Papers by Lucas de Albuquerque
Surgical Neurology International, 2017
Background: Bilateral hemifacial spasm (BHFS) is a rare neurological syndrome whose diagnosis dep... more Background: Bilateral hemifacial spasm (BHFS) is a rare neurological syndrome whose diagnosis depends on excluding other facial dyskinesias. We present a case of BHFS along with a literature review. Methods: A 64-year-old white, hypertense male reported involuntary left hemiface contractions in 2001 (aged 50). In 2007, right hemifacial symptoms appeared, without spasm remission during sleep. Botulinum toxin type A application produced partial temporary improvement. Left microvascular decompression (MVD) was performed in August 2013, followed by right MVD in May 2014, with excellent results. Follow-up in March 2016 showed complete cessation of spasms without medication. Results: The literature confirms nine BHFS cases bilaterally treated by MVD, a definitive surgical option with minimal complications. Regarding HFS pathophysiology, ectopic firing and ephaptic transmissions originate in the root exit zone (REZ) of the facial nerve, due to neurovascular compression (NVC), orthodromically stimulate facial muscles and antidromically stimulate the facial nerve nucleus; this hyperexcitation continuously stimulates the facial muscles. These activated muscles can trigger somatosensory afferent skin nerve impulses and neuromuscular spindles from the trigeminal nerve, which, after transiting the Gasser ganglion and trigeminal nucleus, reach the somatosensory medial posterior ventral nucleus of the contralateral thalamus as well as the somatosensory cortical area of the face. Once activated, this area can stimulate the motor and supplementary motor areas (extrapyramidal and basal ganglia system), activating the motoneurons of the facial nerve nucleus and peripherally stimulating the facial muscles.
Arquivos Brasileiros De Endocrinologia E Metabologia, Feb 1, 2009
Objectives: The use of drug therapy based on cabergoline, octreotide and long-acting release (LAR... more Objectives: The use of drug therapy based on cabergoline, octreotide and long-acting release (LAR) octreotide has presented varying results in the treatment of GH excessive production in patients with McCune-Albright Syndrome. Methods: We report the case of a 29 year-old female patient presenting McCune-Albright Syndrome and complaint of excessive bone growth. Results: The patient presented a pituitary adenoma involving the right internal carotid artery and excessive secretion of growth hormone (no GH suppression was observed after the oral glucose tolerance test). Due to the presence of diffuse thickness in skull base bones, surgical approach was not considered effective and the patient was submitted to drug therapy with octreotide LAR and cabergoline. At the one year follow-up, GH and IGF-1 levels were normal and no adverse effects were present. Conclusion: The use of drug therapy based on the association of cabergoline and octreotide is safe and able to achieve complete hormonal control in the treatment of acromegaly for McCune-Albright patients.
Arquivos Brasileiros de Neurocirurgia, Mar 1, 2008
Tumores hipofisĂĄrios secretores de prolactina representam atĂ© 64% do total de adenomas secretores... more Tumores hipofisĂĄrios secretores de prolactina representam atĂ© 64% do total de adenomas secretores. A proporção superior de macroprolactinomas em homens ainda nĂŁo tem sua causa estabelecida, apesar de estudos moleculares iniciais apontarem para um provĂĄvel crescimento tumoral acelerado no sexo masculino; uma outra causa seria a apresentação clĂnica diferente entre os sexos. O tratamento farmacolĂłgico apresenta-se como escolha inicial na maioria dos casos, com altas taxas de controle tumoral mediante o uso de agonistas dopaminĂ©rgicos. A cirurgia Ă© indicada principalmente a pacientes que nĂŁo toleram ou nĂŁo obtĂȘm bons resultados com as medicaçÔes, em tumores de grande conteĂșdo cĂstico e em casos de apoplexia hipofisĂĄria. A indicação da radioterapia ainda nĂŁo estĂĄ bem definida, porĂ©m os melhores resultados obtidos atualmente com o uso de radiocirurgia indicam o possĂvel papel dessa modalidade no tratamento de adenomas que nĂŁo responderam adequadamente Ă cirurgia nem ao tratamento clĂnico.
