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Demartini Z, Beckhauser MT, Ramos MM, Chave ALV, Cardoso-Demartini A. Perioperative management of dural sinus malformation and high-flow arteriovenous fistula in an infant. Acta Neurol Belg 2024; 124:675-677. [PMID: 37962786 DOI: 10.1007/s13760-023-02369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/21/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clinicas, UFPR, Curitiba, PR, Brazil.
- Hospital Pequeno Principe, Curitiba, PR, Brazil.
- Departamento de Neurocirurgia, Universidade Federal do Parana, Rua General Carneiro 181, 8º andar, Curitiba, PR, 80060-900, Brazil.
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Demartini Z, Beraldo RF, Teixeira BCA. Pediatric Donut-Shaped Basilar Artery Aneurysm. World Neurosurg 2024; 185:221-223. [PMID: 38408700 DOI: 10.1016/j.wneu.2024.02.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
Intracranial aneurysms are uncommon in the pediatric population. We present a case of an 11-year-old boy presenting with subarachnoid hemorrhage caused by a "donut-shaped" basilar tip aneurysm. It occurs when the flow geometry produces a circumferential laminar flow into the aneurysmal sac, resulting in a central thrombosis. Optimal management of this type of aneurysm is not already clear, and further studies are needed to clarify the best treatment approach, especially in the pediatric population.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Complexo Hospital Pequeno Principe, Curitiba, Paraná, Brazil; Department of Neurosurgery, Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Paraná, Brazil.
| | - Renato Fedatto Beraldo
- Department of Neurosurgery, Complexo Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Bernardo C A Teixeira
- Department of Neurosurgery, Complexo Hospital Pequeno Principe, Curitiba, Paraná, Brazil; Department of Neurosurgery, Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Paraná, Brazil
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Gatto LAM, Demartini Z, Telles JPM, Figueiredo EG. Does amantadine improve cognitive recovery in severe disorders of consciousness after aneurysmal subarachnoid hemorrhage? A double-blind placebo-controlled study. Clin Neurol Neurosurg 2024; 237:108135. [PMID: 38330801 DOI: 10.1016/j.clineuro.2024.108135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Severe disorders of consciousness (sDoC) are a common sequela of aneurysmal subarachnoid hemorrhages (aSAH), and amantadine has been used to improve cognitive recovery after traumatic brain injury. OBJECTIVE This study evaluated the effect of amantadine treatment on consciousness in patients with sDoC secondary to aSAH. METHODS This double-center, randomized, prospective, cohort study included patients ≥ 18 years old with sDoC after aSAH from February 2020 to September 2023. Individual patient data of patients were pooled to determine the effect of amantadine, in comparison to placebo. The primary outcomes at 3 and 6 months after the ictus were evaluated using the modified Rankin scale (mRS) and Glasgow outcome scale (GOS). In addition to all-cause mortality, secondary endpoints were assessed weekly during intervention by scores on Rappaport's Disability Rating Scale (RDRS) and Coma Recovery Scale-Revised (CRSR). RESULTS Overall, 37 patients with sDoC and initial Glasgow Coma Scale (GCS) varying between 3 and 11 were recruited and randomized to amantadine (test group, n = 20) or placebo (control group, n = 17). The average age was 59.5 years (28 to 81 year-old), 24 (65%) were women, and the mean GCS at the beginning of intervention was 7.1. Most patients evolved to vasospasm (81%), with ischemia in 73% of them. The intervention was started between 30 to 180 days after the ictus, and administered for 6 weeks, with progressively higher doses. Neither epidemiological characteristics nor considerations regarding the treatment of the aneurysm and its complications differed between both arms. Overall mortality was 10.8% (4 deaths). During the study, four patients had potential adverse drug effects: two presented seizures, one had paralytic ileus, and another evolved with tachycardia; the medication was not suspended, only the dose was not increased. At data opening, 2 were taking amantadine and 2 placebo. CONCLUSION Despite some good results associated with amantadine in the literature, this study did not find statistically significant positive effects in cognitive recovery in patients with delayed post-aSAH sDoC. Further large randomized clinical trials in patients' subgroups are needed to better define its effectiveness and clarify any therapeutic window where it can be advantageous.
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Affiliation(s)
| | - Zeferino Demartini
- Department of Neurosurgery, Hospital de Clinicas - Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, Hospital das Clinicas, Universidade de São Paulo, São Paulo, SP, Brazil
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Beraldo RF, Gatto LAM, Golff IF, Alchieri TG, Pereira MC, Demartini Z. Dural Metastasis of Prostate Cancer Mimicking Chronic Subdural Hematoma. Neurol India 2024; 72:209-210. [PMID: 38443045 DOI: 10.4103/neurol-india.neurol-india-d-23-00702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024]
Affiliation(s)
| | - Luana A M Gatto
- Department of Neurosurgery, Hospital de Clinicas - UFPR - Curitiba-PR, Brazil
| | - Ildo Filho Golff
- Department of Neurosurgery, Hospital Universitario Cajuru - PUCPR - Curitiba-PR, Brazil
| | | | - Marcelo Charles Pereira
- Director of Cadaveric Studies and Skull Base Lab. ENT Department, Albany Medical Center, Albany, New York, United States
| | - Zeferino Demartini
- Department of Neurosurgery, Hospital de Clinicas - UFPR - Curitiba-PR, Brazil
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Demartini Z, Pardins JP, Koppe GL, Maeda AK, Mattozo CA, Cardoso-Demartini A. Pediatric intracranial aneurysms in a Southern Brazilian population. Childs Nerv Syst 2023; 39:3543-3549. [PMID: 37099140 DOI: 10.1007/s00381-023-05965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/16/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION Intracranial aneurysms are rare in the pediatric population, and their diagnosis can be challenging. They differ from their adult counterparts in several aspects, and hemorrhage is the most common presentation. OBJECTIVE To evaluate clinical data, aneurysm characteristics, and therapeutic results in a series of patients younger than 19 years of age with intracranial aneurysms. METHOD A retrospective cross-sectional observational study design analyzed medical records and imaging studies. Variables included age, sex, clinical presentation, comorbidities, aneurysmal characteristics, treatment modality, and clinical outcomes. RESULTS We identified 15 intracranial aneurysms in 11 patients (6 male), with ages ranging from 3 months to 15 years (mean age 5.2 years). Five patients had associated medical conditions, and hemorrhage was the most frequent clinical presentation (45%). Three patients (27%) had multiple aneurysms, and seven aneurysms were fusiform or dysplastic. The internal carotid artery was the most affected site, involved in 47% of cases. Aneurysm size ranged from 2 to 60 mm (mean 16.8 mm), with giant aneurysms in 27%. Seven patients were treated with endovascular procedures, while three aneurysms were clipped. Symptomatic vasospasm requiring angioplasty occurred in two patients and led to worse outcomes. One patient died due to severe aspiration pneumonia and sepsis that precluded treatment. Good functional outcome (modified Rankin scale - mRS ≤ 2) was achieved in all treated patients (91%). CONCLUSION The patients with aneurysms in this series were mostly male, presented mostly hemorrhagic syndromes, and mainly had internal carotid artery involvement. The outcome of treated patients was favorable, regardless of treatment modality.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Complexo Hospital de Clinicas, UFPR, Rua General Carneiro 181, 8° andar, Curitiba, 80.060-900, PR, Brazil.
- Hospital Pequeno Principe, Curitiba, PR, Brazil.
