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Specialties

Neurosurgery Adults and Children

Pediatric Neurosurgery

This is the neurosurgical specialty that treats congenital neurological diseases or ones acquired in childhood.

Congenital diseases, such as malformations of the nervous system, cause neurological problems and compromise neuropsychomotor development, but may be corrected via pediatric neurosurgery.

Hydrocephalus

Hydrocephalus is an abnormal accumulation of cerebrospinal fluid in the head. It may occur in children and symptoms vary according to age. Premature or newborn babies may present apnea and a change in the shape of the skull. Up to 1 year of age, children with hydrocephalus may present a disproportionate increase in head circumference, irritability, nausea, ocular alteration and difficulty in holding and controlling the head. In older children, the symptoms of hydrocephalus may include headaches, vomiting and delay in neuropsychomotor development.Hydrocephalus may be diagnosed by means of neurological and complementary examinations such as ultrasound, computed tomography scan and magnetic resonance imaging. The definitive treatment is neurosurgery, which may consist of implanting a valve to drain this excess liquid (ventricular shunt) or by means of neuroendoscopy (third ventriculostomy).

Spinal dysraphism

Congenital malformations of the spine that occur between the third and fourth week of gestation are known as open spina bifida (spina bifida aperta) or myelomeningocele.
Spine defects that occur later in the gestation and that are covered by skin are known as closed spina bifida (spina bifida occulta). Prenatal examinations enable diagnosis of spinal dysraphism during the second trimester of gestation from which point treatment may be initiated.
The symptoms of spinal dysraphism may include partial or complete paralysis associated with lack of sensitivity in the lower limbs and loss of urinary and fecal control. A large proportion of these children also have hydrocephalus and require neurosurgical treatment.
Corrective surgery can be performed in the gestational period (intrauterine surgery) or immediately after birth (time zero). Infants subjected to this neurosurgical treatment can lead a normal life with multidisciplinary follow-up.

Tumors of the Nervous System and Neurovascular Diseases

Diagnosis may occur via complementary neuroimaging examinations, such as computed tomography and magnetic resonance scans.
Neuronavigation, electrophysiological monitoring and microsurgical techniques enable the removal of tumors and the treatment of neurovascular diseases (cavernoma, moyamoya, aneurysm, arteriovenous malformation) while preserving the delicate structures of the nervous system.

Craniosynostosis (national and international reference)

The cranium has the function of protecting the brain, but it also has an important aesthetic-functional value. Skull symmetry is a sign of health and beauty.

Cranial asymmetry caused by postural defects or congenital torticollis is called positional plagiocephaly. The treatment for these cases consists of repositioning the baby (tummy time), physiotherapy and cranial orthosis (helmet therapy).

Craniosynostosis is characterized by the early closure of one or more cranial sutures. This may be simple or syndromic (for example Apert, Crouzon and Pfeiffer syndromes). Early surgical correction improves craniofacial development, the functioning of the brain, breathing, swallowing and vision.

Depending on the suture that closed early, the head develops a typical shape. See the figures below:

The most common types of simple craniosynostosis are: scaphocephaly, trigonocephaly and frontal plagiocephaly.

The neurosurgical procedure may be performed up to six months of age, and in specific cases, employing a minimally invasive neuroendoscopic technique associated with the use of cranial orthosis.

From the sixth month, classical open neurosurgery is indicated for treating craniosynostosis  – correction via the surgical removal of the prematurely closed suture (suturectomy) and cranial vault remodeling with absorbable plates.

Neurosurgery for Adults

Neurosurgery treats diseases that affect the central nervous system (brain and spinal chord), their surroundings (cranium and vertebral column) and the peripheral nervous system (plexus and nerves).

These diseases may be genetic, congenital or acquired – tumor, aneurysm, AVM, cavernoma, hydrocephalus, idiopathic intracranial hypertension (pseudotumor cerebri), cyst, degenerative diseases of the spine (herniated disk, for example), cranioencephalic trauma, spinal cord trauma, chronic pain, epilepsy and movement disorders, Parkinson’s Disease (spasticity, dystonia).

Neurosurgical treatment

Cranioencephalic trauma (CET) and spinal cord trauma can cause immediate physical changes that may be corrected through neurosurgery.

Sequels such as depressions and deformities of the skull, mental alterations (coma, persistent vegetative state, minimum state of consciousness, epilepsy, changes in reasoning, attention and memory), quadriplegia, paraplegia, language disorders, abnormalities in swallowing and chronic pain may be treated by a multidisciplinary team with support from neurosurgical procedures.

The cranium may be assessed and neurosurgical cranioplasty may be planned using a CT scan and 3D reconstruction to correct aesthetic and functional defects. Post-trauma hydrocephalus may be identified and treated with neurosurgery, leading to improved quality of life.

Diseases of the vertebral column (after spinal cord trauma or degenerative pathologies such as herniated disk, spondylolisthesis, narrowing of the spinal canal, scoliosis, spinal tumors, fractures and vertebral deformities caused by osteoporosis) can be treated by neurosurgery for decompression of the nervous system or for fixation and stabilization of the bone.

Electrical stimulation of the spinal cord, and deep brain stimulation (DBS) are neurosurgical procedures which may be used in rehabilitation after traumatic brain or spinal cord injury (TBI or TSCI) or in abnormal movement diseases such as Parkinson’s.

Normal pressure hydrocephalus (national and international reference)

Normal pressure hydrocephalus (NPH) is a type of reversible dementia which affects people aged 60 and over and can easily be mistaken for Alzheimer’s or Parkinson’s Disease.

Currently it is estimated that more than 60,000 Brazilians have NPH, but most are not aware of this.

NPH is characterized by three perceptible alterations:

  • alteration in gait
  • urinary incontinence
  • impairment of memory or behavior

The best clinical results are obtained when hydrocephalus is diagnosed and treated rapidly, resulting in the recovery of health and quality of life.

Imaging examinations, such as computed tomography scan and magnetic resonance imaging of the cranium confirm the diagnosis of this disease.

The tap test, the lumbar infusion test and 72-hour external lumbar drainage are examinations predictive of therapeutic success.

Once hydrocephalus has been diagnosed and with the clinical state permitting, the patient should be submitted to neurosurgery to promote recovery of the mental and motor skills, as well as bladder and bowel control.

Currently there are two neurosurgical options for treating hydrocephalus:

• VP (ventriculoperitoneal) shunt – consisting of the implantation of a valve which drains the excess intracerebral fluid, controls intracranial pressure and the dimensions of the cerebral ventricles.

• ETV (endoscopic third ventriculostomy) – is a minimally invasive procedure that consists of a perforation of the floor of the third ventricle improving the circulation of the cerebrospinal fluid.

Idiopathic intracranial hypertension (national and international reference)

Idiopathic intracranial hypertension, also known as benign intracranial hypertension or pseudotumor cerebri is a hydrodynamic disorder that is more common in obese women of childbearing age. It is a neurological disease that occurs in 1 out of each 100,000 individuals.

The symptoms may include headache, nausea, vomiting, dizziness, tinnitus and visual disorders (double vision, visual blurring, partial loss of vision). If not treated, it may lead to permanent blindness.

The diagnosis can be confirmed with the following exams: cranial computed tomography scan, magnetic resonance imaging of the brain, lumbar puncture of the cerebrospinal fluid with measurement of blood pressure, fundus examination and visual field examination.

The treatment comprises reduction of body weight, medication to reduce the production of cerebrospinal fluid and neurosurgery to relieve intracranial pressure (ventriculoperitoneal shunt, lumboperitoneal shunt, bitemporal decompressive craniectomy) or optic nerve sheath fenestration.

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