Biomedical subjects

Sebastião Gusmão

Publications and source records attributed to Sebastião Gusmão.

16 recordsLinked to original sources

PubMed2006

Occipital bi-transtentorial/falcine approach for falcotentorial meningioma: case report.

Lesions located in the bilateral posterior incisural space are difficult to treat due to limited exposure. The classical approaches to this area are limited for lesions located bilaterally and especially when the lesion extends also below the tentorium as it may occur with meningiomas. Kawashima et al. reported, in anatomic studies, a new occipital transtentorial approach: the occipital bi-transtentorial/falcine approach, to treat such lesions. We present a patient with a large falcotentorial meningioma, located bilaterally in the posterior incisural space. The occipital bi-transtentorial/falcine approach allowed an excellent surgical exposure and complete tumor removal with an excellent patient outcome.

Cerebral Veins↗

PubMed2006

Transbasal approach to skull base tumors: evaluation and proposal of classification.

A clinical study of the TBA was performed in 22 patients harboring tumors of the skull base. The follow-up ranged from 3 to 89 months (average, 30.5 months). The main complications were intracerebral hematoma, ptosis, and infection. One patient died (4.5%) because of an extradural hematoma. Eight patients died during the follow-up because of tumor complications. Among the survivals, the median of the Karnofsky index was 96.4. Based on this study, we propose a classification for the TBA, according to its extension.

Angiofibroma↗

PubMed2006

[Decompressive craniectomy in children and adolescents with head injury: analysis of seven cases].

INTRODUCTION: Decompressive craniectomy (DC) is a surgical technique used to treat patients with elevated intracranial pressure often found in head injury. Its indication remains a controversial issue in the pediatric population. OBJECTIVE: To report seven cases managed with this technique. METHOD: Retrospective study of seven patients, aged from 2 to 17 years, treated with unilateral DC due to increased intracranial pressure (ICP) as a consequence of head injury. All patients had ICP monitored post operatively and the DC classified as ultra-early (<6h), early (6-12h) or late (>24h) according to the time of its application. The minimum follow-up was six months. RESULTS: Patients were evaluated with CT scans and clinical exams, and graded according the Glasgow Outcome Scale (GOS). Three patients deceased (GOS1), one was in vegetative state (GOS2), two recovered but still requiring nursing care (GOS3 and 4), and one had a full recovery (GOS5) at hospital discharge. After six months the GOS2 and a GOS3 patients achieved full recovery (GOS5). Subdural collection (2), hydrocephalus (1) and superficial infection (1) occurred as complication. Two patients had autologous cranioplasty and the other two heterologous cranioplasty. CONCLUSION: Decompressive craniectomy remains a feasible treatment method to lower the ICP, but is not safe from complications. A multicentric study should be done for appropriate protocol treatment of pediatric patients.

Adolescent↗

PubMed2005

Cleft cavum of the septum pellucidum in victims of fatal road traffic accidents: a distinct type of cavum associated with severe diffuse axonal injury.

BACKGROUND: The cavum of the septum pellucidum (CSP) is a small cavity constantly present in fetuses and newborns, of variable frequency among necropsied adults and with a high frequency in professional boxers. METHOD: A pathologic study was conducted on brains of 626 patients without a history of head trauma (group 1) autopsied consecutively from a general hospital and of 120 random victims of fatal road traffic accidents (group 2). RESULTS: In group 1, 237 (37.9%) cases of CSP were observed, virtually all in a triangular or trapezoidal shape. In group 2, 65 (54.2%) cases of CSP were observed, 50 (76.9%) in triangular or trapezoidal shape and 15 (23.1%) in cleft shape. Cleft CSP was always associated with severe diffuse axonal injury (grades 2 and 3). CONCLUSION: Although described in boxers, the CSP has not been reported in other types of head injury. The largest frequency of CSP found in fatal victims of head trauma, particularly in patients with severe diffuse axonal lesion (grades 2 and 3), when compared with the individuals without a history of head trauma, suggests that the high-intensity angular acceleration of the head causes complementary and independent displacement of the 2 cerebral hemispheres and dislocation of one of the leaves of the septum pellucidum on the other. This could result in separation of the 2 leaves and formation of CSP, usually in cleft shape.

Acceleration↗

PubMed2005

A new device with pressure regulation for microsurgical suction: technical note.

