR app in the hybrid model. On the basis of the questionnaire, the hybrid AR tool was approved by the senior surgery team and considered adequate for educational purposes. Statistical analysis of the questionnaire responses also highlighted the potential for the use of the hybrid model in future applications.

Conclusions: This new preoperative platform that combines physical and virtual models may represent an important method to improve multidisciplinary discussion in addition to being a powerful teaching tool. The hybrid model associated with the AR app provided an effective training environment, and it enhanced the teaching of surgical anatomy and operative strategies in a challenging neurosurgical procedure.
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http://dx.doi.org/10.3171/2019.12.FOCUS19854DOI Listing
March 2020

The Craniosynostosis Puzzle: New Simulation Model for Neurosurgical Training.

World Neurosurg 2020 06 25;138:e299-e304. Epub 2020 Feb 25.

Neurosurgery Department, São Paulo University, USP, São Paulo, Brazil. Electronic address:

Background: Neurosurgical training usually requires long hours for hands-on procedures, making it difficult for inexperienced surgeons to quickly learn in an error-proof environment. The objective of this study was to propose a puzzle-like new model for neurosurgical education that simulates craniosynostosis correction (scaphocephaly type) using Renier's H technique. A model of a 3-dimensional (3D) anatomic simulator for craniosynostosis training is presented and evaluated.

Methods: The cranial model was created using 1-mm computed tomography scan images from patients with scaphocephaly in the Digital Imaging and Communications in Medicine format. This information was processed using an algorithm to generate a 3D biomodel in resin. The puzzle model and its variable training models were assessed qualitatively by a team of expert neurosurgeons. Next, the model was applied in trainees and was evaluated using specific questionnaires.

Results: Experts and trainees evaluated the model. The mean number of attempts without errors was 2.3 ± 0.675, for 1 error was 2.2 ± 0.918, and for 2 errors was 1.3 ± 0.707. The mean score of the simulator was 9.2 ± 0.421. Twelve residents (second evaluation) answered the questionnaire with a positive assessment of diagnosis capabilities, appropriateness of the model, time commitment, adequate environment, reliable 3D reconstruction, and teaching method. Three participants had used a 3D simulator previously, and the simulator was evaluated obtaining a 9.9 final average (range, 0-10).

Conclusions: The puzzle may be a complementary tool for surgical training. It allows several degrees of immersion and realism, offering symbolic, geometric, and dynamic information with 3D visualization. It provides additional data to support the practice of complex surgical procedures without exposing real patients to undue risk.
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http://dx.doi.org/10.1016/j.wneu.2020.02.098DOI Listing
June 2020

Development and evaluation of a new pediatric mixed-reality model for neurosurgical training.

J Neurosurg Pediatr 2019 Aug 2:1-10. Epub 2019 Aug 2.

3Pediatric Neurosurgery Center/CENEPE, Beneficência Portuguesa Hospital; and.

Objective: Craniosynostosis is a premature cranial suture junction and requires a craniectomy to decrease cranial compression and remodel the affected areas of the skull. However, mastering these neurosurgical procedures requires many years of supervised training. The use of surgical simulation can reduce the risk of intraoperative error. The authors propose a new instrument for neurosurgical education, which mixes reality with virtual and realistic simulation for repair of craniosynostosis (scaphocephaly type).

Methods: This study tested reality simulators with a synthetic thermo-retractile/thermosensitive rubber joined with different polymers. To validate the model, 18 experienced surgeons participated in this study using 3D videos developed using 3DS Max software. Renier's "H" technique for craniosynostosis correction was applied during the simulation. All participants completed questionnaires to evaluate the simulator.

Results: An expert surgical team approved the craniosynostosis reality and virtual simulators. More than 94% of participants found the simulator relevant, considering aspects such as weight, surgical positioning, dissection by planes, and cranial reconstruction. The consistency and material resistance were also approved on average by more than 60% of the surgeons.

Conclusions: The virtual simulator demands a high degree of effectiveness with 3D perception in anatomy and operative strategies in neurosurgical training. Physical and virtual simulation with mixed reality required psychomotor and cognitive abilities otherwise acquired only during practical surgical training with supervision.
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http://dx.doi.org/10.3171/2019.2.PEDS18597DOI Listing
August 2019

The Role of Mixed Reality Simulation for Surgical Training in Spine: Phase 1 Validation.

Spine (Phila Pa 1976) 2018 Nov;43(22):1609-1616

Pediatric Neurosurgery Center/CENEPE - Beneficência Portuguesa Hospital, São Paulo, Brazil.

Study Design: This study shows the first phase of validation of a new model for realistic training on spine surgery, conducted from January 2014 to November 2015.