- Department of Neurosurgery, Hospital Universitario Cajuru PUCPR, Curitiba, PR, Brazil.
| | - Junio Pereira Pardins
- Department of Neurosurgery, Hospital Universitario Cajuru PUCPR, Curitiba, PR, Brazil
| | - Gelson Luis Koppe
- Hospital Pequeno Principe, Curitiba, PR, Brazil
- Department of Neurosurgery, Hospital Universitario Cajuru PUCPR, Curitiba, PR, Brazil
| | | | - Carlos Alberto Mattozo
- Hospital Pequeno Principe, Curitiba, PR, Brazil
- Department of Neurosurgery, Hospital Universitario Cajuru PUCPR, Curitiba, PR, Brazil
| | - Adriane Cardoso-Demartini
- Department of Neurosurgery, Complexo Hospital de Clinicas, UFPR, Rua General Carneiro 181, 8° andar, Curitiba, 80.060-900, PR, Brazil
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Demartini Z, Guerios E. Letter to the Editor regarding the paper "Bleeding pediatric AVM with negative pre-operative angiography: the first case report". Childs Nerv Syst 2023; 39:3039-3040. [PMID: 37707625 DOI: 10.1007/s00381-023-06148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clinicas, Departamento de Neurocirurgia, Universidade Federal do Parana, Curitiba, PR, 80.060-900, Brazil.
- Hospital Pequeno Principe, Curitiba, PR, Brazil.
| | - Enio Guerios
- Complexo Hospital de Clinicas, Departamento de Neurocirurgia, Universidade Federal do Parana, Curitiba, PR, 80.060-900, Brazil
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Guérios MS, Demartini Z, Guerios EE. Myocardial ischaemia caused by two remote non-cardiac stenoses. AsiaIntervention 2023; 9:154-155. [PMID: 37736200 PMCID: PMC10509609 DOI: 10.4244/aij-d-23-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 09/23/2023]
Affiliation(s)
| | - Zeferino Demartini
- Interventional Neuroradiology Department, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Enio E Guerios
- Interventional Cardiology Department, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
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Demartini Z, Teixeira BCDA, Koppe GL. Carotid artery aneurysm and hypomelanosis of Ito. Pediatr Neurosurg 2023:000530354. [PMID: 37011605 DOI: 10.1159/000530354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Hypomelanosis of Ito is a rare neurocutaneous syndrome characterized by hypopigmented skin lesions, abnormalities of the central nervous system, skeletal system, eyes and teeth. CASE PRESENTATION We present a case of a 4-year-old boy with hypomelanosis of Ito and neck pulsatile mass due to a giant left common carotid dissecting aneurysm. DISCUSSION To our knowledge, this is the first report of association of hypomelanosis of Ito with carotid aneurysm. CONCLUSION For children with hypomelanosis of Ito and abnormal neurologic findings, vascular neuroimaging should be considered.
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Demartini Z, Calzada T, Afornali S. Moyamoya Angiopathy and 15q11.2 Gene Deletion Syndrome. World Neurosurg 2023; 172:1-2. [PMID: 36627015 DOI: 10.1016/j.wneu.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Although the moyamoya angiopathy has already been associated with several genetic and chromosomal alterations, its physiopathologic mechanisms are not completely understood. We report a case of a 7-year-old male with epilepsy, autism spectrum disorder, and delayed psychomotor development whose genetic investigation showed a deletion of the 15q11.2 gene. He presented with sudden neurologic deficits and neuroimaging studies showed cerebral infarctions, bilateral hypoperfusion, and intracranial carotid artery stenosis. Medical treatment with anticonvulsants and antiplatelets was followed by bilateral cerebral revascularization surgery (encephaloduroarteriosynangiosis). There were no seizures nor ischemic events during the follow-up period. The 15q11.2 gene deletion is a rare mutation related to epilepsy, neurodevelopmental disorders, and malformations. Therefore it is noteworthy that the deletion may also be related to other delayed brain diseases still unknown. To our knowledge, this is the first report of moyamoya syndrome with concurrent 15q11.2 gene deletion.
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Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, PR, Brazil; Complexo Hospital Pequeno Principe, Curitiba, PR, Brazil.
| | - Thiago Calzada
- Complexo Hospital Pequeno Principe, Curitiba, PR, Brazil
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Demartini Z, Furtado Neves PJ, Carmo ALSD, Antoniuk S, Bufara DC, Prestes ACB, Rodrigues MD LB, Araujo LZ, Cardoso-Demartini A. Angiopathy and Stroke Associated with Homocystinuria in Childhood. Vasc Endovascular Surg 2022; 57:417-419. [PMID: 36495244 DOI: 10.1177/15385744221144978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A previously healthy 13 year-old boy presented with acute-onset headaches, aphasia and right-sided hemiparesis. Imaging showed cerebral ischemic infarction due to bilateral carotid occlusion, and investigation for stroke etiology diagnosed homocystinuria. Homocystinuria is an autosomal recessive condition that affects the metabolism of the amino acid methionine due to an enzyme deficiency. This disorder involves multiple organs systems, and complications include thromboembolic events, ectopia lentis, mental retardation, and skeletal abnormalities. The early diagnosis and treatment of hyperhomocystinemia can significantly improve outcomes. Therefore, metabolic screening for homocystinuria is strongly recommended for children presenting with stroke.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Universidade Federal do Parana Hospital de Clinicas, Curitiba, PR, Brazil
| | - Pedro Juan Furtado Neves
- Department of Vascular Surgery, Universidade Federal do Parana Hospital de Clinicas, Curitiba, PR, Brazil
| | | | - Sergio Antoniuk
- Department of Pediatrics, Universidade Federal do Parana Hospital de Clinicas, Curitiba, PR, Brazil
| | - Danielle Caldas Bufara
- Department of Pediatrics, Universidade Federal do Parana Hospital de Clinicas, Curitiba, PR, Brazil
| | | | | | - Laura Ziemba Araujo
- Department of Vascular Surgery, Universidade Federal do Parana Hospital de Clinicas, Curitiba, PR, Brazil
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Demartini Z, Maeda AK, Koppe GL, Guimarães RMDR, Maranha Gatto LA, Cardoso-Demartini AA. Torcular Dural Sinus Malformation. Pediatr Neurosurg 2022; 57:141-143. [PMID: 35026762 DOI: 10.1159/000521935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil.,Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Gelson Luis Koppe
- Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Ricardo Munhoz da Rocha Guimarães
- Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Luana A Maranha Gatto
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Demartini Z, Afornali S, Teixeira BCDA, Maeda AK, Carboni EK, Cardoso-Demartini AA. Spinal Kaposiform Hemangioendotheliomas: Is There a Role for Endovascular Treatment? Pediatr Neurosurg 2022; 57:385-388. [PMID: 35696991 DOI: 10.1159/000525455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil.,Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Sandrieli Afornali
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Demartini Z, Teixeira BCA, Cardoso-Demartini AA. Choreoathetosis in Moyamoya Disease. World Neurosurg 2021; 156:103-104. [PMID: 34601171 DOI: 10.1016/j.wneu.2021.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
Moyamoya disease is a cerebral angiopathy characterized by bilateral progressive narrowing of internal carotid arteries, developing collateral vessels with the aspect of a "puff of smoke." The presentation with movement disorders is extremely rare. We present the case of an 11-year-old girl with low academic performance who complained of involuntary movements starting in her right hand. Neurologic examination showed preserved muscle strength and right hemichoreoathetosis. Neuroimaging showed left hemisphere hypoperfusion and a hypertrophic distal lenticulostriate artery. The symptoms were controlled with medications, and cerebral revascularization was performed. Although movement disorders are usually related to cerebral lesions or hypoperfusion, cases without these etiologies were described. Thus the finding of asymmetric lenticulostriate arteries improving after asymmetry reduction suggests a possible role in the pathogenesis. Further studies are needed to fully elucidate the mechanisms between moyamoya disease and movement disorders.
