{"id":1782,"date":"2025-03-20T13:53:15","date_gmt":"2025-03-20T13:53:15","guid":{"rendered":"https:\/\/alevato.xyz\/?p=1782"},"modified":"2026-03-09T17:47:15","modified_gmt":"2026-03-09T17:47:15","slug":"gemeos-craniopagos-estudo-clinico-1-neurocirurgia","status":"publish","type":"post","link":"https:\/\/alevato.xyz\/portugues\/gemeos-craniopagos-estudo-clinico-1-neurocirurgia\/","title":{"rendered":"CIRURGIA P\u00d3S-NATAL \u2013 Casos desafiadores"},"content":{"rendered":"<figure class=\"wp-block-vimeo-create vimeo-create__video-container\"><div style=\"width:100%\"><iframe class=\"vimeo-core-video\" loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/1088390627?autopause=true&amp;autoplay=true&amp;background=false&amp;byline=true&amp;controls=true&amp;dnt=true&amp;loop=false&amp;muted=true&amp;pip=false&amp;playsinline=true&amp;portrait=true&amp;responsive=true&amp;speed=false&amp;title=true&amp;transparent=false\" width=\"320\" height=\"240\" frameborder=\"0\" allowfullscreen title=\"video 1\" style=\"max-width:100%;width:100%;height:100%;aspect-ratio:320 \/ 240\"><\/iframe><\/div><figcaption class=\"vimeo-create__video-caption\">VIS\u00c3O GERAL DO CRANIOPAGUS 3D<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">O uso de modelos m\u00e9dicos 3D e realidade virtual (RV) no planejamento pr\u00e9-cir\u00fargico tem sido uma ferramenta fundamental na estrat\u00e9gia cir\u00fargica e localiza\u00e7\u00e3o para o cirurgi\u00e3o, especialmente em situa\u00e7\u00f5es nas quais a anatomia \u00e9 completamente divergente dos padr\u00f5es normais. A RV tamb\u00e9m tem sido um avan\u00e7o importante, auxiliando e permitindo ao cirurgi\u00e3o encontrar a melhor abordagem cir\u00fargica.<\/p>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-1f14f69\" id=\"gspb_container-id-gsbp-1f14f69\">\n<p class=\"wp-block-paragraph\">Estudo Cl\u00ednico 1<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"neurosurgery\" style=\"margin-top:0;margin-bottom:0;font-style:normal;font-weight:300\">(Neurocirurgia)<\/h3>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"craniopagus-twins\" style=\"margin-top:0;margin-bottom:0\">G\u00caMEOS CRANIOPAGOS<\/h2>\n<\/div>\n\n\n\n<figure class=\"wp-block-vimeo-create vimeo-create__video-container\"><div style=\"width:100%\"><iframe class=\"vimeo-core-video\" loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/1087811234?autopause=true&amp;autoplay=false&amp;background=false&amp;byline=true&amp;controls=true&amp;dnt=true&amp;loop=false&amp;muted=true&amp;pip=false&amp;playsinline=true&amp;portrait=true&amp;responsive=true&amp;speed=false&amp;title=true&amp;transparent=false\" width=\"1280\" height=\"720\" frameborder=\"0\" allowfullscreen title=\"Fotogrametria com auxilio de RA no caso de craniopagos\" style=\"max-width:100%;width:100%;height:100%;aspect-ratio:1280 \/ 720\"><\/iframe><\/div><figcaption class=\"vimeo-create__video-caption\">Rastreamento de malha em Realidade Estendida<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">G\u00eameos craniopagos (GC) s\u00e3o uma malforma\u00e7\u00e3o extremamente rara na qual os g\u00eameos est\u00e3o unidos pela cabe\u00e7a. Esse fen\u00f4meno ocorre em aproximadamente 1 a cada 2,5 milh\u00f5es de nascimentos vivos. Apesar da gravidade da anomalia, que est\u00e1 associada a alta morbidade e mortalidade, as separa\u00e7\u00f5es bem-sucedidas t\u00eam se tornado mais frequentes principalmente devido aos constantes avan\u00e7os em neuroimagem, neuroanestesia e t\u00e9cnicas neurocir\u00fargicas. Em rela\u00e7\u00e3o \u00e0 neuroimagem, houve grande progresso, principalmente relacionado aos desenvolvimentos em RV e modelos 3D gerados a partir de dados de imagens de TC ou RM. Esses modelos t\u00eam sido extremamente importantes no planejamento de estrat\u00e9gias cir\u00fargicas e como refer\u00eancias anat\u00f4micas para o cirurgi\u00e3o durante o procedimento.