Papers by José Carlos Esteves Veiga
Revista do Colégio Brasileiro de Cirurgiões, 2021
Objective: to evaluate the clinical-epidemiological characteristics, treatment, and evolution of ... more Objective: to evaluate the clinical-epidemiological characteristics, treatment, and evolution of patients with occipital condyle fracture (OCF) at one of the largest referral trauma centers in Latin America. Methods: this was a retrospective observational study of OCF identified from trauma cases admitted between December 2011 and December 2019 by the neurosurgery team at a Type 3 trauma center. Results: a total of twenty-eight occipital condyle fractures were identified in twenty-six patients. The incidence was less than 0.2% per year and more common in male patients (4:1 ratio) involved in traffic accidents. The mean age was 42.08 years. Anderson and Montesano type II and Tuli type 1 were the most frequent (67.9% and 89.3%, respectively) and no case presented C0-C1-C2 instability. All patients were treated with a cervical collar for 3 to 6 months. About 65% of the patients exhibited good progression (Glasgow Outcome Scale equal to 4), and the severity of traumatic brain injury was...
Objetivo : A hemorragia intraparenquimatosa cerebral esta presente em mais de um terco dos trauma... more Objetivo : A hemorragia intraparenquimatosa cerebral esta presente em mais de um terco dos traumatismos cranioencefalicos graves, estando relacionada a pior desfecho. O objetivo do estudo e caracterizar a amostra de pacientes submetidos a tratamento cirurgico da hemorragia cerebral intraparenquimatosa traumatica atendida em nosso servico. Metodo : Foi realizado estudo descritivo e retrospectivo de 48 pacientes submetidos a tratamento cirurgico de hemorragia intraparenquimatosa cerebral traumatica num periodo de 18 meses, observando-se variaveis demograficas como idade do paciente, localizacao da hemorragia, tipo de tratamento cirurgico empregado e presenca de outras lesoes cerebrais associadas. Resultados: Em nossa amostra houve predominio do genero masculino (87%). Quanto a idade, 14,5% tinham entre 21 e 30 anos, 15,5% entre 31 e 40 anos, 16,6% entre 41 e 50 anos e 25% entre 51 e 60 anos. As principais localizacoes anatomicas das lesoes intraparenquimatosas cerebrais foram os lobos...
Objective: To analyze the epidemiology, clinical and radiological presentation of patients with e... more Objective: To analyze the epidemiology, clinical and radiological presentation of patients with extradural hematoma (EDH) who underwent surgery in our service and their neurological status at the time of discharge. Method: we reviewed the charts of 189 patients who were admitted to our service with EDH and were treated surgically, during the period of August 1998 to January 2007. Results: In 49,2% the mechanism of trauma was falling; 49,7% of the cases had GCS between 13-15; 45,0% had skull fractures; 32,8% had associated intracranial injuries. Conclusion: we observed that 76,2% of surgically treated patients were discharged with minimum or no neurological deficits.
Revista Brasileira De Fisioterapia, 2006
Brazilian journal of anesthesiology, 2021
Intracranial pial Arteriovenous Fistulas (AVFs) are rare cerebral vascular lesions composed of on... more Intracranial pial Arteriovenous Fistulas (AVFs) are rare cerebral vascular lesions composed of one or more arterial connections to a single venous channel. We report a 50 year-old patient with a ruptured pial AVF located in an eloquent area. Microsurgery for pial AVF occlusion was proposed with awake craniotomy for motor function and neurological evaluation. Awake craniotomy is a technique that is especially useful for cerebral vascular lesions in eloquent areas, where an occlusion often compromises or suppresses the blood supply, culminating in ischemia with consequent transient or definitive deficits in neurological function.
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo, 2021
Introdução: O ureter retrocava é uma malformação congênita rara que pode ser causa de uropatia ob... more Introdução: O ureter retrocava é uma malformação congênita rara que pode ser causa de uropatia obstrutiva com sintomas inespecíficos como dor lombar e complicações como ureterolitíase e pielonefrite, que normalmente aparecem entre a terceira e a quarta décadas de vida, e exige tratamento cirúrgico na maior parte dos casos. Objetivo: Apresentar um caso de ureter retrocava associado a ureterolitíase e uma revisão da literatura a respeito das técnicas cirúrgicas para sua correção. Relato de caso: Os autores apresentam um caso de ureterolitíase e ureter retrocava, diagnosticado por tomografia computadorizada, em um paciente masculino de 43 anos com dor lombar direita, corrigido através de técnica laparoscópica transperitoneal. Conclusão: A correção cirúrgica laparoscópica do ureter retrocava tem se mostrado benéfica em diversos aspectos quando comparada ao acesso aberto e uma abordagem que ainda não havia sido publicada é a correção do ureter retrocava associado a ureterolitíase num mes...