Objective: To propose and validate a new tool for neurosurgical education, associating virtual and realistic simulation (mixed reality), for spine surgery.

Summary Of Background Data: Surgical simulation is a relatively new filed that has a lot to offer to neurosurgical education. Training a new surgeon may take years of hands-on procedures, increasing the risk to patient's safety. The development of surgical simulation platforms is therefore essential to reducing the risk of potentially serious risks and improving outcome.

Methods: Sixteen experienced spinal surgeons evaluated these simulators and answered the questionnaire regarding the simulation as a beneficial education tool. They evaluated the simulators in regard to dissection by planes, identification of pathology (lumbar canal stenosis), instrumentation and simulation of cerebrospinal fluid (CSF) leak, and the relevant aspects of the computerized tomography (CT) imaging.

Results: The virtual and physical simulators for spine surgery were approved by an expert surgery team, and considered adequate for educational purposes. The proportion of the answers was estimated by the confidence intervals.

Conclusion: The surgery team considered that this virtual simulation provides a highly effective training environment, and it significantly enhances teaching of surgical anatomy and operative strategies in the neurosurgical field. A mixture of physical and virtual simulation provided the desired results of enhancing the requisite psychomotor and cognitive skills, previously acquired only during a surgical apprenticeship. The combination of these tools may potentially improve and abbreviate the learning curve for trainees, in a safe environment.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000002856DOI Listing
November 2018

Multimaterial 3D printing preoperative planning for frontoethmoidal meningoencephalocele surgery.

Childs Nerv Syst 2018 04 24;34(4):749-756. Epub 2017 Oct 24.

Department of Plastic Surgery, Santa Marcelina Hospital, Sao Paulo, Brazil.

Introduction: Surgical correction of frontoethmoidal meningoencephalocele, although rare, is still challenging to neurosurgeons and plastic reconstructive surgeons. It is fundamental to establish reliable and safe surgical techniques. The twenty-first century has brought great advances in medical technology, and the 3D models can mimic the correct tridimensional anatomical relation of a tissue organ or body part. They allow both tactile and spatial understanding of the lesion and organ involved. The 3D printing technology allows the preparation for specific surgery ahead of time, planning the surgical approach and developing plans to deal with uncommon and high-risk intraoperative scenarios.

Case Presentation: The present report describes a case of frontoethmoidal encephalocele, (nasofrontal subtype) of a 19-month-old girl, whose surgical correction was planned using 3D printing modeling.

Conclusion: The 3D model allowed a detailed discussion of the aspects of the surgical approach by having tissues of different consistencies and resistances, and also predicting with millimetric precision the bilateral orbitotomy measurements. Moreover, it was a fundamental and valuable factor in the multidisciplinary preoperative discussion. This approach allowed reducing the time of surgery, accurately planning the location of the osteotomies and precontouring the osteosynthesis material. 3D models can be very helpful tools in planning complex craniofacial operative procedures.
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http://dx.doi.org/10.1007/s00381-017-3616-6DOI Listing
April 2018

A new simulator model for knee arthroscopy procedures.

Knee Surg Sports Traumatol Arthrosc 2017 Oct 4;25(10):3076-3083. Epub 2016 Apr 4.

Scientific Innovation and Education Development Institute (SIEDI), Rua George Ohm 230. Torre B CJS 121 e 122 - Cidade Monções, São Paulo, SP, CEP: 04576-020, Brazil.

Purpose: Arthroscopy is currently the "gold standard" for various surgeries performed on the knee joint. Therefore, surgeons wishing to operate in this professional field should be able to perform this technique. Arthroscopic training, an experimental laboratory, is important for the surgeons' training, enabling them to increase their skills with the specific instruments and to become familiar with the operating techniques. The aim of this study was to present a new surgical simulator for training in arthroscopic procedures of the knee.

Methods: The Kneetrainer 1 is a simulator consisting of a type of thermo-retractile, thermo-sensitive synthetic rubber that has texture, colour, consistency, and mechanical resistance that mimic many human tissues. Nine simulators were used, operated by seventeen expert Brazilian surgeons in knee surgery. The surgeons performed arthroscopy, meniscectomy, and reconstruction of the anterior cruciate ligament (ACL), responded to an electronic questionnaire with several variables, and gave an overall score on the ability of the device to perform realistic simulation for the above procedures.

Results: The ability to perform the procedures of meniscectomy and ACL reconstruction was considered adequate by 82 and 100 % of the specialists, respectively. The overall scores for the ability to perform realistic simulation for the procedures meniscectomy and reconstruction of the anterior cruciate ligament by arthroscopy were 64.7 and 82.4 %, respectively. The simulator was therefore considered suitable for practical application with novice surgeons.