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-vimeo-create vimeo-create__video-container\"><div style=\"width:100%\"><iframe class=\"vimeo-core-video\" loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/1087811182?autopause=true&amp;autoplay=false&amp;background=false&amp;byline=true&amp;controls=true&amp;dnt=true&amp;loop=false&amp;muted=true&amp;pip=false&amp;playsinline=true&amp;portrait=true&amp;responsive=true&amp;speed=false&amp;title=true&amp;transparent=false\" width=\"640\" height=\"352\" frameborder=\"0\" allowfullscreen title=\"Craniopagos-video\" style=\"max-width:100%;width:100%;height:100%;aspect-ratio:640 \/ 352\"><\/iframe><\/div><figcaption class=\"vimeo-create__video-caption\">Discuss\u00e3o do Crani\u00f3pago no Metaverso<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">A primeira classifica\u00e7\u00e3o anat\u00f4mica foi descrita por O'Connell, onde os g\u00eameos craniopagos foram classificados como parciais ou totais. G\u00eameos GC totais compartilham uma extensa \u00e1rea da superf\u00edcie craniana com muitas conex\u00f5es entre as cavidades cranianas, enquanto g\u00eameos GC parciais compartilham apenas uma pequena superf\u00edcie da convexidade craniana. A cirurgia de separa\u00e7\u00e3o em GC parciais est\u00e1 associada a um melhor resultado do que em GC totais.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Em setembro de 2019, recebemos g\u00eameos craniopagos de oito meses de idade no Instituto Estadual do C\u00e9rebro Paulo Niemeyer. Eles foram classificados como craniopagos verticais totais, apresentando uma anatomia extremamente complexa, com um significativo seio venoso circunferencial e regi\u00f5es de c\u00e9rebro compartilhado. Eles se tornaram o maior desafio da equipe de neurocirurgia pedi\u00e1trica da institui\u00e7\u00e3o.<\/p>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container alignwide gspb_container gspb_container-gsbp-446bdc1\" id=\"gspb_container-id-gsbp-446bdc1\">\n<div class=\"wp-block-greenshift-blocks-container alignwide gspb_container gspb_container-gsbp-88923d7\" id=\"gspb_container-id-gsbp-88923d7\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"1259\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagofig4-1.png\" alt=\"\" class=\"wp-image-2164\" style=\"object-fit:cover\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagofig4-1.png 1000w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagofig4-1-238x300.png 238w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagofig4-1-813x1024.png 813w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagofig4-1-768x967.png 768w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagofig4-1-10x12.png 10w\" sizes=\"auto, (max-width: 1000px) 100vw, 1000px\" \/><figcaption class=\"wp-element-caption\">Vistas da reconstru\u00e7\u00e3o 3D<\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-da1fc53\" id=\"gspb_container-id-gsbp-da1fc53\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"852\" height=\"1184\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-2.jpg\" alt=\"\" class=\"wp-image-1846\" style=\"object-fit:cover\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-2.jpg 852w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-2-216x300.jpg 216w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-2-737x1024.jpg 737w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-2-768x1067.jpg 768w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-2-9x12.jpg 9w\" sizes=\"auto, (max-width: 852px) 100vw, 852px\" \/><figcaption class=\"wp-element-caption\">Processo de segmenta\u00e7\u00e3o para uma das primeiras cirurgias dos g\u00eameos<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container alignwide gspb_container