A new suction tube that allows precise control of suction pressure during microsurgical procedures is described. The new device consists of a suction tube that has a series of small holes on its proximal end. These holes can be progressively opened or closed by a laterally placed sliding bar. The surgeon can readily adjust the suction pressure by slightly moving his thumb up and down with accordance to his convenience during the operation. This creates an easy and prompt way to regulate suction pressure, thus removing the need of suction adjustment by the assistant or the scrub nurse. This new device provides an easy, precise, and quick suction regulation during the different stages of the microsurgical procedure. When the holes are totally closed, a maximum suction pressure is achieved, and when the holes are fully opened the suction pressure can be brought to zero. This device is very simple and ergonomic and allows an adjustable suction pressure mechanism that is regulated by the surgeon. By smoothly using the thumb to move the sliding bar up and down, the suction pressure may vary within the range of a maximum to zero almost instantaneously providing the appropriate suction pressure at any surgical time.

Brain↗

PubMed2005

Minor skin lesions as markers of occult spinal dysraphisms--prospective study.

BACKGROUND: Neonates with occult spinal dysraphisms (OSDs) may not present any clinical manifestations, but may be associated to cutaneous stigmas that indicate dysraphism. Association of minor cutaneous stigmas (discreet skin lesions, most of which are not assessed) with OSD was investigated in this study, as well as the use of ultrasonography (US) as a screening method for those patients. METHODS: Two thousand ten neonates were evaluated trough active search. Both the pediatrician and the neurosurgeon performed the search for the presence of cutaneous stigmas on the midline of the dorsal region. For all of them, the gestational age, type of delivery, gender, ethnicity, age of mother, and whether it was a high-risk gestation were recorded. Patients with skin lesions comprised the case group. For each case, another neonate of the same gender, gestational age, and ethnicity was selected as control. Both groups were evaluated with respect to personal, social, and medical information. Spinal US was performed in all case and control patients-if altered or inconclusive, it was complemented with magnetic resonance imaging (MRI). RESULTS: Of the 2010 patients, 144 presented cutaneous stigmas. Of these, 8 had alterations to US (5.5%) and 6 to MRI. There were no alterations to US in the control group. The most frequent lesions were tufts of hair and dimples; through US, the most frequent findings were dermal sinuses. CONCLUSIONS: The so-called minor skin lesions were not markers of OSD in the evaluated population. However, in 4 patients, US was decisive for the surgical decision. From the statistical point of view, there is no indication for complementary examinations in patients with minor cutaneous stigmas. However, because of the feasibility, simplicity, and low cost of the spinal US, the examination is justified in the benefits of early diagnosis, regardless of the need of immediate surgical treatment.

Age Factors↗

PubMed2005

[Supratentorial-infraoccipital (or occipitopolar) approach: clinical and anatomical study].

Twenty-two patients harboring tumors or vascular lesions (AVMs and aneurysms) located at the posterior aspect of the parahipocampal gyrus and the pulvinar of thalamus operated by supratentorial-infraoccipital approach were analysed. Total resection was achieved in all five AVM patients as well as in six out of fifteen tumor patients. This approach was performed in five anatomical specimens (ten approaches); It results, along with the surgical results, allow this approach to be considered a good option for lesions of the pulvinar of thalamus and postero-medial temporal lobe which are evident at the transverse fissure.

Adolescent↗

PubMed2005

[Interhemispheric supraorbital or frontopolar approach: anatomical study].

A modification of the supraorbital approach is proposed in order to improve the access to the medial portions of the anterior and middle fossas (supraselar region). It consists of a midline extension of the frontal craniotomy along with an interhemispheric approach: interhemispheric supraorbital or frontopolar approach. The anatomical basis of this approach were studied in eight cadaveric heads. Its results demonstratete that this approach adequaly access the medial structures of the anterior and medial fossas with minimal brain retraction and wide exposure.

Cadaver↗

PubMed2004

[Microsurgical anatomy of the recurrent laryngeal nerve: applications on the anterior approach to the cervical spine].

OBJECTIVE: To present an anatomical description of the recurrent laryngeal nerve (RLN) on both sides of the larynx as it relates to the possible lesion mechanisms in anterior cervical spine surgery. METHOD: Twelve adult cadavers were examined from the microsurgical laboratory at the School of Medicine at UFMG, MG, Brazil. The data collected were analyzed in terms of frequency, average and standard deviation. RESULTS: The left RLN had a total average length of 9.4 +/- 1.6 cm entering the larynx in 36.3% of the cases at the approximate height of C5, 18.2% at C4, 18.2% at C5-C6, 18.2% at C6 and 9.1% at C4-C5. Recurrence appeared in 45.4% of the cases at the approximate height of T3, 18.2% at T3-T4, 18.2% at T4 and 18.2% at T5. The right RLN had a total average length of 5 +/- 0.3 cm entering the larynx in 44.4% of the cases at the approximate height of C5, 44.4% at C6, and 11.1% at C3-C4. Recurrence appeared in 60% of the cases at the approximate height of T1, 30% at C7 and 10% at T2. CONCLUSION: The right RLN was found to be more vulnerable to operational lesions due to two complimentary yet different reasons, trajectory and length. Owing to the fact that a more oblique and unprotected trajectory is not related directly with the tracheoesphageal groove, there is a strong possibility of direct traumas occurring as with the resulting compression from the employ of surgical retractors or an accidental cut, principally in surgeries involving lower vertebral levels. In the same way, the smallest RNL length favors the stretching of fibers during the per-operative traction.