Revista Chilena de Neurocirugía, 2021
Background: Although most traumatic epidural hematomas are secondary to arterial injuries, partic... more Background: Although most traumatic epidural hematomas are secondary to arterial injuries, particularly rupture of the middle meningeal artery, around 9.7% of cases are associated with dural venous sinus injury, leading to poorer prognosis and greater complications. We report a case of a patient presenting cranial trauma with bone fracture and laceration of the transverse sinus producing epidural hematoma, and discuss the main aspects of this condition. Case description: A 47-year-old man struck by a motorcycle was admitted to the Emergency Room with a score of 15 on the Glasgow Coma Scale, evolving over 5 hours with reduced level of consciousness. A cranial CT scan was performed disclosing right parieto- occipital hyperdensity, consistent with acute epidural hematoma, and a parieto-occipital fracture line crossing the path of the ipsilateral transverse sinus. Parietal craniotomy was performed to drain the hematoma, revealing a venous sinus injury requiring immediate repair. Conclus...
Journal of Craniofacial Surgery, 2020
Abstract Cranioplasty is a common neurosurgical procedure. The main reasons for performing cranio... more Abstract Cranioplasty is a common neurosurgical procedure. The main reasons for performing cranioplasty are, in addition to aesthetic correction and protection of the brain, the reestablishment of the adequate flow of cerebrospinal fluid and the prevention of complications inherent to the perpetuation of bone failure. In our institution the patient's autologous bone remains the best method for performing cranioplasty, despite the existence of other heterologous grafts and bone substitutes. Despite representing for us, the best material for cranioplasty, the use of autologous grafting is subject to complications. In this paper, the authors present the case of a patient who underwent cranioplasty with autologous bone that progressed with spontaneous resorption of the bone flap. The authors herein briefly discuss the case and review the literature on the subject, with an emphasis on the factors that can lead to such an outcome.
Surgical Neurology International, 2020
Background: Angioplasty using a carotid stent is a treatment modality for carotid stenosis, with ... more Background: Angioplasty using a carotid stent is a treatment modality for carotid stenosis, with results similar to those obtained with endarterectomy, as demonstrated by important studies. The increasing use of this procedure has also led to a larger number of reports of complications, stent fractures among those. Stent fracture is a rare manifestation and hence needs further studying so that its actual prevalence can be determined, as well as its associated risk factors and proper clinical management. The current study reports the case of a patient who had previously undergone angioplasty with a carotid stent and, after an automobile accident, presented with a stent fracture and distal embolization of fragments thereof with neurological manifestation. Case Description: A male patient, 40 years old, presented with a history of previously stent carotid angioplasty. He had been involved in an automobile accident and suffered a stent fracture with distal fragment migration. As he was ...
Revista da Associação Médica Brasileira, 2020
SUMMARY Microsurgical clipping is currently the main method of treating cerebral aneurysms, even ... more SUMMARY Microsurgical clipping is currently the main method of treating cerebral aneurysms, even with the improvement of endovascular therapy techniques in recent years. Treatment aims at complete occlusion of the lesion, which is not always feasible. Although appearing superior to endovascular treatment, microsurgical clipping may present varying percentages of incomplete occlusion. Such incidence may be reduced with the use of intraoperative vascular study. Some classifications were elaborated in an attempt to standardize the characteristics of residual lesions, but the classification criteria and terminology used in the studies remain vague and poorly documented, and there is no consensus for a uniform classification. Thus, there is also no agrément on which residual aneurysms should be treated. The aim of this study is to review the literature on residual lesions after microsurgery to treat cerebral aneurysms and how to proceed with them.
Revista da Associação Médica Brasileira, 2020
SUMMARY INTRODUCTION Retro-odontoid pseudotumor (ROP) is a rare disease that affects the atlantoa... more SUMMARY INTRODUCTION Retro-odontoid pseudotumor (ROP) is a rare disease that affects the atlantoaxial joint and, in general, is associated with local biomechanical alterations that may or may not cause instability. METHODS Descriptive study of the literature available in databases MEDLINE/PubMed, LILACS, and Scopus. The research was conducted in April 2019. DISCUSSION ROP is, possibly, a syndromic designation that encompasses a significant variety of diseases of the atlantoaxial joint. There are different pathophysiological mechanisms implicated in its genesis. The patients, almost in their entirety, present with severe myelopathy, and most of them are treated surgically, with the posterior decompression being the most commonly used method, with or without arthrodesis. Evolution is usually favorable. CONCLUSION The ROP is still poorly recognized as a differential diagnosis between the diseases of the cranial-cervical junction. The information available in the literature analyzed was...
