Journal of Neurology, Neurosurgery & Psychiatry, 2019
ObjectivesPercutaneous balloon compression (PBC) can be offered to medically refractory patients ... more ObjectivesPercutaneous balloon compression (PBC) can be offered to medically refractory patients with trigeminal neuralgia who are unsuitable for microvascular decompression. Its associated with up to 4% risk of anaesthesia dolorosa which increases with duration and severity of compression and is more common with repeat procedures. We audited our outcomes for this procedure over last 7 years.DesignRetrospective audit of prospectively collected data.SubjectsAll patients undergoing PBC at our centre.MethodsTheatre and radiology records reviewed to identify patients. Case notes and radiology reviewed for history, diagnosis, details of procedure, immediate symptom relief, complications, further procedures and last follow up. Descriptive, comparative Kaplan Meir analysis undertaken.ResultsTotal 93 patients (4 b/l), 165 procedures. Average follow up 36 months. 24 patients had MS, 17 patients had atypical pain. All except 4 patients had good immediate pain relief. No patient developed anae...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Surgical resection of the insula (insulectomy) is a procedure used for brain lesions and for refr... more Surgical resection of the insula (insulectomy) is a procedure used for brain lesions and for refractory epilepsy. It has a difficult surgical access and the need of a wide anatomical knowledge and preoperative planning. There are two types of surgical approaches aiming the exposure of the insular cortex: transsylvian and transcortical. The importance of insulectomies is the efficacy in providing a remarkable decrease in seizures. The objective of the present article is to document the results of a series of 10 patients submitted to insulectomies for refractory epilepsies and compare them with the results of other studies reported in the literature, as well as to describe the main nuances of the surgical approaches and their associated risks. In the new case series, all patients corresponded to preoperative Engel classification IV for; after a mean 2-year follow-up period, they corresponded to Engel classification II. A subtotal resection was performed in six patients, and the remain...
INTRODUCCIÓN: Este estudio analiza los tratamientos disponibles para el Síndrome de Landau Kleffn... more INTRODUCCIÓN: Este estudio analiza los tratamientos disponibles para el Síndrome de Landau Kleffner (LKS) y evalúa sus potenciales beneficios, comparando la literatura con dos casos de pacientes diagnosticados de LKS tratados quirúrgicamente mediante la técnica adaptada de la transección subpial múltiple (MST). MÉTODO: Se realizó una revisión del PUBMED. Los artículos seleccionados fueron los que tenían "DOI" o en caso de no tener "DOI", el artículo contenido en la información resumida del paciente. Se seleccionaron y organizaron 113 artículos para el análisis estadístico. RESULTADOS: Los pacientes masculinos son los más afectados. La probabilidad de tener una regresión total es más probable en el tratamiento quirúrgico. El MST está indicado en los casos reportados debido a la necesidad de resección quirúrgica de las áreas afectadas para asegurar el mantenimiento de funciones cerebrales elocuentes. CONCLUSIONES: La MST presenta resultados de mejoría significativa...
The middle cerebral artery has unique microsurgical anatomy and complexity. A true middle cerebra... more The middle cerebral artery has unique microsurgical anatomy and complexity. A true middle cerebral artery trifurcation is rare, occurring in only 12% of cerebral hemispheres. Here we present a literature review and an unusual case of middle cerebral artery trifurcation aneurysm. This aneurysm was found incidentally in an asymptomatic patient during serial screening CT for head and neck neoplasm. Digital cerebral angiography diagnosed a saccular aneurysm located at the inferior branch of the right middle cerebral artery trifurcation (M1-M2 transition). He underwent a successful classic pterional craniotomy for microsurgical clipping. Postoperatively, the patient was clinically and neurologically intact. Aneurysms represent a rare condition, accounting for approximately 5 to 10% of prevalence in the general population and have a slightly higher prevalence when adjusted for age and sex. Then, it is depictable that a middle cerebral artery trifurcation aneurysm is an even rarer conditio...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Introduction Complex regional pain syndrome (CRPS) is a disease that causes intense pain mainly i... more Introduction Complex regional pain syndrome (CRPS) is a disease that causes intense pain mainly in the upper and lower limbs of the patients, impairing the quality of life of those affected by the syndrome. Its pathophysiology has not yet been fully discovered and described. Also, treatments need to advance in the search for pain relief in those affected by the disease. The present article aims to describe the pathophysiology of CRPS and, mainly, to quantitatively analyze the efficiency of new treatments against pain caused by the disease. Methods Several articles on clinical trials described in a table were included in the present study, and a systematic review of the effectiveness of current treatments was performed. Results A total of 29 articles from clinical trials were selected using the preselection criteria. Surgical treatments against CRPS had a 56.9% efficiency in reducing painful sensation, and conservative treatments against CRPS had a 40.82% efficiency in reducing pain ...
Revista da Sociedade Brasileira de Medicina Tropical, 2012
Cysticercosis is an infection caused by the larval stage of the tapeworm Taenia solium. The paras... more Cysticercosis is an infection caused by the larval stage of the tapeworm Taenia solium. The parasite may infect the central nervous system, causing neurocysticercosis (NCC). The clinical manifestations depend on load, type, size, location, stage of development of the cysticerci, and the host's immune response against the parasite. The racemose variety occurs in the ventricles or basal cisterns and is a malignant form. Mobile ventricular mass can produce episodic hydrocephalus on changing head posture with attacks of headache, vomiting, and vertigo, triggered by abrupt movement of the head, a phenomenon called Bruns' syndrome (BS). We report a patient with racemose NCC and BS.