Arquivos Brasileiros de Neurocirurgia, Dec 1, 2007
Cistos aracnĂłides sĂŁo lesĂ”es de carĂĄter benigno que se constituem de cavidades extra-axiais preen... more Cistos aracnĂłides sĂŁo lesĂ”es de carĂĄter benigno que se constituem de cavidades extra-axiais preenchidas por lĂquido cefalorraquidiano (LCR) e paredes formadas por membrana aracnĂłide histologicamente idĂȘntica Ă normal 51,71. SĂŁo quase sempre lesĂ”es Ășnicas, porĂ©m hĂĄ relatos de lesĂ”es mĂșltiplas 109. A primeira descrição destes foi feita por Bright 16 que, em 1831, os descreveu como uma bolsa serosa em conexĂŁo com a aracnĂłide e aparentemente formada entre suas membranas. Surgem, em sua maioria, em locais prĂłximos Ă s cisternas aracnĂłides, comunicando-se de maneira variĂĄvel com o espaço subaracnĂłide 2,39. Sua etiologia Ă© discutida, sendo descrita por alguns autores como lesĂ”es congĂȘnitas que surgem durante o desenvolvimento a partir de uma divisĂŁo da membrana aracnĂłide 117. HĂĄ vĂĄrios argumentos que falam a favor dessa teoria: prevalĂȘncia definitiva na infĂąncia, pelo fato de a maior parte das lesĂ”es ser diagnosticada nas primeiras duas dĂ©cadas de vida 2,66,83, , relato de ocorrĂȘncia entre parentes 46 e de concomitĂąncia com outras malformaçÔes-sĂndrome de Down 92 , mucopolissacaridose 93 , esquizencefalia 110 , neurofibromatose 73,125. A associação com outras malformaçÔes chega a 30% dos pacientes em algumas sĂ©ries 76. Acredita-se tambĂ©m que possam surgir a partir de traumatismos cranianos, infecçÔes do sistema nervoso central e pressĂŁo intracraniana elevada 8 .
Journal of Neurosurgery, Jul 1, 2015
L ife expectancy in developed countries increased by approximately 30 years during the 20th centu... more L ife expectancy in developed countries increased by approximately 30 years during the 20th century, and continues to rise linearly. 1,27,28 The population â„ 60 years of age is currently increasing at the fastest pace ever (3.7% annually between 2010 and 2015), and is projected to increase by 2.9% annually until 2050. Its numbers are expected to rise from 554 million in 2013 to 1.6 billion in 2050. 41 Pituitary tumors are not unusual in patients > 70 years; this group represents up to 14% of all patients with pituitary tumors according to previous studies.
Arquivos De Neuro-psiquiatria, Jun 1, 2007
The advances of the endovascular techniques observed in the past two decades has made this surgic... more The advances of the endovascular techniques observed in the past two decades has made this surgical alternative, previously recommended only for aneurysms with no indication to be treated by conventional surgical technique (clipping), into a first choice approach for a large number of cerebral aneurysms in some services 1-3. One of the main advances in these techniques was the advent of detachable platinum coils termed Guglielmi detachable coils (GDC). The development of coils with a better capacity to conform to aneurysms, quicker and safer detachable mechanisms and the use of bioactive materials in addition to coils are responsible for the higher rate currently obtained in aneurysm occlusion 4. The development of the remodeling techniques, the use of intracranial stents and of liquid embolic ma
World Neurosurgery, Jun 1, 2023
Arquivos Brasileiros de Neurocirurgia, Mar 1, 2009
Background: Intracranial aneurysm rupture is associated with substantial rates of morbidity and m... more Background: Intracranial aneurysm rupture is associated with substantial rates of morbidity and mortality. The classic neurosurgical treatment for such lesions is the craniotomy for clipping. However, over the last 10 years, surgery has been increasingly replaced by the endovascular technique. Objective: Analyze the results of surgery technique in a Public Health Hospital in the "coiling age". Method: We reviewed a series of 149 patients treated for 191 aneurysms by the traditional craniotomy and clipping technique. Results: We observed an overall mortality of 12.1%, poor outcome of 8% and good outcome of 79.8%. Hunt Hess scores â„ 3 in the pre-surgical evaluation were associated to a higher length of hospital stay (p = 0.047). Better outcome was observed in patients with Hunt Hess score < 3 comparing with patients with Hunt Hess score â„ 3 before surgery (p < 0.000). Patients who presented with Fisher Scale grade 4 presented a poor prognosis when compared to the other groups (p = 0.016). Conclusion: Excellent results may be achieved by craniotomy to treat aneurysms, which still represents a useful technique for lesions that can not be safely treated by endovascular techniques nowadays.