gspb_container-gsbp-8478e11\" id=\"gspb_container-id-gsbp-8478e11\">\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-2ecbb85\" id=\"gspb_container-id-gsbp-2ecbb85\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"1500\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_77.png\" alt=\"\" class=\"wp-image-2132\" style=\"object-fit:cover\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_77.png 1000w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_77-200x300.png 200w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_77-683x1024.png 683w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_77-768x1152.png 768w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_77-8x12.png 8w\" sizes=\"auto, (max-width: 1000px) 100vw, 1000px\" \/><figcaption class=\"wp-element-caption\">Diferentes vistas do sistema circulat\u00f3rio do c\u00e9rebro<\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-ed0aec9\" id=\"gspb_container-id-gsbp-ed0aec9\">\n<figure class=\"wp-block-image aligncenter size-full has-custom-border\"><img loading=\"lazy\" decoding=\"async\" width=\"1000\" height=\"1500\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_9.png\" alt=\"\" class=\"wp-image-2131\" style=\"border-radius:82px\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_9.png 1000w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_9-200x300.png 200w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_9-683x1024.png 683w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_9-768x1152.png 768w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure_9-8x12.png 8w\" sizes=\"auto, (max-width: 1000px) 100vw, 1000px\" \/><figcaption class=\"wp-element-caption\">Tractografia junto com a segmenta\u00e7\u00e3o das estruturas.<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-a334bce\" id=\"gspb_container-id-gsbp-a334bce\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"917\" height=\"1163\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure-6.png\" alt=\"\" class=\"wp-image-2129\" style=\"object-fit:cover\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure-6.png 917w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure-6-237x300.png 237w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure-6-807x1024.png 807w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure-6-768x974.png 768w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/craniopagosfigure-6-9x12.png 9w\" sizes=\"auto, (max-width: 917px) 100vw, 917px\" \/><figcaption class=\"wp-element-caption\">Processo de segmenta\u00e7\u00e3o, mostrando o 3D e a tomografia computadorizada.<\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-1ece2c2\" id=\"gspb_container-id-gsbp-1ece2c2\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"794\" height=\"508\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-5.jpg\" alt=\"\" class=\"wp-image-1849\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-5.jpg 794w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-5-300x192.jpg 300w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-5-768x491.jpg 768w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-5-18x12.jpg 18w\" sizes=\"auto, (max-width: 794px) 100vw, 794px\" \/><figcaption class=\"wp-element-caption\">Impress\u00e3o 3D feita para uma das cirurgias.