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Search Results: 1 - 10 of 477303 matches for " Ricardo A. Hanel "
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Endovascular Treatment and Selective Image Guided Partial Resection of Epidural Spinal Vascular Malformation in Klippel-Trenaunay Syndrome: Case Report  [PDF]
Ramon Navarro, Stephen Pirris, Ricardo A. Hanel
Open Journal of Modern Neurosurgery (OJMN) , 2014, DOI: 10.4236/ojmn.2014.44035
Abstract: Background: Klippel-Trenaunay-Weber syndrome is a rare congenital condition that may involve the central nervous system with extensive vascular malformations, and soft-tissue hypertrophy of the affected limb. Methods: A 51-year-old patient underwent previous procedures including decompressive laminectomy and endovascular embolization using Onyx and a self-expandable stent. However, recanalization of the malformation was observed, his symptoms progressed, and the decision was made to undergo selective surgical resection with intraoperative image guidance using Stealth system paired with the O-arm. Results: Adequate decompression of the affected spinal cord and cervical roots were obtained, and the patient’s symptoms improved. Conclusion: Since the typical anatomic landmarks were obliterated by the extensive vascular malformation and previous surgery, intraoperative image guidance proved to be very beneficial. This case reports on the usage of spinal navigation to efficiently dissect out the affected nerve roots and avoid vascular injury by referencing the Onyx and stent.
Fatal Outcome after Delayed Pipeline Embolization Device Migration for the Treatment of a Giant Superior Cerebellar Artery Aneurysm: Technical Note for Complication Avoidance  [PDF]
Ramón Navarro, Edison J. Cano, Leonardo B. C. Brasiliense, Guilherme Dabus, Ricardo A. Hanel
Open Journal of Modern Neurosurgery (OJMN) , 2014, DOI: 10.4236/ojmn.2014.44028
Abstract: Purpose: Flow diversion is a relatively novel technique to treat some intracranial aneurysms. With new techniques, unusual complications can occur. We described a case of Pipeline Embolization Device (PED) migration, strategy for its recognition, and a technical point to prevent its occurrence. Publication of these rare events is important to make physicians aware of potential complications. Methods: A patient with a previously coiled giant superior cerebellar aneurysm presented with brainstem compression symptoms. Imaging verified progressive aneurysm growth. A decision was made to treat the aneurysm with PED. Results: Development of new neurologic symptoms prompted a computed tomography that showed hydrocephalus. An angiogram also showed recanalization of the aneurysm secondary to upward migration/retraction of the flow diverter. A ventriculo-peritoneal shunt was implemented and planning for placement of a second flow diverter was made. Unfortunately, the patient expired while waiting for the endovacular intervention. Conclusions: PED migration may occur even after correct placement of the device. Early recognition of this complication is essential. When clinical changes occur, it is paramount that this uncommon, but potentially deadly, complication is suspected. Appropriate sizing and deployment technique are important for the long-term stability of the device.
Angioma cavernoso espinhal epidural: relato de caso
Félix Alexandre,Koerbel Andrei,Hanel Ricardo A,Cichon Erasto
Arquivos de Neuro-Psiquiatria , 2001,
Abstract: A ocorrência de um angioma cavernoso epidural primário é incomum, constituindo aproximadamente 4% de todos os tumores epidurais espinhais, entretanto o número de relatos desta entidade tem aumentado nos últimos anos, provavelmente devido aos melhores recursos diagnósticos. Relatamos o caso de um paciente com um angioma cavernoso epidural puro em nível espinhal de L1-L2 , que apresentava quadro clínico de compress o medular lenta e progressiva, com piora importante recente. A ressonancia magnética de coluna lombosacra demonstrou les o hipo e isointensa em T1 e hiperintensa em T2. O paciente foi submetido a tratamento cirúrgico com boa recupera o neurológica. Os achados clínicos, de imagem, anátomo-patológicos e de tratamento desta patologia s o analisados e discutidos.
Pseudoaneurisma de artéria ilíaca comum como complica o de cirurgia para hérnia discal lombar: relato de caso
HANEL RICARDO A.,MADALOZZO LUIZ E.,ARAúJO JO?O C?NDIDO,RODRIGUES MARCELO A.