Revista de Medicina da Universidade Federal do CearĂĄ, Apr 15, 2021
Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a seizure-associated rare l... more Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a seizure-associated rare lesion that currently appears to be a malformative lesion or hamartoma rather than a low-grade neoplastic lesion. MVNT pathognomonic magnetic resonance imaging (MRI) features allow for diagnostic accuracy in the differential diagnosis. Lesions are usually asymptomatic, nonprogressive and incidentally found requiring only imaging monitoring over time. Although uncommon, it is important to be familiar with MVNT clinical presentation and key imaging features. We here present a series of three cases with imaging findings similar to those described in the literature. These patients were followed with serial neuroimaging.
Arquivos Brasileiros de Neurocirurgia, Mar 29, 2021
Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). ... more Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies. Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy. Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection. At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other key markers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma. Discussion Meningeal carcinomatosis presents clinically with headache, motor deficits, vomiting, changes in consciousness and seizures. The two most discussed mechanisms of neoplastic infiltration are the hematogenous route and retrograde drainage by the vertebral venous plexus.
Surgical Neurology International, Aug 1, 2020
îąis is an open-access article distributed under the terms of the Creative Commons Attribution-Non... more îąis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Surgical Neurology International
Background: Pituitary apoplexy (PA) is a syndromic condition described in 1950. The main symptoms... more Background: Pituitary apoplexy (PA) is a syndromic condition described in 1950. The main symptoms are headache, visual impairment, ophthalmoplegia, and hypopituitarism. The relationship between stroke and PA is uncommon and two mechanisms are described: vascular compression and vasospasm. Case Report: A 65-old-year man presented with severe headache, vomiting, ophthalmoplegia, and somnolence. Radiological examinations showed an expansive sellar and suprasellar lesion with a heterogeneous signal, besides Diffusion-weighted imaging (DWI) restriction in the bifrontal area was present. The findings were compatible with PA and stroke. Conclusion: PA leading to cerebral infarction is a rare condition that presents high morbidity and mortality levels. There are two main mechanisms related: direct arterial compression and arterial vasospasm. The cases must be conducted as neuroendocrinological emergencies and surgical management is a key point to better the prognosis of patients.
World neurosurgery, Jan 31, 2017
Symptomatic pituitary apoplexy is a rare but life-threatening condition caused by sudden hemorrha... more Symptomatic pituitary apoplexy is a rare but life-threatening condition caused by sudden hemorrhage or infarction of a pituitary adenoma. In the current study, we aim to evaluate the clinical presentation, management and clinical outcomes in a cohort of patients who were treated for this condition in our center in the last 16 years. We performed a retrospective analysis of all patients who underwent endoscopic endonasal surgery for treatment of symptomatic pituitary apoplexy between 2001 and 2016 in our center. A total of 39 patients were included in the study, mean age of 54.9 (range 18-70) years and mean follow-up 5.1 (0.6-16) years. Most of the patients had non-functioning adenomas (32 patients). Headache (89%), visual impairment (79%) and hypopituitarism (86%) were the most common preoperative findings. Surgical treatment led to gross total resection in 31 patients (79.4%). During follow up, visual fields and oculomotor improvement was observed in 23 (74.1%) and 21 (67.7%) of th...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2016
Prior studies have shown high prevalence of neuropsychological deficits after aneurysmal subarach... more Prior studies have shown high prevalence of neuropsychological deficits after aneurysmal subarachnoid hemorrhage; however, few studies detect cognitive impairments in patients with good functional outcome, measured whith Rankin Modified Scale, in the late phase of subarachnoid hemorrhage. We confirmed a high prevalence of alterations in neuropsychological tests in 44 patients with Rankin Modified 2. We proposed the application of simple and fast tests that allowed us to detect impairments with precision similar to that of complex cognitive batteries used in previous studies. We also attempt to confirm statistical association between factors that could be related to poor cognitive outcome, like Hunt-Hess scale classification, bleeding intensity measured with Fisher scale, therapeutic type (microsurgery ou embolization), and aneurysm localization; however, there was no significance. Palavras-chave âș hemorragia subaracnoide âș cognição âș embolização terapĂȘutica âș microcirurgia âș evolução clĂnica Resumo Estudos anteriores mostraram que a prevalĂȘncia de dĂ©ficits neuropsicolĂłgicos apĂłs hemorragia subaracnĂłide aneurismĂĄtica Ă© alto, mas poucos estudos detectaram alteraçÔes cognitivas em pacientes com bom desfecho funcional, medido atravĂ©s da escada de Rankin Modificada, na fase tardia da hemorragia subaracnĂłide. O estudo confirmou em 44 pacientes com RankiN Modificado 2 a alta prevalĂȘncia de alteraçÔes em testes neuropsicolĂłgicos. Propusemos a aplicação de testes simples e rĂĄpidos, capazes de detectar alteraçÔes, com precisĂŁo semelhante a baterias cognitivas complexas utilizadas em estudos anteriores. NĂłs tambĂ©m avaliamos a associação estatĂstica entre alguns fatores como a escala de Hunt-Hess (HH), a intensidade do sangramento pela escala de Fisher, tipo de tratamento (microcirurgia ou embolização) e localização do aneurisma, ao pior desempenho cognitivo, no entanto nĂŁo houve significĂąncia.