<\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container alignwide gspb_container gspb_container-gsbp-2b309a6\" id=\"gspb_container-id-gsbp-2b309a6\">\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-d854721\" id=\"gspb_container-id-gsbp-d854721\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"540\" height=\"481\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-1.jpg\" alt=\"\" class=\"wp-image-1845\" style=\"object-fit:cover\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-1.jpg 540w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-1-300x267.jpg 300w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/Figure-1-13x12.jpg 13w\" sizes=\"auto, (max-width: 540px) 100vw, 540px\" \/><figcaption class=\"wp-element-caption\">Ultrassom 4D dos g\u00eameos craniopagos<\/figcaption><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-0cf18bb\" id=\"gspb_container-id-gsbp-0cf18bb\">\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"850\" height=\"648\" src=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-3.jpg\" alt=\"\" class=\"wp-image-1847\" style=\"object-fit:cover\" srcset=\"https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-3.jpg 850w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-3-300x229.jpg 300w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-3-768x585.jpg 768w, https:\/\/alevato.xyz\/wp-content\/uploads\/2025\/03\/figure-3-16x12.jpg 16w\" sizes=\"auto, (max-width: 850px) 100vw, 850px\" \/><figcaption class=\"wp-element-caption\">Resson\u00e2ncia Magn\u00e9tica dos g\u00eameos craniopagos<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Iniciamos um plano elaborado com um grupo multidisciplinar de especialistas para desenvolver uma estrutura para iniciar o processo cir\u00fargico. Para este tipo de craniopagos, \u00e9 crucial dividir a cirurgia em m\u00faltiplas etapas, j\u00e1 que um \u00fanico procedimento de separa\u00e7\u00e3o seria imposs\u00edvel. Essas etapas cir\u00fargicas seriadas s\u00e3o necess\u00e1rias em termos do desenvolvimento e reagrupamento da distribui\u00e7\u00e3o do retorno venoso, visto que devemos esqueletizar o seio venoso circunferencial por meio da coagula\u00e7\u00e3o das veias que drenam para este seio. Isso \u00e9 feito ap\u00f3s an\u00e1lise por meio de angiografia cerebral, elegendo assim o melhor ponto de partida para o primeiro procedimento em uma sequ\u00eancia de quatro ou cinco. Em cada uma dessas etapas, as veias que drenam para o seio circunferencial s\u00e3o coaguladas, bem como a separa\u00e7\u00e3o entre os c\u00e9rebros dos g\u00eameos. Ap\u00f3s cada etapa de separa\u00e7\u00e3o, uma interposi\u00e7\u00e3o de silastic foi colocada entre as estruturas separadas, que foi gentilmente doada pelo Dr. Ricardo Oliveira, neurocirurgi\u00e3o pedi\u00e1trico da USP de Ribeir\u00e3o Preto, que esteve presente durante duas das cirurgias e nos orientou sobre como proceder nesta opera\u00e7\u00e3o complexa.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neste tipo de craniopagos grave, \u00e9 sempre necess\u00e1rio decidir, ap\u00f3s analisar cuidadosamente tanto cl\u00ednica quanto radiologicamente, com qual g\u00eameo come\u00e7ar e prosseguir para a cirurgia de desconex\u00f5es parciais. A literatura recomenda considerar iniciar as separa\u00e7\u00f5es no g\u00eameo menos favorecido, aquele com menor chance de sobreviv\u00eancia. Na avalia\u00e7\u00e3o inicial, conclu\u00edmos que um dos g\u00eameos estava clinicamente e radiologicamente menos favorecido. Este g\u00eameo tinha fissura palatina e apresentava instabilidade hemodin\u00e2mica significativa quando manipulado.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neste tipo de malforma\u00e7\u00e3o, dada a anatomia complexa, distorcida e at\u00edpica, o uso de modelos anat\u00f4micos impressos em 3D \u00e9 indispens\u00e1vel. Esses modelos proporcionam ao cirurgi\u00e3o uma compreens\u00e3o clara da anatomia cir\u00fargica, o que oferece melhor orienta\u00e7\u00e3o para a equipe durante a cirurgia. Portanto, iniciamos a constru\u00e7\u00e3o desses modelos anat\u00f4micos atrav\u00e9s de uma parceria com o Biodesign Lab Dasa\/PUC-Rio. Ap\u00f3s a obten\u00e7\u00e3o das imagens de resson\u00e2ncia magn\u00e9tica, os modelos 3D foram preparados.