Conclusion: The Kneetrainer 1 simulator was assessed as an effective tool for recreating accurate arthroscopic knee procedures. In addition, the simulator may be effective as a means of honing the skills of novice surgeons. Future investigations should be performed to validate the reliability of the simulator.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-016-4099-9DOI Listing
October 2017

The role of simulation in neurosurgery.

Childs Nerv Syst 2014 Dec 24;30(12):1997-2000. Epub 2014 Sep 24.

Pediatric Neurosurgery Center, Beneficência Portuguesa Hospital, Rua Capitão Mor Roque Barreto nº 47 - Térreo, Bela Vista, São Paulo, 01323-030, Brazil,

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http://dx.doi.org/10.1007/s00381-014-2548-7DOI Listing
December 2014

New anatomical simulator for pediatric neuroendoscopic practice.

Childs Nerv Syst 2015 Feb 3;31(2):213-9. Epub 2014 Sep 3.

Pediatric Neurosurgery Center/CENEPE, Beneficência Portuguesa Hospital, Rua Capitão Mor Roque Barreto, no 47-Térreo Bela Vista, São Paulo, SP CEP, 01323-030, Brazil,

Introduction: The practice of neuroendoscopic procedures requires many years of training to obtain the adequate skills to perform these operations safely. In this study, we present a new pediatric neuroendoscopic simulator that facilitates training.

Description Of The Simulator: This realistic simulator was built with a synthetic thermo-retractile and thermo-sensible rubber called Neoderma® which, when combined with different polymers, produces more than 30 different formulae, which present textures, consistencies, and mechanical resistances similar to many human tissues. Silicon and fiberglass molds, in the shape of the cerebral ventricles, constitute the basic structure of the neuroendoscopic training module. The module offers the possibility for practicing many basic neuroendoscopic techniques such as: navigating the ventricular system to visualize important anatomic landmarks (e.g., septal and thalamostriate veins, foramen of Monro, temporal horns, aqueduct, and fourth ventricle), performing third ventriculostomy and choroid plexus cauterization, and resecting intraventricular "tumors" that bleed.

Conclusion: It is important to emphasize that it is possible to perform with this simulator not only the rigid but also the flexible endoscopy, with good correspondence to reality and no risks. Notable future perspectives can be considered regarding this new pediatric simulator, for example, to improve the learning curve for nonexperienced neurosurgeons and to spread the flexible endoscopy technique.
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http://dx.doi.org/10.1007/s00381-014-2538-9DOI Listing
February 2015

Anatomical pediatric model for craniosynostosis surgical training.

Childs Nerv Syst 2014 Dec 3;30(12):2009-14. Epub 2014 Sep 3.

Pediatric Neurosurgery Center/CENEPE, Beneficência Portuguesa Hospital, Rua Capitão Mor Roque Barreto, no. 47 - Térreo Bela Vista, São Paulo, SP, 01323-030, Brazil,

Introduction: Several surgical training simulators have been created to improve the learning curve of residents in neurosurgery and plastic surgery. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and the skill in handling instruments. The aim of this study is to present a novel simulator for training in the technique of craniosynostectomy, specifically for the scaphocephaly type.

Description Of The Simulator: This realistic simulator was built with a synthetic thermo-retractile and thermo-sensible rubber which, when combined with different polymers, produces more than 30 different formulas. These formulas present textures, consistencies, and mechanical resistance similar to many human tissues. Fiberglass molds in the shape of the skull constitute the basic structure of the craniosynostectomy training module. It has been possible to perform computerized tomography images due to the radiopacity of this simulator and to compare the pre- and postoperative images.

Results: The authors present a training model to practice the biparietal remodeling used in scaphocephaly correction. All aspects of the procedure are simulated: the skin incision, the subcutaneous and subperiosteal dissection, the osteotomies, and finally, the skull remodeling with absorbable microplates. The presence of superior sagittal sinus can simulate emergency situations with bleeding.

Conclusion: The authors conclude that this training model can represent a fairly useful method to accustom trainees to the required surgical techniques and simulates well the steps of standard surgery for scaphocephaly. This training provides an alternative to the use of human cadavers and animal models. Furthermore, it can represent the anatomical alteration precisely as well as intraoperative emergency situations.
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http://dx.doi.org/10.1007/s00381-014-2537-xDOI Listing
December 2014

Quality assessment of a new surgical simulator for neuroendoscopic training.

Neurosurg Focus 2011 Apr;30(4):E17

Discipline of Neurosurgery, Escola Paulista de Medicina da Universidade Federal de São Paulo, Brasil.