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2015
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2018
The term multicystic encephalomalacia is used to describe the presence of necrosis areas that tur... more The term multicystic encephalomalacia is used to describe the presence of necrosis areas that turn into cystic lesions inside the brain. It is usually seen in the first year of life. We describe a case of a newborn with a large occipital encephalocele surgically treated. He complicated with Staphylococcus aureus meningoencephalitis that was treated with Vancomycin. Control computed tomography twenty-four days after surgery showed significant multicystic encephalomalacia, which is a uncommonly rapid progression, since it usually takes months for a complete cystic degeneration. The pathophysiological mechanism that we propose is a direct aggression of the bacterial infection and a disturb of the brain perfusion. Secondary to a Staphylococcus aureus infection stablished a severe infection of CNS inducing a disrupt in the vascular autoregulation. Multicystic encephalomalacia is an uncommon disease of the childhood and has a very poor outcome, early diagnosis is very important for family...
World Neurosurgery, Nov 1, 2021
BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery p... more BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil.-CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.
Neurosurgical Focus, Nov 1, 2020
M edical malpractice is an adverse event or outcome resulting from a medical action or its omissi... more M edical malpractice is an adverse event or outcome resulting from a medical action or its omission due to unskillfulness, neglect, or imprudence, correlating ethical and legal aspects. 1-3 Neurosurgery has one of the highest proportions of malpractice lawsuits in the United States annually. The average compensation paid is also considerably higher in neurosurgery than in other specialties. 4,5 A lack of adequate communication with patients and family members to understand their expectations about a neurosurgical procedure could explain the higher litigation rates. 6 Medical malpractice events are still underreported in
Clinical biochemistry, Jan 5, 2018
Intracranial aneurysms are arterial anomalies affecting 2% to 3% of the general population in the... more Intracranial aneurysms are arterial anomalies affecting 2% to 3% of the general population in the world and these ruptures are associated with a high mortality. Some risk factors, such as age, gender, smoking, alcohol, hypertension and familial history are associated with the number of aneurysms and their size. In addition, inflammatory processes within the blood vessels of the brain can activate matrix metalloproteinase-9 (MMP-9), which degrades various components of the extracellular matrix, such as elastin. Thereby, this work has aimed at evaluating the relationship between plasma MMP-9 levels and the risk factors that are associated with intracranial aneurysm, as well as investigating the aneurysm statuses (ruptured and unruptured) and comparing them with the control volunteers. Between August 2014 to June 2016, blood samples were collected from 282 patients (204 ruptured and 78 unruptured saccular intracranial aneurysms) and 286 control volunteers. The MMP-9 plasma levels were ...
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium... more Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Observation of open-ring enhancement in magnetic resonance imaging (MRI) is considered a specificity marker for diagnosing pseudotumoral multiple sclerosis (MS). This finding is of great value in the differential diagnosis of tumefactive lesions. Case Report. We describe a 55-year-old white woman, with previous history of ovarian cancer and recent history of fatigue and bilateral retroorbital pain. Important bilateral visual impairment evolved over one month. Physical examination detected the presence of right homonymous hemianopia. Cranial MRI showed an expanding lesion with open-ring enhancement. Given
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Papers by Lucas de Albuquerque