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<figure class=\"wp-block-vimeo-create vimeo-create__video-container\"><div style=\"width:100%\"><iframe class=\"vimeo-core-video\" loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/1088361454?autopause=true&amp;autoplay=false&amp;background=false&amp;byline=true&amp;controls=true&amp;dnt=true&amp;loop=false&amp;muted=false&amp;pip=false&amp;playsinline=true&amp;portrait=true&amp;responsive=true&amp;speed=false&amp;title=true&amp;transparent=false\" width=\"1920\" height=\"1080\" frameborder=\"0\" allowfullscreen title=\"Planejamento ciru\u0301rgico no Metaverso no caso de ge\u0302meos cranio\u0301pagos\" style=\"max-width:100%;width:100%;height:100%;aspect-ratio:1920 \/ 1080\"><\/iframe><\/div><figcaption class=\"vimeo-create__video-caption\">Metaverso com o segundo caso de g\u00eameos crani\u00f3pagos.<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Ap\u00f3s a cria\u00e7\u00e3o do primeiro modelo anat\u00f4mico 3D e a realiza\u00e7\u00e3o de todos os exames complementares necess\u00e1rios, agendamos a primeira cirurgia, que ocorreu em novembro de 2019. Considerei esta cirurgia como uma das mais desafiadoras, posteriormente chamada de \"cirurgia quebra-medo\", por ser o primeiro caso de tal gravidade. O maior desafio foi lidar com o desconhecido, bem como a enorme responsabilidade que t\u00ednhamos para com os pais dos g\u00eameos.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Agendamos a segunda cirurgia de separa\u00e7\u00e3o parcial ap\u00f3s a primeira. Este procedimento ocorreu dois meses depois da primeira cirurgia. Este per\u00edodo de espera entre as cirurgias foi necess\u00e1rio para que a circula\u00e7\u00e3o venosa se estabilizasse e para o desenvolvimento de uma circula\u00e7\u00e3o venosa colateral. Ap\u00f3s criar um novo modelo anat\u00f4mico, estabelecemos o planejamento cir\u00fargico, com excelente progress\u00e3o da coagula\u00e7\u00e3o das veias hemisf\u00e9ricas que drenavam em dire\u00e7\u00e3o ao seio circular, alcan\u00e7ando uma boa separa\u00e7\u00e3o parcial. O resultado p\u00f3s-operat\u00f3rio foi satisfat\u00f3rio, com os g\u00eameos demonstrando excelente recupera\u00e7\u00e3o, sem qualquer d\u00e9ficit motor, infarto venoso, isquemia ou sangramento. Uma tomografia p\u00f3s-operat\u00f3ria mostrou um bom grau de separa\u00e7\u00e3o.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Seguimos o protocolo e realizamos separa\u00e7\u00f5es segmentares. Inicialmente, programamos quatro separa\u00e7\u00f5es parciais, seguidas pela desconex\u00e3o final; entretanto, devido \u00e0 complexidade do caso, optamos por fragmentar ainda mais os segmentos, e at\u00e9 o momento realizamos sete cirurgias, sem quaisquer complica\u00e7\u00f5es. Entre cada procedimento, novos exames de imagem como resson\u00e2ncia magn\u00e9tica, tomografia computadorizada e angiografia cerebral foram realizados, e novos modelos anat\u00f4micos 3D foram feitos. Esses exames e a impress\u00e3o 3D dos modelos s\u00e3o de extrema import\u00e2ncia, tanto para o planejamento cir\u00fargico quanto para a visualiza\u00e7\u00e3o da nova circula\u00e7\u00e3o colateral estabelecida.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A separa\u00e7\u00e3o final foi agendada para junho de 2022. Neste procedimento, seria realizada a separa\u00e7\u00e3o definitiva dos g\u00eameos, quase tr\u00eas anos ap\u00f3s a primeira cirurgia. Seria um presente para esta fam\u00edlia que tanto sofreu.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Em fevereiro de 2023, recebemos nosso segundo caso de g\u00eameos craniopagos com 13 semanas de gesta\u00e7\u00e3o. Este apresentou outro grande desafio para n\u00f3s porque, al\u00e9m do craniopagos, havia tamb\u00e9m uma malforma\u00e7\u00e3o card\u00edaca complexa (ventr\u00edculo \u00fanico) em um dos fetos. Iniciamos um plano elaborado com um grupo multidisciplinar de especialistas para desenvolver uma estrutura para o processo cir\u00fargico.