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Affiliation(s)
- Zeferino Demartini
- Hospital of Clinical Complex, Federal University of Parana, Curitiba-PR, Brazil; Hospital Pequeno Principe Complex, Curitiba-PR, Brazil.
| | - Bernardo C A Teixeira
- Hospital of Clinical Complex, Federal University of Parana, Curitiba-PR, Brazil; Hospital Pequeno Principe Complex, Curitiba-PR, Brazil
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Demartini Z, Dos Santos de Alencar G, Cardoso-Demartini A, Sprengel SL, Zanine SC, Borba LAB. Delayed diagnosis of intracranial aneurysm in pediatrics: the risk of misdiagnosis-a case report. Childs Nerv Syst 2021; 37:3245-3249. [PMID: 33392649 DOI: 10.1007/s00381-020-05006-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aneurysms in the pediatric population are uncommon, requiring a high index of suspicion for diagnosis. We report a case of a child with head trauma and delayed diagnosed cerebral aneurysm. METHODS A 2-year-old girl was brought to the emergency room with seizures. Head imaging showed acute intraventricular hemorrhage, hydrocephalus, and paraclinoid aneurysm of the right internal carotid artery. She had been hospitalized elsewhere 1 month prior for traumatic brain injury after falling to the ground with subarachnoid and intraventricular hemorrhage and good recovery, but without diagnosis of aneurysm. RESULTS The child was treated with aneurysm embolization and ventriculoperitoneal shunt, being discharged asymptomatic. CONCLUSION Most primary intraventricular hemorrhage in pediatric population has identifiable etiology. A high rate of clinical suspicion, associated with a low threshold for vascular neuroimaging studies for children with spontaneous or atypical intracranial hemorrhage allow accurate diagnosis, appropriate treatment, and improved outcome.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil.
| | | | | | - Sergio Luiz Sprengel
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil
| | - Simone Cristina Zanine
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil
| | - Luis Alencar Biurrum Borba
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil
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Abstract
BACKGROUND The continuous development of microsurgical techniques to treat lesions in and around the optic canal (OC) emphasizes the need for an accurate understanding of the microanatomy of the region. METHODS Forty anatomic specimens were studied, with emphasis on the OC. The sphenoid bone and related structures were decalcified, added to animal gelatin, cut into 1-mm thick slices, and observed through a surgical microscope. The OC was considered the course that contained exclusively the optic nerve (ON) and ophthalmic artery. RESULTS The mean distance between the medial walls of the OC was 12.2 mm, and the OC had an average length of 12.06 mm. The OC has a horizontal oval shape in the proximal (internal) segment; a round shape in the middle segment; and a vertical oval shape in the distal (external) segment at the orbital cavity. In the middle segment of the OC, the thickest wall of the OC was the lateral (average: 0.68 mm), while the medial, inferior, and superior wall measures had averages of 0.75, 0.40, and 0.39 mm, respectively. The lateral wall of the sphenoid sinus is located under the OC, and the inferior wall of the OC separates both structures. The ophthalmic artery inside the OC was always located under the ON, between the dural sheaths, and had an average diameter of 1.03 mm. CONCLUSIONS The neurovascular structures within the OC vary in size and shape. The anatomic knowledge of the OC and its variations allows better surgical results and minimizes the surgical morbidity.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Hospital de Clinicas-UFPR-Curitiba-PR, Brazil.
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Demartini Z, Gatto LAM, Francisco AN, Koppe GL. Endovascular treatment of P3 segment of posterior cerebral artery aneurysm with stent and coils. Neurochirurgie 2021; 68:437-442. [PMID: 34499946 DOI: 10.1016/j.neuchi.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/12/2019] [Accepted: 08/24/2021] [Indexed: 11/27/2022]
Abstract
Posterior cerebral artery (PCA) aneurysms are rare and usually arise from proximal portion of the artery. The distal location is even less frequent, and aneurysms in this location tend to be larger and dissecting. Although they can be treated by direct surgery, recently endovascular procedures have been preferred in some centers. We report a case of large aneurysm of the posterior cerebral artery in a 45-year-old female presenting with headache. An uneventful endovascular treatment was performed with stent and platinum coils achieving total occlusion of the aneurysm, and the patient had good recovery. The findings are compared to earlier reports and literature regarding the issue is discussed.
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Affiliation(s)
- Z Demartini
- Neurosurgeon, Neuroradiologist, Hemodynamics Division, Federal University of Parana - UFPR, Curitiba, PR, Brazil; Neurosurgeon, Neuroradiologist, Department of Neurosurgery - Cajuru University Hospital, Pontifical University Catholic of Parana - PUCPR, Curitiba, PR, Brazil.
| | - L A M Gatto
- Neurosurgeon, Neuroradiologist, Department of Neurosurgery - Cajuru University Hospital, Pontifical University Catholic of Parana - PUCPR, Curitiba, PR, Brazil
| | - A N Francisco
- Neurosurgeon, Department of Neurosurgery - Cajuru University Hospital, Pontifical University Catholic of Parana - PUCPR, Curitiba, PR, Brazil
| | - G L Koppe
- Interventional Radiologist, Department of Neurosurgery-Hospital Vita Curitiba, Curitiba, PR, Brazil
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Teixeira BCA, Demartini Z, Bertholdo DB, Coelho LOM, Escuissato DL. Author Response: Teaching NeuroImages: Pseudopathologic Brain Parenchymal Enhancement due to Vascular Compression in Parotid Tumor. Neurology 2021; 97:48-49. [PMID: 34226289 DOI: 10.1212/wnl.0000000000012219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Demartini Z, Munhoz da Rocha Guimaraes R, Cardoso-Demartini AA. Cervical Disorders in Mucopolysaccharidosis IVA-Morquio disease. World Neurosurg 2021; 153:41-43. [PMID: 34246824 DOI: 10.1016/j.wneu.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
Morquio disease or mucopolysaccharidosis type IVA (Online Mendelian Inheritance in Man No. 253000) is a rare autosomal recessive disease classified in the group of metabolism inborn errors. The glycosaminoglycans accumulate in chondrocytes, which disturbs bone growth and leads to skeletal manifestations, such as skeletal dysplasia and a short stature. In addition, the disproportionate growth of the trachea can lead to airway insufficiency. We report the case of a 27-year-old man with dwarfism due to Morquio disease, which had resulted in quadriparesis, hyperreflexia, and dyspnea, requiring a "look up to the sky" compensatory position. Imaging studies of the neck showed tracheal tortuosity, spinal stenosis, myelopathy, and neurogenic arthropathy (Charcot joint). The patient was treated with occipital-cervical-thoracic instrumentation. However, postoperative tracheal correction was required. Considering the wide spectrum of clinical features in those with mucopolysaccharidosis type IVA, individualized multidisciplinary treatment is recommended.
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Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil; Complexo Hospital Pequeno Principe, Curitiba, Brazil.