Arquivos de Neuro-Psiquiatria , 1999,
Abstract: A cirurgia para tratamento da doen a discal lombo-sacra pode cursar com complica es severas, iatrogênicas incluindo-se as neurológicas, vasculares, entéricas, ureterais e disfun o sexual podendo levar o paciente à morte dependendo da extens o da les o. Abramovitz relata que as complica es vasculares do acesso posterior para o tratamento hérnia discal lombo-sacra ocorrem em menos de 0,1% dos casos As les es vasculares podem manifestar-se de maneira imediata como hemorragia arterial levando a choque hipovolêmico no per ou pós-operatório imediato, devendo ser diagnosticadas e tratadas prontamente. Sinais precoces de hemorragia retroperitoneal se manifestam na vigência de les es traumáticas, sendo os pseudoaneurismas e as fístulas arteriovenosas diagnosticados tardiamente, semanas ou mesmo após anos. Descrevemos o caso de uma paciente de 39 anos que foi submetida a tratamento cirúrgico de hérnia discal no espa o L4-L5, à direita, em outro servi o. Devido ao fato de persistirem os sintomas dolorosos, foi encaminhada ao nosso servi o. Na investiga o a ressonancia magnética mostrou les o paravertebral sugestiva de abscesso. A angiografia aorto-ilíaca revelou a presen a de pseudoaneurisma na artéria ilíaca comum esquerda, o qual foi reparado cirurgicamente com sucesso. Discutimos os mecanismos das les es vasculares e as precau es para evitá-las.
Angioma cavernoso espinhal epidural: relato de caso
Félix, Alexandre;Koerbel, Andrei;Hanel, Ricardo A;Cichon, Erasto;Araujo, Jo?o Candido;
Arquivos de Neuro-Psiquiatria , 2001, DOI: 10.1590/S0004-282X2001000300025
Abstract: epidural spinal cavernous angiomas account for approximately 4% of all spinal epidural tumors. more recently the diagnosis has become more frequent due to refinement of imaging modalities. we describe a 50-year-old woman with a spinal epidural cavernous angioma at l1-l2, which was successfully surgical treated. clinical picture, imaginology and treatment of this entity is reviewed.
Síndrome neuroléptica maligna: relato de caso com recorrência associada ao uso de olanzapina
HANEL, RICARDO A.;SANDMANN, MARCOS C.;KRANICH, MARTINA;BITTENCOURT, PAULO R. M. DE;
Arquivos de Neuro-Psiquiatria , 1998, DOI: 10.1590/S0004-282X1998000500022
Abstract: the neuroleptic malignant syndrome (nms) consists in an idiosyncratic reaction to neuroleptic drugs, probably related to a blockage of dopamine receptors in basal ganglia. research criteria for diagnosing nms from dsm-iv require severe rigidity and fever accompanied by 2 of 10 minor features including diaphoresis, dysphagia, tremor, incontinence, altered mentation, mutism, tachycardia, elevated or labile blood pressure, leukocytosis and elevation of creatine phosphokinase. from a clinical point of view, the nms may range a large spectrum of presentations. haloperidol is the most frequent drug associated with this syndrome. we report the case of a 30 year-old man who developed nms at two different occasions, the first related to haloperidol and chlorpromazine and the second related to olanzapine, to our knowledge without previous mention in the indexed literature.
Síndrome neuroléptica maligna: relato de caso com recorrência associada ao uso de olanzapina
HANEL RICARDO A.,SANDMANN MARCOS C.,KRANICH MARTINA,BITTENCOURT PAULO R. M. DE
Arquivos de Neuro-Psiquiatria , 1998,
Abstract: A síndrome neuroléptica maligna (SNM) consiste em rea o idiossincrática a neurolépticos, provavelmente relacionada a bloqueio dos receptores dopaminérgicos nos ganglios da base, sendo por isso também conhecida como síndrome da deficiência aguda de dopamina.A SNM é caracterizada por hiperpirexia, altera o do nível de consciência, hipertonia, disfun o auton mica e insuficiência respiratória, podendo ainda ser encontrados rabdomiólise e leucocitose. O haloperidol é a droga mais frequentemente associada à síndrome. Relatamos o caso de um paciente de 30 anos que apresentou SNM em duas ocasi es diferentes, a primeira delas relacionada ao uso de haloperidol e clorpromazina e a segunda relacionada ao uso de olanzapina, fato este sem men o anterior na literatura indexada.