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo, 2019
Introduction: Cerebral Arteriovenous Malformations (AVMs) are vascular lesions defined by arterio... more Introduction: Cerebral Arteriovenous Malformations (AVMs) are vascular lesions defined by arteriovenous shunting flowing through a nidus of coiled and tortuous vascular connections. Cerebral Proliferative Angiopathy (CPA) is a rare type of AVM with pathological, clinical, diagnostic features and treatment differences from a typical AVM. We aimed to summarize important features of CPA already described and identify important gaps of evidence. Methods: Data was selected by a search of PUBMED with the term “cerebral proliferative angiopathy”. The articles considered relevant were included in this review. We also screened article references and included them as needed. Discussion: CPA shows a diffuse nidus appearance, presence of transdural supply and stenosis of feeding arteries, without dominant feeders or flow-related aneurysms. There is intermingled brain between the vascular spaces. The usual clinical presentation is seizures, headaches, and progressive neurological deficits. Sound...
Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo, 2019
Introduction: A measure of an epidemiological event occurrence contributes in institutional healt... more Introduction: A measure of an epidemiological event occurrence contributes in institutional health planning, resource allocation, sickness trend prediction and a surgical divisions operating profile. Objective: Census in prevalence of spinal epidural metastases among spinal and spinal tissue neoplasms in the neurosurgical context is the encountered epidemiological literature gap and the proposed reason for this research. Methods: A surgically treated spinal neoplasms patient descriptive cross-sectional update census was performed between February 1997 and January 2018 in a single neurosurgical division. In addition, using the systematic research method for literature review, authors selected comparative descriptive studies in patients submitted to surgical procedures for spinal epidural metastases, epidural primary and intradural neoplasms. The methodological quality analysis was in accordance to the Oxford Centre for Evidence-Based Medicine. Results: The primary outcome obtained in...
Revista da Associação Médica Brasileira, 2019
SUMMARY OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of ... more SUMMARY OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of 595 patients with an initial diagnosis of Chronic Subdural Hematoma (CSDH) who underwent surgical treatment at a Reference Hospital of São Paulo. METHODS: A retrospective descriptive study, in which the medical records of all patients with a CSDH diagnosis submitted to surgical treatment from 2000 to 2014 were analyzed. RESULTS: The final study population consisted of 500 patients with a diagnosis of CSDH (95 patients with a diagnosis of Cystic Hygroma were excluded), of which 27 patients presented recurrence of the disease (5.4%). There were no statistically significant differences in relapses when cases were stratified by gender, laterality of the first episode or surgical procedure performed in the first episode (trepanning vs. craniotomy). It was possible to demonstrate an age-related protective factor, analyzed as a continuous variable, regarding the recurrence of the CSDH, with a l...
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2018
Introduction: Lung cancer, breast cancer, renal cell cancer, gastrointestinal carcinoma, and mela... more Introduction: Lung cancer, breast cancer, renal cell cancer, gastrointestinal carcinoma, and melanoma are common sources of cerebral metastasis. Brain metastasis from malignant gynecological tumors are considered rare. According to the literature, fewer than 3% of all brain metastases originate from gynecological lesions. The primary mechanism of metastatic spread from genital tract cancers to the brain is through the hematogenous rout. The endometrial carcinoma metastasis to the brain is a very rare event. The objective of this study is to describe this rare event and conduct a brief review of the literature. Case description: We report on a unique case of a cystic endometrial adenocarcinoma metastasis treated by neurosurgical procedure. The patient underwent “en bloc” tumor resection guided by neuronavigation and there were no complications during surgery. After discharge, she underwent whole brain radiation therapy, currently makes quarterly outpatient follow-up and showed no sig...
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2018
Bell’s cruciate paralysis is characterized by paralysis of the upper limbs associated with little... more Bell’s cruciate paralysis is characterized by paralysis of the upper limbs associated with little or no deficit in lower limbs. Its diagnosis is often overlooked, given that its symptoms similarities to that occasioned by the centromedullary syndrome, whose incidence is considerably higher. The present case report describes the case of a 16-year-old male patient victim of a gunshot wound in the anterior cervical region that developed Bell’s cruciate paralysis. The Magnetic Resonance Imaging (MRI) of the cervical spine showed medullary signal change in the cervicomedullary junction, with anteromedial location. A somatotopy of the corticospinal tract was suggested by Bell (1970) at cervicomedullary transition, with the anatomical hypothesis that fibers responsible for the movement of the upper limbs would cross higher and more superficially that the fibers of the lower limbs. This case combines the MRI assessment with the clinical outcome and corroborates with the Bell’s anatomical th...