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Demartini Z, Maeda AK, Koppe GL, Gatto LAM, Cardoso-Demartini A. Letter: Spinal Neurovascular Malformations in Klippel-Trenaunay Syndrome: A Single Center Study. Neurosurgery 2021; 89:E182-E183. [PMID: 34161588 DOI: 10.1093/neuros/nyab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas Universidade Federal do Parana Curitiba, Brazil.,Complexo Hospital Pequeno Principe Curitiba, Brazil.,Hospital Universitário Cajuru Pontifícia Universidade Católica do Paraná Curitiba, Brazil
| | | | - Gelson Luis Koppe
- Complexo Hospital Pequeno Principe Curitiba, Brazil.,Hospital Universitário Cajuru Pontifícia Universidade Católica do Paraná Curitiba, Brazil
| | - L A M Gatto
- Hospital Universitário Cajuru Pontifícia Universidade Católica do Paraná Curitiba, Brazil
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Abstract
Ondine's curse is one of the most enchanting mythical tales in the field of Medicine. The nymph Ondine was an immortal water spirit who became human after falling in love for a man, marrying him, and having a baby. In one of the versions of the tale, when she caught her husband sleeping with another woman, she cursed him to remain awake in order to control his own breathing. During the 19th century, the rare syndrome characterized by loss of autonomic breath control, while voluntary respiration remains intact, was cleverly named “Ondine's curse”. Nowadays, the term Ondine's curse is usually associated with congenital central hypoventilation syndrome; however, in medical literature, it also designates several respiratory disorders. Here, we present a review of the myth focused on history, arts and medicine.
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Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clinicas - Universidade Federal of Parana, Curitiba, PR, Brazil
- Hospital Universitário Cajuru, Pontifical Catholic University of Parana - PUCPR, Curitiba, PR, Brazil
- Corresponding author. Departamento de Neurocirurgia, Rua General Carneiro 181, 8º andar, Curitiba, PR, Brazil.
| | | | - Gelson Luis Koppe
- Hospital Universitário Cajuru, Pontifical Catholic University of Parana - PUCPR, Curitiba, PR, Brazil
| | | | - Enio Eduardo Guerios
- Complexo Hospital de Clinicas - Universidade Federal of Parana, Curitiba, PR, Brazil
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21
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Demartini Z, Cardoso-Demartini A, Pardins JP, Maeda AK, Koppe GL, Gatto LAM. Giant Aneurysm of Posterior Fossa in Childhood. Pediatr Neurosurg 2021; 56:497-500. [PMID: 34284389 DOI: 10.1159/000517651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/06/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil.,Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Junio Pereira Pardins
- Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Gelson Luis Koppe
- Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Luana A Maranha Gatto
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Demartini Z, Maeda AK, Koppe GL, Gatto LAM, Cardoso-Demartini A. Parkes-Weber Syndrome with Spinal Arteriovenous Fistula in Childhood. Pediatr Neurosurg 2021; 56:99-101. [PMID: 33556946 DOI: 10.1159/000512877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/08/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil, .,Complexo Hospital, Pequeno Principe, Curitiba, Brazil, .,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil,
| | | | - Gelson Luis Koppe
- Complexo Hospital, Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Luana A M Gatto
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Demartini Z, Ceccato GHW, da Trindade ÉSGG, Borba LAB. Multimodal treatment of a pediatric posterior fossa arteriovenous malformation employing endovascular and microsurgical techniques. Neurosurgical Focus: Video 2021; 4:V17. [PMID: 36284618 PMCID: PMC9542227 DOI: 10.3171/2020.10.focvid2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022]
Abstract
Intracranial hemorrhage is the most common presentation of posterior fossa arteriovenous malformations (AVMs) and may have serious consequences. The authors present a case of a 7-year-old girl with headache, vomiting, dysmetria, and ataxia due to a ruptured cerebellar grade III AVM. After two sessions of embolization, the patient underwent total microsurgical resection through a suboccipital craniotomy. There were no additional postoperative deficits, and the patient improved progressively during 6 months of rehabilitation. These challenging lesions should be removed after rupture, especially in children with long-term cumulative risk of rebleeding. Multimodal treatment reduces the perioperative bleeding, allowing better outcomes for pediatric AVM. The video can be found here: https://youtu.be/HQWnjD8ENZQ
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Fachin CG, Demartini Z, Pinto ASA, Klüppel EN, Teixeira BCDA, Bischoff C, Bonin EA, Dias AIBDS. Carotid-Esophageal Fistula Treated By Endovascular Approach. Vasc Endovascular Surg 2020; 55:419-421. [PMID: 33375907 DOI: 10.1177/1538574420976732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The carotid-esophageal fistula is a rare and serious complication of the metallic esophageal prosthesis. A high index of suspicion is required for early diagnosis and treatment, decreasing the morbidity and mortality rate of this severe complication. We report a case of a 4-year-old boy presenting severe upper gastrointestinal bleeding due to a carotid-esophageal fistula, secondary to deployment of an esophageal metallic prosthesis for treatment of a recurrent stenosis. The carotid pseudo-aneurism was successfully treated with stents and coils. Although endovascular treatment is a safe and effective option, arterial stenting in children needs further studies with long-term follow-up.
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Affiliation(s)
- Camila Girardi Fachin
- Department of Pediatric Surgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Zeferino Demartini
- Department of Neurosurgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Amanda Satuti Alcure Pinto
- Department of Pediatric Surgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Elis Novochadlo Klüppel
- Hospital de Clínicas and Medical School, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | | | - Cristiano Bischoff
- Department of Pediatric Surgery, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
| | - Eduardo Aimore Bonin
- Gastrointestinal Endoscopy Unit, 274922Federal University of Paraná-Rua Padre Camargo, Curitiba, Parana, Brazil
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Demartini Z, Koppe GL, Corrêa de Almeida Teixeira B, Keijiro A, Francisco AN, Maranha Gatto LA. Matas test revisited: carotid compression for embolization of high-flow pediatric pial arteriovenous fistulas. J Neurosurg Pediatr 2020; 27:364-367. [PMID: 33338991 DOI: 10.3171/2020.7.peds20401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cerebral pial arteriovenous fistula (AVF) is a rare vascular malformation and may cause hemorrhage and neurological deficit. The presence of high-flow shunts constitutes a challenge when performing the endovascular technique, due to risk of distal embolization. The authors report a simple maneuver, adapted from the Matas test, that was successfully applied to treat a child with two pial AVFs. METHODS An 8-year-old boy presented with headache and vomiting due to two single-channel high-flow intracerebral pial AVFs. He was treated with an endovascular approach using brief, gentle compression of the ipsilateral cervical carotid artery. The temporary flow arrest ensured proper placement of the first coil, allowing definitive obliteration of the shunt. RESULTS There were no complications with the procedure, and the patient recovered uneventfully. Throughout the 9-month follow-up, the patient experienced a stable neurological condition, with both fistulas occluded and improvement of local circulation. CONCLUSIONS This easy-to-perform maneuver allows precise positioning of embolic material into high-flow shunts to facilitate treatment of pial AVF.