Adult↗

PubMed2004

[Paraclinoid aneurysms: surgical technique and results in 51 patients].

An analysis of the surgical results of 51 patients harboring 55 paraclinoid aneurysms is performed, along with a throughoutful description of its complex microsurgical technique. The anterior clinoid process was removed by the extradural route after sectioning the dural duplication between the superior orbital fissure and the dura of the temporal lobe, and/or by the intradural approach. All 55 aneurysms was excluded. In two cases the clipping was partial and the internal carotid artery were occluded in three cases. The surgical outcome was good in 42 (82%) patients, moderate incapacity occurred in five (10%) and severe incapacity in one patient (2%). Three patients (6%) died due to brain infarction. Seven patients (13,7%) had additional lesion of the optic nerve, being partial in 4 (7,7%) and total in 3 (6%).

Adult↗

PubMed2003

[Trigeminal radiofrequency rhizotomy for the treatment of trigeminal neuralgia: results and technical modification].

The purpose of this study was to evaluate the efficacy of radiofrequency trigeminal rhizotomy in treating 135 patients harboring trigeminal neuralgia, and to introduce a technical modification to guide the puncture of the foramen ovale. A hundred and one (74.8%) patients were treated with a single surgical procedure whereas the 34 (25.2%) remaining patients required two procedures. Follow-up ranges from 6 months to 15 years. Pain relief in the immediate postoperative was achieved in 131 (97.0%) patients. After the initial procedure, recurrence happened in 33 (24.5%) patients. The complications included decrease corneal reflex (4.4%), masseter paresis (2.2%), painful dysesthesia (1.5%) and anesthesia dolorosa (0.7%). The radiofrequency trigeminal rizhotomy is a low risk, highly effective and minimally invasive procedure. The use of the computerized tomography guided fluoroscopy turns foramen ovale's puncture easier, fast and precise.

Aged↗

PubMed2003

[Neurovascular structures of the posterior surface of the petrous pyramid: correlation with the approaches of the cerebellopontine angle].

A topographic study of posterior surface of the petrous pyramid was performed in 20 human cadaveri heads. The distances between the neurovascular structures were measured in the points where they contact the posterior surface of the petrous pyramid. The study also points out the relationship between the bone landmarks and the transverse and the superior petrous sinuses. The result of this study was correlated with the approaches to the cerebellopontine angle.

Cadaver↗

PubMed2003

[Suction-irrigator device for microsurgery: technical note].

A modification of the conventional suction device for microsurgery is described. It consists of a built-in tube in another tube, being the first connected to the suction device and the second to the irrigation. This suction-irrigator device allows to accomplish the suction and irrigation simultaneously and in a precise way.

Equipment Design↗

PubMed2003

[Landmarks to the cranial approaches].

The knowledge of the craniotopography allows the delimitation of the cranial approaches. In this study the landmarks, defined in relation to the craniometric points and used in the different cranial approaches, were systematized. Twenty two landmarks are described: the first twelve are in relation to the skull base and the remainder are in relation to the skull vertex.

Humans↗

PubMed2003

Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography fluoroscopy. Technical note.

The authors describe a new procedure for percutaneous trigeminal radiofrequency rhizotomy. Computerized tomography fluoroscopy is used for guidance of the rhizotomy needle insertion through the foramen ovale. Ten patients were treated using this method, and in each case the target was reached with a single puncture. The potential benefits of this method are presented.

Female↗

PubMed2002

[Definition of the anterolateral occipital lobe limit in anatomical specimens and image examination].

The anterolateral limit of the occipital lobe was studied in anatomical specimens and with neuroimaging. Seven human cadaver heads, 103 normal CT-scan and 104 MRJ of the brain were studied. There was a fold of the dura mater on the transverse sinus (preoccipital tentorial plica) and a bony protuberance related directly to the preoccipital notch. It was also determined the mean distance between the parieto-occipital sulcus and the lambdoid suture. In the imaging studies, especially magnetic resonance, it was possible to identify the preoccipital notch and/or a protuberance in the cranial vault related to this notch, besides the parieto-occipital sulcus and lambdoid suture, making possible, therefore, the definition of the anterolateral limit of the occipital lobe.

Adolescent↗