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Neste caso, a abordagem cir\u00fargica teve que ser realizada em um \u00fanico procedimento devido \u00e0 malforma\u00e7\u00e3o card\u00edaca. Para o melhor planejamento poss\u00edvel, o uso de modelos anat\u00f4micos impressos em 3D foi indispens\u00e1vel, assim como discuss\u00f5es com a equipe do Professor Owase Jeelani utilizando o metaverso.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ap\u00f3s o nascimento com 32 semanas de gesta\u00e7\u00e3o, novos exames foram realizados com TC e RM. Os g\u00eameos foram separados 52 dias ap\u00f3s o nascimento. A neurocirurgia foi um sucesso. O g\u00eameo com a malforma\u00e7\u00e3o card\u00edaca n\u00e3o sobreviveu, mas doou meninges, osso e pele para seu irm\u00e3o, que teve um excelente resultado cl\u00ednico.<\/p>\n\n\n\n<div class=\"wp-block-greenshift-blocks-container gspb_container gspb_container-gsbp-0302111\" id=\"gspb_container-id-gsbp-0302111\">\n<p class=\"wp-block-paragraph\">Estudo Cl\u00ednico 2<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"neurosurgery\" style=\"margin-top:0;margin-bottom:0;font-style:normal;font-weight:300\">(Cirurgia Pedi\u00e1trica)<\/h3>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"craniopagus-twins\" style=\"margin-top:0;margin-bottom:0\">G\u00caMEOS CONJUGADOS<\/h2>\n<\/div>\n\n\n\n<figure class=\"wp-block-vimeo-create vimeo-create__video-container\"><div style=\"width:100%\"><iframe class=\"vimeo-core-video\" loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/1088383946?autopause=true&amp;autoplay=false&amp;background=false&amp;byline=true&amp;controls=true&amp;dnt=true&amp;loop=false&amp;muted=false&amp;pip=false&amp;playsinline=true&amp;portrait=true&amp;responsive=true&amp;speed=false&amp;title=true&amp;transparent=false\" width=\"1920\" height=\"1080\" frameborder=\"0\" allowfullscreen title=\"Video 2 2\" style=\"max-width:100%;width:100%;height:100%;aspect-ratio:1920 \/ 1080\"><\/iframe><\/div><figcaption class=\"vimeo-create__video-caption\">Discuss\u00e3o na Realidade Estendida<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Como cirurgi\u00e3o geral neonatal, frequentemente trabalho com diagn\u00f3stico pr\u00e9-natal e compreendo plenamente seu papel crucial no planejamento de cirurgias perinatais e acompanhamentos. Na maioria dos casos, as les\u00f5es s\u00e3o identificadas por meio do ultrassom obst\u00e9trico (US) de rotina. No entanto, a resson\u00e2ncia magn\u00e9tica (RM) pode fornecer uma avalia\u00e7\u00e3o mais detalhada. A RM serve como uma modalidade diagn\u00f3stica complementar, especialmente em casos inconclusivos que exigem investiga\u00e7\u00e3o adicional. Diferentemente do US, a RM n\u00e3o \u00e9 afetada pela posi\u00e7\u00e3o fetal, pelo oligo\u00e2mnio, pela interfer\u00eancia \u00f3ssea ou pela obesidade materna.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Um dos maiores desafios na cirurgia pedi\u00e1trica \u00e9 o manejo de g\u00eameos conjugados (GC), uma anomalia cong\u00eanita associada a significativa morbidade e mortalidade. Os GC s\u00e3o classificados com base no local da fus\u00e3o, sendo os g\u00eameos fundidos ventralmente os mais comuns. Entre eles, os tipos onfal\u00f3pagos e torac\u00f3pagos s\u00e3o frequentemente observados. O grau de compartilhamento de \u00f3rg\u00e3os, especialmente o envolvimento card\u00edaco, determina a viabilidade e o progn\u00f3stico da separa\u00e7\u00e3o cir\u00fargica. Uma avalia\u00e7\u00e3o pr\u00e9-operat\u00f3ria meticulosa, um planejamento detalhado e uma equipe multidisciplinar bem-preparada s\u00e3o essenciais para um procedimento de separa\u00e7\u00e3o bem-sucedido.