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Affiliation(s)
- Zeferino Demartini
- 1Department of Neurosurgery, Complexo Hospital de Clinicas, Universidade Federal do Paraná-UFPR.,2Department of Neurosurgery, Hospital Pequeno Principe.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | - Gelson Luis Koppe
- 2Department of Neurosurgery, Hospital Pequeno Principe.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | | | - Adriano Keijiro
- 1Department of Neurosurgery, Complexo Hospital de Clinicas, Universidade Federal do Paraná-UFPR.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | - Alexandre Novicki Francisco
- 2Department of Neurosurgery, Hospital Pequeno Principe.,3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
| | - Luana Antunes Maranha Gatto
- 3Department of Neurosurgery, Cajuru University Hospital and Pontifical Catholic University of Paraná, PUCPR; and
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Maranha Gatto LA, Rodrigues Seabra DDM, Koppe GL, Demartini Z. Complications of Endovascular Treatment in Fibromuscular Dysplasia. Neurol India 2020; 68:1220-1223. [PMID: 33109882 DOI: 10.4103/0028-3886.299152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Fibromuscular dysplasia affects generally renal artery, causing renovascular hypertension. The most classical angiographic pattern, string-of-beads, can be found in cervical and more rarely in other arteries. With the advance of endovascular procedures techniques, the number of open surgeries is decreasing, and complications related to the selective catheterization of diseased vessels are increasing. CASE REPORT A 37-year-old man presenting with subarachnoid hemorrhage was submitted to angioplasty for dissecting aneurysms of vertebral artery with a good outcome. Several arteries were angiographically diagnosed with the dysplasia (renal, carotid, femoral), and some complications like stenosis, dissection, arteriovenous fistula, and dissecting aneurysm occurred in sequence. CONCLUSIONS FMD of cervical arteries is usually asymptomatic. There are no guidelines or protocols to cervical FMD treatment, being indicated only for the complications. Because of the vessels fragility, a several spontaneous or post endovascular procedure complications can be disastrous.
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Affiliation(s)
- Luana Antunes Maranha Gatto
- Neurosurgeon and Interventional Neuroradiologist of Cajuru University Hospital of Pontifical Catholic University of Paraná (HUC-PUC PR), Curitiba - Parana, Brazil
| | | | - Gelson Luis Koppe
- Head of Department of Interventional Neuroradiology of HUC-PUC PR, Curitiba - Parana, Brazil
| | - Zeferino Demartini
- Neurosurgeon and Interventional Neuroradiologist of Cajuru University Hospital of Pontifical Catholic University of Paraná (HUC-PUC PR), Curitiba - Parana, Brazil
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Demartini Z, Gatto LAM, de Oliveira TVWF, Guimaraes RMR, Francisco AN, Koppe GL. Dural Arteriovenous Fistula Associated with Dental Implant. World Neurosurg 2020; 141:69-71. [PMID: 32525091 DOI: 10.1016/j.wneu.2020.05.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) are characterized by pathologic shunts between meningeal arteries and venous sinuses, without nidus. Although many lesions are considered idiopathic, there may be an association with inflammatory processes, including sinus thrombosis, venous hypertension, craniotomy, trauma, and infections. CASE DESCRIPTION A 50-year-old woman with an infectious complication of a dental implant evolved with an occipital DAVF. To our knowledge, this is the first case of a dental implant-related DAVF reported in the medical literature. CONCLUSIONS Physicians should be aware of the possibility of DAVF formation after craniofacial infections. Better understanding of the etiopathogenesis of this type of lesion is required to avoid and treat potential complications.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Hospital de Clinicas, UFPR, Curitiba-PR, Brazil; Department of Neurosurgery, Hospital Pequeno Principe, Curitiba-PR, Brazil.
| | - Luana A M Gatto
- Department of Neurosurgery, Cajuru University Hospital, Department of Neurosurgery, Pontifical University Catholic of Parana, PUCPR, Curitiba-PR, Brazil
| | - Tatiana V W F de Oliveira
- Department of Neurosurgery, Cajuru University Hospital, Department of Neurosurgery, Pontifical University Catholic of Parana, PUCPR, Curitiba-PR, Brazil
| | - Ricardo M R Guimaraes
- Department of Neurosurgery, Cajuru University Hospital, Department of Neurosurgery, Pontifical University Catholic of Parana, PUCPR, Curitiba-PR, Brazil
| | - Alexandre N Francisco
- Department of Neurosurgery, Cajuru University Hospital, Department of Neurosurgery, Pontifical University Catholic of Parana, PUCPR, Curitiba-PR, Brazil
| | - Gelson Luis Koppe
- Department of Neurosurgery, Hospital Pequeno Principe, Curitiba-PR, Brazil; Department of Neurosurgery, Cajuru University Hospital, Department of Neurosurgery, Pontifical University Catholic of Parana, PUCPR, Curitiba-PR, Brazil
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Brito RN, Demartini Z, Zanine SC, Borba LAB. Letter: A Meta-Analysis of Risk Factors for the Formation of de Novo Intracranial Aneurysms. Neurosurgery 2020; 86:E475. [PMID: 31927587 DOI: 10.1093/neuros/nyz568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Zeferino Demartini
- Department of Neurosurgery Universidade Federal do Paraná Curitiba - PR, Brazil
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Demartini Z, Koppe GL, Guimarães RMDR, da Rocha LEM, Francisco AN, Gatto LAM. Pediatric Cervical Aneurysmal Bone Cyst Treated by Endovascular Approach. Pediatr Neurosurg 2020; 55:304-308. [PMID: 33202414 DOI: 10.1159/000511281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Aneurysmal bone cyst (ABC) is a rare, benign, and expansible bone lesion, occurring mainly in childhood. Although most lesions are located at the metaphysis of long bones, they can also be found in flat bones and spine. CASE PRESENTATION We report a case of a 16-year-old boy with cervical ABC treated by endovascular embolization. The afferents were occluded as a preoperative preparation for surgery; however, as the patient became asymptomatic after the procedure, the family refused surgery. Image at 1-year follow-up showed reduction and ossification of the lesion. CONCLUSION Endovascular treatment decreases surgical morbidity by reducing blood loss, which is particularly important in the pediatric population. This therapeutic option may also halt ABC growth in selected cases.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Hospital Pequeno Principe, Curitiba, Curibita, Puerto Rico, Brazil, .,Department of Neurosurgery, Hospital de Clinicas, Parana Federal University, Curibita, Puerto Rico, Brazil, .,Department of Neurosurgery, Hospital Universitario Cajuru, Pontifical Catholic University of Parana, Curibita, Puerto Rico, Brazil,
| | - Gelson Luis Koppe
- Department of Neurosurgery, Hospital Pequeno Principe, Curitiba, Curibita, Puerto Rico, Brazil.,Department of Neurosurgery, Hospital Universitario Cajuru, Pontifical Catholic University of Parana, Curibita, Puerto Rico, Brazil
| | - Ricardo Munhoz da Rocha Guimarães
- Department of Neurosurgery, Hospital Pequeno Principe, Curitiba, Curibita, Puerto Rico, Brazil.,Department of Neurosurgery, Hospital Universitario Cajuru, Pontifical Catholic University of Parana, Curibita, Puerto Rico, Brazil
| | | | - Alexandre Novicki Francisco
- Department of Neurosurgery, Hospital Pequeno Principe, Curitiba, Curibita, Puerto Rico, Brazil.,Department of Neurosurgery, Hospital Universitario Cajuru, Pontifical Catholic University of Parana, Curibita, Puerto Rico, Brazil
| | - Luana A M Gatto
- Department of Neurosurgery, Hospital Universitario Cajuru, Pontifical Catholic University of Parana, Curibita, Puerto Rico, Brazil
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Demartini Z, Teixeira BCDA, Koppe GL, Gatto LAM. Pediatric Stroke Associated with Rete Middle Cerebral Artery. Pediatr Neurosurg 2020; 55:232-233. [PMID: 33045714 DOI: 10.1159/000510604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Zeferino Demartini
- Complexo Hospital de Clínicas, Universidade Federal do Parana, Curitiba, Brazil, .,Complexo Hospital Pequeno Principe, Curitiba, Brazil, .,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil,
| | | | - Gelson Luiz Koppe
- Complexo Hospital Pequeno Principe, Curitiba, Brazil.,Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Luana A M Gatto
- Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Gatto LAM, De Souza TFS, Naves de Lima Alves G, Padilha Miranda T, Koppe GL, Demartini Z. Endovascular Treatment of a Dural Arteriovenous Fistula after Cerebral Sinovenous Thrombosis in a Child. Pediatr Neurosurg 2019; 54:66-70. [PMID: 30481758 DOI: 10.1159/000494563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dural arteriovenous fistula (DAVF) is rare in children. Development theories postulate a response to cerebral sinovenous thrombosis (CSVT) or to venous hypertension. The symptoms are highly nonspecific and depend on lesion location. Standard treatment of thrombosis is based on antithrombotic therapy, while the main therapy for DAVF is embolization. CASE REPORT An 8-year-old boy presented with headache was diagnosed with CSVT and treated with anticoagulant. He developed tinnitus, mental confusion, and lowering of consciousness. Magnetic resonance imaging showed a DAVF draining through a single stenotic venous sinus. Successful endovascular treatment was performed with arterial embolization of multiple feeders and stent and balloon sinus angioplasty. CONCLUSION Risk factors associated with sinus thrombosis must be always investigated; endovascular treatment is safe and reasonable in a clinical deterioration scenario.