Object: Ideal surgical training models should be entirely reliable, atoxic, easy to handle, and, if possible, low cost. All available models have their advantages and disadvantages. The choice of one or another will depend on the type of surgery to be performed. The authors created an anatomical model called the S.I.M.O.N.T. (Sinus Model Oto-Rhino Neuro Trainer) Neurosurgical Endotrainer, which can provide reliable neuroendoscopic training. The aim in the present study was to assess both the quality of the model and the development of surgical skills by trainees.

Methods: The S.I.M.O.N.T. is built of a synthetic thermoretractable, thermosensible rubber called Neoderma, which, combined with different polymers, produces more than 30 different formulas. Quality assessment of the model was based on qualitative and quantitative data obtained from training sessions with 9 experienced and 13 inexperienced neurosurgeons. The techniques used for evaluation were face validation, retest and interrater reliability, and construct validation.

Results: The experts considered the S.I.M.O.N.T. capable of reproducing surgical situations as if they were real and presenting great similarity with the human brain. Surgical results of serial training showed that the model could be considered precise. Finally, development and improvement in surgical skills by the trainees were observed and considered relevant to further training. It was also observed that the probability of any single error was dramatically decreased after each training session, with a mean reduction of 41.65% (range 38.7%-45.6%).

Conclusions: Neuroendoscopic training has some specific requirements. A unique set of instruments is required, as is a model that can resemble real-life situations. The S.I.M.O.N.T. is a new alternative model specially designed for this purpose. Validation techniques followed by precision assessments attested to the model's feasibility.
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http://dx.doi.org/10.3171/2011.2.FOCUS10321DOI Listing
April 2011

Assessment of neurosurgical outcome in children prenatally diagnosed with myelomeningocele and development of a protocol for fetal surgery to prevent hydrocephalus.

Childs Nerv Syst 2007 Apr 17;23(4):421-5. Epub 2007 Jan 17.

Discipline of Neurosurgery-Fetal Medicine Group, Universidade Estadual de Campinas-UNICAMP, Rua Alexander Fleming, 181, Barão Geraldo, Campinas-SP, Brazil.

Introduction: Prenatal diagnosis of myelomeningocele (MMC) has permitted a better planning for optimum management of the disease. More recently, it has allowed for a possible intrauterine repair of the spinal defect.

Objective: To describe neurosurgical outcome in children with myelomeningocele and follow-up at a referral center in Fetal Medicine. Patients were characterized for the development of a protocol suitable for fetal surgery, and fetuses who were possible candidates for intrauterine surgery were identified.

Materials And Methods: A retrospective descriptive analysis was performed of 98 cases of fetal myelomeningocele, seen at CAISM-UNICAMP, from January 1994 to December 2002, identifying cases with a possible indication for fetal surgery.

Results: Mean gestational age at diagnosis was 29 weeks (17-39); level of lesion was above the sacral region in 92.84%; association with hydrocephalus occurred in 78.57%. During clinical course, 82.5% of patients had neurogenic bladder and 60% had neural and mental deficits. Potential intrauterine repair rate was 11.57%, using criteria from the protocol developed in our service.

Conclusion: Myelomeningocele is associated with severe and frequent sequelae. In virtually 12% of our cases, fetal surgery could have been offered as a therapeutic option.
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http://dx.doi.org/10.1007/s00381-006-0261-xDOI Listing
April 2007

Texture analysis of hippocampal sclerosis.

Epilepsia 2003 Dec;44(12):1546-50

Department of Neurology, Medical School, State University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, SP, CEP 13083-970, Brazil.

Unlabelled: Mesial temporal lobe epilepsy (MTLE) is frequently associated with refractory seizures and pathologic features of hippocampal sclerosis (HS). Quantitative magnetic resonance imaging (MRI) techniques can improve the detection and quantification of HS. The objective of this study was to evaluate whether MRI texture analysis can detect hippocampal abnormalities in patients with pathologically proven HS.

Methods: Nineteen consecutive patients who underwent surgery for refractory unilateral MTLE and had HS diagnosed on histopathology (12 right and seven left) had their preoperative MRIs evaluated. We performed texture analysis in 3-mm coronal T1-IR MRIs, focusing on the hippocampal head, by using the software MAZDA. Data were compared with those of a group of 78 normal hippocampi from 39 healthy adult volunteers through multivariate analysis of variance and selection of the most significant texture parameters.

Results: Overall, almost all parameters of texture could discriminate the group of hippocampi with HS and the group of contralateral hippocampi from the group of normal hippocampi, but the post hoc comparison showed no differences between HS and contralateral hippocampi.

Conclusions: These results provide evidence of texture alteration in MRIs of hippocampi with HS and corroborate the hypothesis of bilaterality of hippocampal damage in patients with MTLE, but further studies are needed to investigate the lateralization power of texture analysis.
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http://dx.doi.org/10.1111/j.0013-9580.2003.27103.xDOI Listing
December 2003