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2018
O resultado do tratamento dos aneurismas cerebrais é influenciado por diversos fatores. O tratame... more O resultado do tratamento dos aneurismas cerebrais é influenciado por diversos fatores. O tratamento cirúrgico pode ter sua evolução comprometida pela ocorrência de isquemia cerebral decorrente da clipagem inadvertida de vasos adjacentes, assim como o risco de hemorragia futura aumenta diante de oclusão incompleta do aneurisma. A utilização do Doppler intra-operatório para o estudo da hemodinâmica dos aneurismas e dos vasos adjacentes vem sendo preconizada como ferramenta assistente, com análises recentes a respeito da sua segurança e confiabilidade. O presente caso tem o intuito de expor e discutir a situação em que após a clipagem inicial do aneurisma, considerada adequada sob a óptica do microscópio, o Doppler constatou fluxo intraaneurismático residual, sendo necessárias medidas adicionais para a oclusão do aneurisma.
Sao Paulo Medical Journal, 2017
CONTEXT: Central nervous system (CNS) infectious diseases have high prevalence in developing coun... more CONTEXT: Central nervous system (CNS) infectious diseases have high prevalence in developing countries and their proper diagnosis and treatment are very important for public health planning. Cryptococcus neoformans is a fungus that may cause several CNS manifestations, especially in immunocompromised patients. Cryptococcal meningitis is the most common type of involvement. Mass-effect lesions are uncommon: they are described as cryptococcomas and their prevalence is even lower among immunocompetent patients. The aim here was to report an extremely rare case of cryptococcoma causing a mass effect and mimicking a brain tumor in an immunocompetent patient. The literature on CNS cryptococcal infections was reviewed with emphasis on cryptococcomas. Clinical, surgical and radiological data on a female patient with this rare presentation of cryptococcoma mimicking a brain tumor are described. CASE REPORT: A 54-year-old female patient presented to the emergency department with a rapid-onset progressive history of confusion and completely dependency for basic activities. Neuroimaging showed a left occipital lesion and neurosurgical treatment was proposed. From histopathological evaluation, a diagnosis of cryptococcoma was established. She received clinical support with antifungals, but despite optimal clinical treatment, her condition evolved to death. CONCLUSIONS: Cryptococcal infections have several forms of presentation and, in immunocompetent patients, their manifestation may be even more different. Cryptococcoma is an extremely rare presentation in which proper surgical and clinical treatment should be instituted as quickly as possible, but even so, there is a high mortality rate.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2007
Resumo Objetivo: Atualizar conceitos e recomendar condutas da prática médica nos aspectos de prog... more Resumo Objetivo: Atualizar conceitos e recomendar condutas da prática médica nos aspectos de prognóstico, diagnóstico e tratamento das metástases epidurais da coluna vertebral. Método: O período de apuração das publicações situou-se entre janeiro de 1990 a janeiro de 2006, incluídas as referências relevantes prévias. A ausência de evidências de valor científico para determinar padrões ou diretrizes de conduta em temas médicos que geram incertezas da prática, permite usar do termo diretrizes para todas as recomendações. Resultados: A modalidade de tratamento a ser escolhido depende da análise dos fatores preditivos de prognóstico, tais como: o estado clínico do doente; a possibilidade de resgatar ou manter a capacidade de deambulação; grau de disseminação e transmissão da neoplasia primária. As informações obtidas com o diagnóstico de imagem da ressonância magnética efetuada em toda a extensão da coluna vertebral e o complemento das imagens ósseas pertinentes da tomografia axial comp...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2009
Resumo Objetivo: Revisão crítica das abordagens atuais para aneurismas do topo da artéria basilar... more Resumo Objetivo: Revisão crítica das abordagens atuais para aneurismas do topo da artéria basilar. Análise dos aspectos anatômicos e angiográficos relevantes para cirurgia. Métodos: Revisão crítica da literatura e relato da experiência dos autores. Resultados: Os principais acessos para aneurismas de topo de basilar de acordo com sua posição em relação ao dorso da sela são: Kawase transpetroso para os aneurismas baixos, transcavernoso para os médios e temporopolar para os altos. A monitoração eletrofisiológica e com doppler pode minimizar complicações isquêmicas por clipagem prolongada, estenose ou fechamento inadvertido de perfurantes. Neuroproteção e hipotermia devem ser consideradas em lesões gigantes e complexas. Lesões complexas geralmente excedem ao tratamento endovascular. Conclusão: Existe uma tendência na literatura a considerar o tratamento cirúrgico dos aneurismas como método ultrapassado; entretanto a tecnologia de novas formas de proteção cerebral, técnicas microcirúrgi...
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Papers by José Carlos Esteves Veiga