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Affiliation(s)
- Luana Antunes Maranha Gatto
- Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Brazil,
| | | | | | - Tayna Padilha Miranda
- Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Brazil
| | | | - Zeferino Demartini
- Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Brazil
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Demartini Z, Gatto LAM, Lages RO, Koppe GL. Henrique Dumont: how a traumatic brain injury contributed to the development of the airplane. Arq Neuropsiquiatr 2019; 77:60-62. [PMID: 30758444 DOI: 10.1590/0004-282x20180149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/29/2018] [Indexed: 06/09/2023]
Abstract
The life and death of Henrique Dumont (1832-1892) is little known, being usually remembered as Alberto Santos-Dumont's father. This report describes the history of this Brazilian engineer, also known as the King of Coffee, who achieved enormous business success and fortune in the late nineteenth century. In 1890, during the inspection of his farm, the world's largest coffee plantation at that time, he fell from a carriage, which left him a hemiplegic. This forced him to sell the farm and move to France for treatment. Before his death two years later, he gave his 18-year-old son bits of advice, and distributed his inheritance, which allowed Alberto to study in Paris and finance his experiments that would culminate in the development of the airplane. The diagnostic and therapeutic possibilities are also discussed.
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Affiliation(s)
- Zeferino Demartini
- Universidade Federal do Paraná, Divisão de Hemodinâmica, Curitiba PR, Brasil
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Divisão de Neurocirurgia, Curitiba PR, Brasil
| | - Luana A Maranha Gatto
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Divisão de Neurocirurgia, Curitiba PR, Brasil
| | - Roberto Oliver Lages
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Divisão de Neurocirurgia, Curitiba PR, Brasil
| | - Gelson Luis Koppe
- Hospital Vita Curitiba, Departamento de Neurocirurgia, Curitiba PR, Brasil
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Antunes Maranha Gatto L, Naves de Lima Alves G, do Monte Rodrigues Seabra D, Koppe GL, Demartini Z. Single-session percutaneous embolization with onyx and coils of sinus pericranii. Surg Neurol Int 2018; 9:114. [PMID: 29963324 PMCID: PMC6000716 DOI: 10.4103/sni.sni_456_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/15/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sinus pericranii (SP) is a rare vascular malformation consisting of an abnormal communication between the extra- and the intracranial venous system. It occurs due to the adhesion of vessels without a muscular layer or a hemangioma on the outer surface of the skull through diploic vessels, communicating with an intracranial venous sinus. CASE DESCRIPTION A 10-month-old female presented with a pulsatile mass on the posterior parietal region. Investigation with brain vascular examinations showed a venous malformation communicating with the superior sagittal sinus under the scalp, without arterial feeder or nidus. An endovascular embolization with coils and a percutaneous embolization with Onyx ® were performed. The final venography showed complete exclusion of the lesion, which was gradually being absorbed. CONCLUSION This is the first case of an SP successfully treated in a single session by embolization with coils and onyx.
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Affiliation(s)
- Luana Antunes Maranha Gatto
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Guilherme Naves de Lima Alves
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Diego do Monte Rodrigues Seabra
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Gelson Luis Koppe
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
| | - Zeferino Demartini
- Departments of Neurosurgery and Interventional Neuroradiology, Cajuru University Hospital of Pontifical Catholic University (HUC-PUC), Curitiba, Parana, Brazil
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Demartini Z, Galdino J, Koppe GL, Bignelli AT, Francisco AN, Gatto LAM. Endovascular treatment of cerebral aneurysm after renal transplantation in polycystic kidney disease. Interv Neuroradiol 2018; 24:284-287. [PMID: 29444616 PMCID: PMC5967191 DOI: 10.1177/1591019918758037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/16/2018] [Indexed: 11/16/2022] Open
Abstract
Background Patients with polycystic kidney disease have a higher prevalence of intracranial aneurysms and may progress to renal failure requiring transplantation. The endovascular treatment of intracranial aneurysms may improve prognosis, since rupture often causes premature death or disability, but the nephrotoxicity risk associated with contrast medium must be always considered in cases of renal impairment. Methods A 55-year-old female patient with polycystic kidney disease and grafted kidney associated with anterior communicant artery aneurysm was successfully treated by embolization. Results The renal function remained normal after the procedure. To the authors' knowledge, this is the first case of endovascular treatment of brain aneurysm in a transplanted patient reported in the medical literature. Conclusions The endovascular procedure in renal transplant patients is feasible and can be considered to treat this population. Further studies and cases are needed to confirm its safety.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Jennyfer Galdino
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Gelson L Koppe
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Alexandre T Bignelli
- Department of Internal Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Alexandre N Francisco
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Luana AM Gatto
- Department of Neurosurgery, Pontifical Catholic University of Paraná, Curitiba, Brazil
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Abstract
Sneddon syndrome (SS) is a rare progressive non-inflammatory thrombotic vasculopathy affecting small/medium-sized blood vessels of unknown origin. It is strongly associated with the presence of antiphospholipid antibodies (AA). The presence of livedo reticularis and cerebrovascular disease are hallmark features. The condition is far more common in young women. We report a case of SS in a 43 year-old male with a two-year history of progressive cognitive impairment consistent with dementia syndrome, and major personality changes, besides livedo reticularis and cerebral angiographic pattern of vasculitis. AA were borderline. The recognition of skin blemishes that precede strokes should raise the hypothesis of SS. AA are elevated in more than half of cases, but their role in the pathogenesis or association of positive antibodies and SS remains unclear. Dementia syndrome in young patients should be extensively investigated to rule out reversible situations. Typical skin findings, MRI and angiography may aid diagnosis.
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Affiliation(s)
| | - Raul Martins
- Radiologist of CETAC - Diagnóstico por Imagem, Curitiba, PR, Brazil
| | - Gelson Luis Koppe
- Interventional Neuroradiologist of Hospital das Nações, Curitiba, PR, Brazil
| | - Zeferino Demartini
- Neurosurgeon and Interventional Neuroradiologist of Hospital das Nações, Curitiba, PR, Brazil
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Abstract
AbstractProliferative angiopathy (PA) is a rare cerebral vascular disease in which anomalous vessels continually recruit additional feeder arteries, amid a functional brain parenchyma. We report the case of a young woman with progressive history of headache, motor deficit, seizures and drowsiness. She received a misdiagnosis of brain arteriovenous malformation (AVM) and evolved with dysarthria and cognitive decline after an unsuccessful embolization performed at another institution. We opted for conservative treatment with periodic control by imaging tests. Proliferative angiopathy differs in natural history, prognosis, histopathology and treatment of the usual AVMs. Endovascular procedures aggravate the neurological deficits, which are usually progressive and tend to worsen over time.