<\/p>\n\n\n\n<figure class=\"wp-block-vimeo-create vimeo-create__video-container\"><div style=\"width:100%\"><iframe class=\"vimeo-core-video\" loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/1088364490?autopause=true&amp;autoplay=false&amp;background=false&amp;byline=true&amp;controls=true&amp;dnt=true&amp;loop=false&amp;muted=false&amp;pip=false&amp;playsinline=true&amp;portrait=true&amp;responsive=true&amp;speed=false&amp;title=true&amp;transparent=false\" width=\"1280\" height=\"720\" frameborder=\"0\" allowfullscreen title=\"Discussa\u0303o de caso de ge\u0302meos unidos pelo to\u0301rax e abdome no Metaverso\" style=\"max-width:100%;width:100%;height:100%;aspect-ratio:1280 \/ 720\"><\/iframe><\/div><figcaption class=\"vimeo-create__video-caption\">Discuss\u00e3o de caso de g\u00eameos unidos no t\u00f3rax e abdome no Metaverso<\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Uma mulher de 31 anos, G2P1, com gesta\u00e7\u00e3o de trig\u00eameos, foi encaminhada para RM fetal \u00e0s 28 semanas de gesta\u00e7\u00e3o. Suspeitava-se que os fetos fossem dicori\u00f4nicos e diamni\u00f3ticos, com um par de g\u00eameos conjugados fundidos na regi\u00e3o abdominal. A RM foi realizada utilizando um scanner de 1,5 Tesla, confirmando o diagn\u00f3stico pr\u00e9vio de um feto \u00fanico normal ao lado de um par de GC. A fus\u00e3o se estendia do processo xifoide at\u00e9 a inser\u00e7\u00e3o do cord\u00e3o umbilical (onfal\u00f3pagos). Ambos os f\u00edgados estavam fundidos, mas as al\u00e7as intestinais e os c\u00f3lons apresentavam-se normais. As ves\u00edculas biliares foram identificadas e visualizadas.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ap\u00f3s o parto, ocorrido com 35 semanas de gesta\u00e7\u00e3o, novos exames de imagem foram realizados. Uma tomografia computadorizada confirmou a fus\u00e3o hep\u00e1tica. As conex\u00f5es vasculares do f\u00edgado foram isoladas e reconstru\u00eddas em 3D, classificando a fus\u00e3o como do tipo I hepatobiliar. Imagens imersivas foram geradas e exportadas, permitindo uma an\u00e1lise pr\u00e9-operat\u00f3ria e intraoperat\u00f3ria detalhada utilizando o aplicativo 3D Slicer em dispositivos m\u00f3veis. A reconstru\u00e7\u00e3o 3D possibilitou que a equipe cir\u00fargica estudasse minuciosamente as conex\u00f5es vasculares, facilitando o planejamento cir\u00fargico para a separa\u00e7\u00e3o.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A separa\u00e7\u00e3o de GC requer um esfor\u00e7o multidisciplinar coordenado para lidar com as complexas necessidades m\u00e9dicas e cir\u00fargicas desses pacientes. Foi empregada uma abordagem baseada em simula\u00e7\u00e3o, utilizando manequins pr\u00e9-montados que replicavam a anatomia dos g\u00eameos toraco-onfal\u00f3pagos. Essa modalidade de simula\u00e7\u00e3o proporcionou um ambiente seguro de treinamento para uma equipe multidisciplinar, incluindo neonatologistas, enfermeiros, terapeutas respirat\u00f3rios e cirurgi\u00f5es, a fim de aperfei\u00e7oar a tomada de decis\u00f5es cl\u00ednicas, as estrat\u00e9gias procedimentais e os protocolos de manejo de emerg\u00eancia. Os ensaios cl\u00ednicos baseados em simula\u00e7\u00e3o oferecem uma oportunidade valiosa para se preparar para procedimentos raros, complexos e espec\u00edficos de cada paciente.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">O procedimento cir\u00fargico ocorreu sem intercorr\u00eancias, e os pacientes permanecem sob acompanhamento sem complica\u00e7\u00f5es.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"references\">Refer\u00eancias<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">PERILLA AB, DARDES RDCM, NUNES MG, ARAUJO J\u00daNIOR E, WERNER H, RIBEIRO G, CASTRO PT, TAKANO CC, COSSI PS, SCHOR E. Herlyn\u2013Werner\u2013Wunderlich syndrome: value of 3D ultrasound, 3D sonovaginography and virtual navigation in diagnosis of Mullerian malformations. Ultrasound Obstet Gynecol 2024; 63: 419\u2013425.