Journal of Neurology, Neurosurgery & Psychiatry, 2019
ObjectivesPercutaneous balloon compression (PBC) can be offered to medically refractory patients ... more ObjectivesPercutaneous balloon compression (PBC) can be offered to medically refractory patients with trigeminal neuralgia who are unsuitable for microvascular decompression. Its associated with up to 4% risk of anaesthesia dolorosa which increases with duration and severity of compression and is more common with repeat procedures. We audited our outcomes for this procedure over last 7 years.DesignRetrospective audit of prospectively collected data.SubjectsAll patients undergoing PBC at our centre.MethodsTheatre and radiology records reviewed to identify patients. Case notes and radiology reviewed for history, diagnosis, details of procedure, immediate symptom relief, complications, further procedures and last follow up. Descriptive, comparative Kaplan Meir analysis undertaken.ResultsTotal 93 patients (4 b/l), 165 procedures. Average follow up 36 months. 24 patients had MS, 17 patients had atypical pain. All except 4 patients had good immediate pain relief. No patient developed anae...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Surgical resection of the insula (insulectomy) is a procedure used for brain lesions and for refr... more Surgical resection of the insula (insulectomy) is a procedure used for brain lesions and for refractory epilepsy. It has a difficult surgical access and the need of a wide anatomical knowledge and preoperative planning. There are two types of surgical approaches aiming the exposure of the insular cortex: transsylvian and transcortical. The importance of insulectomies is the efficacy in providing a remarkable decrease in seizures. The objective of the present article is to document the results of a series of 10 patients submitted to insulectomies for refractory epilepsies and compare them with the results of other studies reported in the literature, as well as to describe the main nuances of the surgical approaches and their associated risks. In the new case series, all patients corresponded to preoperative Engel classification IV for; after a mean 2-year follow-up period, they corresponded to Engel classification II. A subtotal resection was performed in six patients, and the remain...
INTRODUCCIÓN: Este estudio analiza los tratamientos disponibles para el Síndrome de Landau Kleffn... more INTRODUCCIÓN: Este estudio analiza los tratamientos disponibles para el Síndrome de Landau Kleffner (LKS) y evalúa sus potenciales beneficios, comparando la literatura con dos casos de pacientes diagnosticados de LKS tratados quirúrgicamente mediante la técnica adaptada de la transección subpial múltiple (MST). MÉTODO: Se realizó una revisión del PUBMED. Los artículos seleccionados fueron los que tenían "DOI" o en caso de no tener "DOI", el artículo contenido en la información resumida del paciente. Se seleccionaron y organizaron 113 artículos para el análisis estadístico. RESULTADOS: Los pacientes masculinos son los más afectados. La probabilidad de tener una regresión total es más probable en el tratamiento quirúrgico. El MST está indicado en los casos reportados debido a la necesidad de resección quirúrgica de las áreas afectadas para asegurar el mantenimiento de funciones cerebrales elocuentes. CONCLUSIONES: La MST presenta resultados de mejoría significativa...
The middle cerebral artery has unique microsurgical anatomy and complexity. A true middle cerebra... more The middle cerebral artery has unique microsurgical anatomy and complexity. A true middle cerebral artery trifurcation is rare, occurring in only 12% of cerebral hemispheres. Here we present a literature review and an unusual case of middle cerebral artery trifurcation aneurysm. This aneurysm was found incidentally in an asymptomatic patient during serial screening CT for head and neck neoplasm. Digital cerebral angiography diagnosed a saccular aneurysm located at the inferior branch of the right middle cerebral artery trifurcation (M1-M2 transition). He underwent a successful classic pterional craniotomy for microsurgical clipping. Postoperatively, the patient was clinically and neurologically intact. Aneurysms represent a rare condition, accounting for approximately 5 to 10% of prevalence in the general population and have a slightly higher prevalence when adjusted for age and sex. Then, it is depictable that a middle cerebral artery trifurcation aneurysm is an even rarer conditio...
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery
Introduction Complex regional pain syndrome (CRPS) is a disease that causes intense pain mainly i... more Introduction Complex regional pain syndrome (CRPS) is a disease that causes intense pain mainly in the upper and lower limbs of the patients, impairing the quality of life of those affected by the syndrome. Its pathophysiology has not yet been fully discovered and described. Also, treatments need to advance in the search for pain relief in those affected by the disease. The present article aims to describe the pathophysiology of CRPS and, mainly, to quantitatively analyze the efficiency of new treatments against pain caused by the disease. Methods Several articles on clinical trials described in a table were included in the present study, and a systematic review of the effectiveness of current treatments was performed. Results A total of 29 articles from clinical trials were selected using the preselection criteria. Surgical treatments against CRPS had a 56.9% efficiency in reducing painful sensation, and conservative treatments against CRPS had a 40.82% efficiency in reducing pain ...
Revista da Sociedade Brasileira de Medicina Tropical, 2012
Cysticercosis is an infection caused by the larval stage of the tapeworm Taenia solium. The paras... more Cysticercosis is an infection caused by the larval stage of the tapeworm Taenia solium. The parasite may infect the central nervous system, causing neurocysticercosis (NCC). The clinical manifestations depend on load, type, size, location, stage of development of the cysticerci, and the host's immune response against the parasite. The racemose variety occurs in the ventricles or basal cisterns and is a malignant form. Mobile ventricular mass can produce episodic hydrocephalus on changing head posture with attacks of headache, vomiting, and vertigo, triggered by abrupt movement of the head, a phenomenon called Bruns' syndrome (BS). We report a patient with racemose NCC and BS.
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Papers by Paulo Franceschini