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Affiliation(s)
- Luana Gatto
- Hospital Universitário Cajuru, Curitiba, PR, Brazil
| | - Rodrigo Brisson
- Division of Neurology, Department of Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
| | - Zeferino Demartini
- Department of Neurosurgery and Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
| | - Gelson Koppe
- Department of Interventional Neuroradiology, Hospital Universitário Cajuru, Curitiba, PR, Brazil
| | - Carlos Rocha
- Department of Neurology, Neurosurgery, Interventional Neuroradiology, Campo Grande, MS, Brazil
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Demartini Z, Gatto LAM, da Rocha TC, Maeda AK, Valerio A, Koppe GL, Francisco AN. Is the Mayfield Head Holder Obligatory for Intracranial Aneurysm Clipping? Pediatr Neurosurg 2018; 53:360-363. [PMID: 30145594 DOI: 10.1159/000491825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/04/2018] [Indexed: 11/19/2022]
Abstract
Intracranial aneurysm surgery is commonly performed using pinned head holders, which pose a higher risk for the pediatric population. Several authors recommend avoiding the use of this device when it is not strictly necessary, and this is currently possible considering advances in anesthesiology and monitoring. As the literature on microsurgery without skull clamp use is scant, we report the case of a 15-year-old boy presenting with a subarachnoid hemorrhage after rupture of a middle cerebral artery aneurysm. Surgical treatment was performed with the head resting on a gel cushion horseshoe; aneurysm clipping was achieved without wakefulness or awareness and the patient had a good recovery.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Cajuru University Hospital, Pontifical Catholic University of Parana, Curitiba, Brazil.,Department of Neurosurgery, Hospital Pequeno Principe, Curitiba, Brazil
| | - Luana Antunes Maranha Gatto
- Department of Neurosurgery, Cajuru University Hospital, Pontifical Catholic University of Parana, Curitiba, Brazil
| | | | | | - Adriana Valerio
- Department of Anesthesiology, Hospital Pequeno Principe, Curitiba, Brazil
| | - Gelson Luis Koppe
- Department of Neurosurgery, Hospital Pequeno Principe and Hospital Vita Curitiba, Curitiba, Brazil
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Demartini Z, Gatto LAM, Lages RO, Francisco AN, Maeda AK, Koppe GL. Atypical Presentation of PHACE Syndrome: Hidden Facial Hemangioma. Pediatr Neurosurg 2018; 53:421-426. [PMID: 30336486 DOI: 10.1159/000493491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022]
Abstract
PHACE(S) syndrome is a neurocutaneous syndrome with a wide array of presentations. The most known and present trait is facial hemangioma > 5 cm. The name is an acronym for Posterior fossa malformations, infantile Hemangiomas, Arterial anomalies, aortic Coarctation, Eye abnormalities, and middle-line malformations of the Sternum. The exact etiopathogenic mechanism of this syndrome is not fully understood, and its treatment depends on detailed and individualized assessment. The aim of this paper is to describe a child with a throat hemangioma, vascular malformations, cognitive delay, and other anomalies to illustrate the neuroimaging found in this syndrome.
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Affiliation(s)
- Zeferino Demartini
- Neurosurgery, Cajuru University Hospital, Curitiba, .,Interventional Neuroradiology, Hospital Pequeno Principe, Curitiba,
| | | | - Roberto Oliver Lages
- Neurosurgery, Cajuru University Hospital, Curitiba, Brazil.,Neurosurgery, Hospital Pequeno Principe, Curitiba, Brazil
| | - Alexandre Novicki Francisco
- Neurosurgery, Cajuru University Hospital, Curitiba, Brazil.,Neurosurgery, Hospital Pequeno Principe, Curitiba, Brazil
| | | | - Gelson Luis Koppe
- Interventional Neuroradiology, Hospital Pequeno Principe, Curitiba, Brazil
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Gatto LAM, Koppe GL, Demartini Z, Zétola VDHF. Physicians are not well informed about the new guidelines for the treatment of acute stroke. Arq Neuropsiquiatr 2017; 75:718-721. [PMID: 29166463 DOI: 10.1590/0004-282x20170122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Treatment of cerebrovascular disease has advanced rapidly in the last two decades. Recent data has added challenges to the treatment of ischemic stroke in the acute phase. OBJECTIVE To evaluate the knowledge of physicians about the treatment of ischemic stroke in the acute phase. METHODS An online questionnaire was submitted to all physicians enrolled in the Regional Council of Medicine in Brazil. RESULTS 456 physicians from different specialties answered the questions. Most of them did not know that mechanical endovascular thrombectomy is often considered as the gold standard treatment in cases of ischemic stroke in the acute phase; and 85% of them did not realize that thrombectomy together with intravenous thrombolysis was possible. The maximum time to act in an acute event also presented many divergences, even with regard to the infusion of rtPA. The lack of structure, medication and absence of a neurologist were considered the main barriers to treatment. CONCLUSION Physicians are not well informed about the new guidelines for the treatment of acute stroke. Most physicians incorrectly answered most of the questions on the questionnaire.
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Affiliation(s)
- Luana Antunes Maranha Gatto
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurocirurgia, Curitiba PR, Brasil.,Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurorradiologia Intervencionista, Curitiba PR, Brasil
| | - Gelson Luis Koppe
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurorradiologia Intervencionista, Curitiba PR, Brasil
| | - Zeferino Demartini
- Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurocirurgia, Curitiba PR, Brasil.,Pontifícia Universidade Católica do Paraná, Hospital Universitário Cajuru, Departamento de Neurorradiologia Intervencionista, Curitiba PR, Brasil
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Gatto LAM, Saurin F, Koppe GL, Demartini Z. Facial palsy after embolization of dural arteriovenous fistula: A case report and literature review. Surg Neurol Int 2017; 8:270. [PMID: 29204306 PMCID: PMC5691552 DOI: 10.4103/sni.sni_428_16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 05/26/2017] [Indexed: 11/04/2022] Open
Abstract
Background Dural arteriovenous fistulas (DAVF) are unusual intracranial vascular malformations consisting of anomalous connections between meningeal arteries and dural sinuses or the veins that pass through them. They have variable clinical presentation and prognosis, which depend on their location and venous hemodynamics. Treatment is based on the closure of the abnormal connections, which is usually conducted via arterial and/or transvenous endovascular techniques. Case Description We present a male patient who complained of headaches and left-sided pulsatile tinnitus due to DAVF from the external carotid artery branches draining directly into the ipsilateral sigmoid sinus. Embolization with Onyx® was successful, obtaining angiographic occlusion and symptom remission. However, on postoperative day 4, the patient presented with left facial palsy and spontaneous regression. Conclusion Although embolization is an effective and safe procedure, complications may occur. Reflux of the embolic agent to the vasa nervorum of the cranial nerve may lead to ischemic neuropathy. Here, we reported a case of embolized DAVF presenting with a postoperative peripheral facial palsy where the two embolized pedicles were branches of the middle meningeal and occipital arteries involved in the vascularization of the extratemporal segment of the facial nerve. We discuss the etiopathogenic, anatomical, and pathophysiological aspects of this complication.