Meningiomas em pacientes pediátricos: relato de 2 casos
Hanel Ricardo A,Tatsui Cláudio Esteves,Araujo Jo?o Candido,Grande César Vinícius
Arquivos de Neuro-Psiquiatria , 2001,
Abstract: Os meningiomas correspondem de 1% a 4% das neoplasias intracranianas primárias em pacientes pediátricos; a incidência nesta popula o aumenta de acordo com a faixa etária. N o há predominancia quanto ao sexo, ao contrário do que acontece na popula o adulta onde predominam no sexo feminino. Relatamos dois casos de meningioma em crian as, discutindo os aspectos clínicos, radiológicos e histológicos desta entidade. O primeiro paciente é do sexo masculino, com 2 anos de idade e apresentava com crises convulsivas há 4 meses. Os exames de imagem revelaram uma les o expansiva de 20 mm na regi o parieto-occipital direita, a qual foi totalmente ressecada. Os exames histológico e imunohistoquímico definiram o diagnóstico de meningioma. Atualmente, 17 meses após a cirurgia, o paciente encontra-se bem, sem evidências de recidiva tumoral. O segundo paciente é do sexo feminino, com 11 anos, e queixava-se de cefaléia frontal há 2 anos. Os exames radiológicos demonstraram presen a de les o expansiva de 5 cm em regi o frontal direita. Realizou-se craniotomia frontal com ressec o total do tumor. O diagnóstico histológico foi de meningioma. Atualmente, 20 meses após a cirurgia, encontra-se sem evidência de recidiva tumoral. Os autores discutem ainda o tratamento e prognóstico dos meningiomas pediátricos ressaltando que apesar de incomuns, estes devem fazer parte do diagnóstico diferencial de les es intracranianas expansivas nesta faixa etária.
Pseudoaneurisma de artéria ilíaca comum como complica??o de cirurgia para hérnia discal lombar: relato de caso
HANEL, RICARDO A.;MADALOZZO, LUIZ E.;ARAúJO, JO?O C?NDIDO;RODRIGUES, MARCELO A.;TRUITE, LUCIANO V. R.;
Arquivos de Neuro-Psiquiatria , 1999, DOI: 10.1590/S0004-282X1999000500028
Abstract: surgery for discogenic disease of lumbar region is a challenging and diverse field. the significance of complications in disc surgery arises from the possibility that failure of primary treatment may lead to a permanently disable patient. the most common iatrogenic lesions in the posterior approach to lumbar disc herniation are neurologic, vascular, enteric, ureteral, and sexual dysfunction. abramovitz reports that vascular complications of the posterior approach occur in at least 0.1% of cases. the vascular complications may present during surgery as severe bleeding leading to hypotension. the most common late complication is arteriovenous fistula followed by false aneurysms. we describe the case of a 39 year-old woman who was operated on for a lumbar disc herniation in other hospital. she came to us with a persistent pain in lumbar area. a mri scan of lumbosacral region revealed a paravertebral lesion suggesting abscess. an angiography was performed and showed a false aneurysm of left common iliac artery, which was surgically treated successfully. we discuss the mechanisms of lesion and precautions against vascular ones during lumbar disc surgery.
Meningiomas em pacientes pediátricos: relato de 2 casos
Hanel, Ricardo A;Tatsui, Cláudio Esteves;Araujo, Jo?o Candido;Grande, César Vinícius;Antoniuk, Affonso;Gasparetto, Emerson Leandro;Torres, Luiz Fernando Bleggi;
Arquivos de Neuro-Psiquiatria , 2001, DOI: 10.1590/S0004-282X2001000400029
Abstract: meningiomas correspond to 1% - 4% of primary intracranial tumors in pediatric group, with their incidence raising according to age. there is not gender prevalence, in spite of some authors describe a male tendency opposed to female one in adulthood. at present study we describe two cases of pediatric meningiomas reviewing clinical, radiological and histological aspects of these lesions. the authors review also treatment options and prognosis of childhood meningiomas. a two-year-old boy was admitted with seizures. computerized tomography showed a right parietal lesion, which was totally resected. histological features were compatible with meningioma. after 17 months the child is doing well, with no deficits or seizures. the second case is a 12-year-old girl, with a headache complain. during investigation, a ct revealed a right frontal lesion. she was operated under a right frontal craniotomy with total tumor resection. nowadays she is asymptomatic, 20 months after surgery. despite meningiomas in pediatric group are uncommon; they should be included in differential diagnosis list of expansive intracranial lesions of childhood.
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