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">OKPAISE OO, TONNI G, WERNER H, ARAUJO J\u00daNIOR E, LOPES J, RUANO R. Threedimensional real and virtual models in fetal surgery: a real vision. Ultrasound Obstet Gynecol. 2024 Mar;63(3):303-311.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">MICHELETTI T, CASTRO PT, ARAUJO J\u00daNIOR E, CASTELLANO MA, ANDRADE CF, WERNER H. Fetal cervical sarcoma: Comparison between virtual and real fetal bronchoscopy. J Clin Ultr asound. 2024;1\u20104. doi:10.1002\/jcu. 23806<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CASTRO P, WERNER H, RIBEIRO G, LOPES J, ARAUJO JE. Omphalopagus in a Dichorionic diamniotic triplet pregnancy: prenatal and postnatal 3D models and virtual reality. J Obstet Gynaecol Can. 2023;45(1):1-3.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"<p>The use of medical 3D models and virtual reality (VR) in pre-surgical planning has been a fundamental tool in surgical strategy and localization for the surgeon, being a situation in which the anatomy is completely divergent from normal standards. VR has also been an important mark, assisting and allowing the surgeon to find the best [&hellip;]<\/p>\n","protected":false},"author":22,"featured_media":2013,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_gspb_post_css":".gspb_container-id-gsbp-0302111,.gspb_container-id-gsbp-0cf18bb,.gspb_container-id-gsbp-1ece2c2,.gspb_container-id-gsbp-1f14f69,.gspb_container-id-gsbp-2b309a6,.gspb_container-id-gsbp-2ecbb85,.gspb_container-id-gsbp-446bdc1,.gspb_container-id-gsbp-8478e11,.gspb_container-id-gsbp-88923d7,.gspb_container-id-gsbp-a334bce,.gspb_container-id-gsbp-d854721,.gspb_container-id-gsbp-da1fc53,.gspb_container-id-gsbp-ed0aec9{flex-direction:column;box-sizing:border-box}#gspb_container-id-gsbp-0302111.gspb_container>p:last-of-type,#gspb_container-id-gsbp-0cf18bb.gspb_container>p:last-of-type,#gspb_container-id-gsbp-1ece2c2.gspb_container>p:last-of-type,#gspb_container-id-gsbp-1f14f69.gspb_container>p:last-of-type,#gspb_container-id-gsbp-2b309a6.gspb_container>p:last-of-type,#gspb_container-id-gsbp-2ecbb85.gspb_container>p:last-of-type,#gspb_container-id-gsbp-446bdc1.gspb_container>p:last-of-type,#gspb_container-id-gsbp-8478e11.gspb_container>p:last-of-type,#gspb_container-id-gsbp-88923d7.gspb_container>p:last-of-type,#gspb_container-id-gsbp-a334bce.gspb_container>p:last-of-type,#gspb_container-id-gsbp-d854721.gspb_container>p:last-of-type,#gspb_container-id-gsbp-da1fc53.gspb_container>p:last-of-type,#gspb_container-id-gsbp-ed0aec9.gspb_container>p:last-of-type{margin-bottom:0}#gspb_container-id-gsbp-1f14f69.gspb_container{position:relative;display:block;box-sizing:border-box}#gspb_container-id-gsbp-446bdc1.gspb_container{position:relative;display:grid;grid-template-columns:repeat(2,minmax(0,1fr));column-gap:20px}@media 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(max-width:575.98px){#gspb_container-id-gsbp-0cf18bb.gspb_container{margin-right:0}}#gspb_container-id-gsbp-0cf18bb.gspb_container{box-sizing:border-box}#gspb_container-id-gsbp-0302111.gspb_container{position:relative;display:block;box-sizing:border-box}","footnotes":"","_links_to":"","_links_to_target":""},"categories":[77],"tags":[],"coauthors":[100,118,128,129,141],"class_list":["post-1782","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine"],"blocksy_meta":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>POSTNATAL SURGERY - Challenging cases - EXPANDED REALITY<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alevato.xyz\/portugues\/gemeos-craniopagos-estudo-clinico-1-neurocirurgia\/\" \/>\n<meta property=\"og:locale\" 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