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Affiliation(s)
| | | | - Gelson Luis Koppe
- Head of Interventional Neuroradiology in HUC-PUC, Curitiba, Parana, Brazil
| | - Zeferino Demartini
- Department of Neurosurgeon and Interventional Neuroradiologist in HUC-PUC, Curitiba, Parana, Brazil
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Demartini Z, Rodrigues Freire M, Lages RO, Francisco AN, Nanni F, Maranha Gatto LA, Koppe GL. Internal Carotid Artery Dissection in Brazilian Jiu-Jitsu. J Cerebrovasc Endovasc Neurosurg 2017; 19:111-116. [PMID: 29152471 PMCID: PMC5678212 DOI: 10.7461/jcen.2017.19.2.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/20/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022] Open
Abstract
Carotid artery dissection is a significant cause of stroke in young patients. It may be asymptomatic and go undiagnosed, or minimal transient manifestations may follow, commanding a higher index of suspicion than ordinarily exists to avoid misdiagnosis. Reported herein is a 27-year-old man who suffered extracranial internal carotid artery dissection while practicing a Brazilian Jiu-Jitsu submission maneuver. The patient's condition suddenly deteriorated one week later due to distal embolization and stroke. Despite endovascular treatment, with stenting of the cervical carotid artery, neurologic deficits remained. Of note, the objective in martial arts, which is to kill or incapacitate, has yet to be fully tempered in transitioning to sport. Brazilian Jiu-jitsu, a relatively new and fast-growing form of martial art, places emphasis on submission maneuvers. Related injuries are not common knowledge and are poorly described in the literature. This account is intended to shed light on the risk of this discipline. Through education and improved supervision, vascular injuries of this nature and the potentially lethal or disabling consequences may thus be prevented in young athletes.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Ponthific Catholic University of Paraná - PUCPR - Curitiba (PR), Brazil
| | - Maxweyd Rodrigues Freire
- Department of Neurosurgery, Ponthific Catholic University of Paraná - PUCPR - Curitiba (PR), Brazil
| | - Roberto Oliver Lages
- Department of Neurosurgery, Ponthific Catholic University of Paraná - PUCPR - Curitiba (PR), Brazil
| | | | - Felipe Nanni
- Department of Neurosurgery, Ponthific Catholic University of Paraná - PUCPR - Curitiba (PR), Brazil
| | - Luana A Maranha Gatto
- Department of Neurosurgery, Ponthific Catholic University of Paraná - PUCPR - Curitiba (PR), Brazil
| | - Gelson Luis Koppe
- Department of Neurosurgery, Ponthific Catholic University of Paraná - PUCPR - Curitiba (PR), Brazil
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Gatto LAM, Sousa LHA, Koppe GL, Demartini Z. Carotid artery occlusion in Kabuki syndrome: Case report and literature review. Surg Neurol Int 2017; 8:88. [PMID: 28607822 PMCID: PMC5461567 DOI: 10.4103/sni.sni_427_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/18/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Kabuki syndrome is a rare multiple congenital anomaly syndrome whose main diagnostic findings are craniofacial phenotypic changes and mental retardation. Organic structural lesions in the central nervous system are rare, although have been described already. Systemic vascular changes have also been reported rarely. CASE DESCRIPTION We report the case of a young patient with Kabuki syndrome who had a transient ischemic attack due to dissection of the internal carotid artery and a likely gliosis area on the white matter. CONCLUSION Association of cervical arterial disease with this syndrome has never been described, and its pathophysiology is not yet established; however, it can direct future research and maybe treatment.
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Affiliation(s)
- Luana A M Gatto
- Neurosurgeon and Interventional Neuroradiologist, University Hospital Cajuru, Curitiba, Parana, Brazil
| | | | - Gelson Luis Koppe
- Head of Interventional Neuroradiology Department, University Hospital Cajuru, Curitiba, Parana, Brazil
| | - Zeferino Demartini
- Neurosurgeon and Interventional Neuroradiologist, University Hospital Cajuru, Curitiba, Parana, Brazil
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Demartini Z, Dos Santos MLT, Koppe GL, Cardoso-Demartini ADA. Sinus Thrombosis after Endovascular Treatment of Vein of Galen Aneurysmal Malformation. Pediatr Neurosurg 2017; 52:136-139. [PMID: 28092907 DOI: 10.1159/000452806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/24/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Cajuru University Hospital, Pontifícia Universidade Católica do Paraná, PUCPR, Curitiba, Brazil
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Demartini Z, Matos LAD, Dos Santos MLT, Cardoso-Demartini ADA. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child. Pediatr Neurosurg 2016; 51:199-203. [PMID: 26974558 DOI: 10.1159/000444193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding.
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Affiliation(s)
- Zeferino Demartini
- Cajuru University Hospital, Department of Neurosurgery, Pontifical University Catholic of Parana, Curitiba, Brazil
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Demartini Z, Liebert F, Gatto LAM, Jung TS, Rocha C, Santos AMB, Koppe GL. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation. Case Rep Ophthalmol 2015; 6:482-7. [PMID: 26955353 PMCID: PMC4777947 DOI: 10.1159/000443141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.
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Nascimento FA, Gatto LAM, Lages RO, Neto HM, Demartini Z, Koppe GL. Diffuse idiopathic skeletal hyperostosis: A review. Surg Neurol Int 2014; 5:S122-5. [PMID: 24843807 PMCID: PMC4023007 DOI: 10.4103/2152-7806.130675] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 12/09/2013] [Indexed: 11/29/2022] Open
Abstract
Background: Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic noninflammatory disease characterized by ossification of the entheses. Methods: This paper reviews the etiopathogenesis, epidemiology, clinical features, differential diagnosis, and treatment of DISH, based on current available literature. Results: Exact prevalence and incidence of DISH remains undetermined. Many external and genetic factors have been reported as being contributors to the pathogenesis of DISH. Current theories focus on the pathologic calcification of the anterior longitudinal ligament of the spine as the main physiopathological mechanism of disease. Clinical features are variable from monoarticular sinovitis to airway obstruction, and can be associated to systemic conditions. Comorbidities include obesity, hypertension, diabetes mellitus, hyperinsulinemia, dyslipidemia, and hyperuricemia according to a number of reports. Conclusions: DISH is a disease which involves the calcification of the anterior longitudinal ligament of the spine and can be associated with numerous clinical presentations and comorbidities.
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Affiliation(s)
| | - Luana Antunes Maranha Gatto
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Neurosurgeon, Fellow of Interventional Neuroradiology, Neurosurgery Resident, Curitiba, Paraná, Brazil
| | - Roberto Oliver Lages
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Brazil
| | | | - Zeferino Demartini
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Neurosurgeon and Interventional Neuroradiologist, Curitiba, Paraná Brazil
| | - Gelson Luis Koppe
- Department of Neurosurgery of Hospital Universitário Cajuru, Curitiba, Paraná, Interventional Neuroradiologist in Hospital Universitário Cajuru, Curitiba, Paraná, Brazil
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de Menezes FO, Demartini Z, Matos LAD, de Godoy JMP, Spotti AR, dos Santos MLT. Anomalous branch of the right common carotid artery. Arq Neuropsiquiatr 2008; 66:916-7. [PMID: 19099144 DOI: 10.1590/s0004-282x2008000600034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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48
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dos Santos MLT, Demartini Z, Matos LAD, Borges MA, Spotti AR, Tognola WA. Radiculopathy due to iatrogenic fistula between subclavian artery and internal jugular vein. Clin Neurol Neurosurg 2008; 110:80-2. [DOI: 10.1016/j.clineuro.2007.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 08/16/2007] [Accepted: 08/24/2007] [Indexed: 10/22/2022]
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