Automated White Matter Fiber Tract Segmentation for the Brainstem Mingchu Li, Qingrun Zeng, Jiawei Zhang, Ying Huang, Xu Wang, Eduardo Carvalhal Ribas, Xiaolong Wu, Xiaohai Liu, Jiantao Liang, Ge Chen, Yuanjing Feng, Mengjun Li NMR in Biomedicine, 2025 This study aimed to develop an automatic segmentation method for brainstem fiber bundles. We utilized the brainstem as a seed region for probabilistic tractography based on multishell, multitissue constrained spherical deconvolution in 40 subjects from the Human Connectome Project (HCP). All tractography data were registered into a common space to construct a brainstem fiber cluster atlas. A total of 100 fiber clusters were identified and annotated. Cortical parcellation–based fiber selection was then performed to extract fibers within the annotated clusters that projected to their corresponding cortical regions. This atlas was applied for automatic brainstem fiber bundle segmentation in 10 HCP subjects and 8 patients with brainstem cavernous malformations. The spatial overlap between automatic and manual reconstruction was assessed. Ultimately, eight fiber bundles were identified in the brainstem atlas on the basis of their trajectories: the corticospinal tract (CST), corticobulbar tract, frontopontine tract, parieto‐occipital‐pontine tract, medial lemniscus, and superior, middle, and inferior cerebellar peduncles. The mean and standard deviation of the weighted dice (wDice) scores between the automatic and manual reconstructions were 0.9076 ± 0.0950 for the affected CST, 0.9388 ± 0.0439 for the contralateral CST, 0.9130 ± 0.0588 for the affected medial lemniscus, and 0.9600 ± 0.0243 for the contralateral medial lemniscus. This proposed method effectively distinguishes major brainstem fiber bundles across subjects while reducing labor costs and interoperator variability inherent to manual reconstruction. Additionally, this method is robust in that it allows for the visualization and identification of fiber tracts surrounding brainstem cavernous malformations.
Anatomy of the Cerebral Cortex Eduardo C. Ribas, Raphael Vicente Alves, Richard Gonzalo Párraga, Guilherme Carvalhal Ribas Atlas of Intrinsic Brain Architecture for Microsurgery, 2025
Refractory late-onset cerebrospinal fluid fistula following mammoplasty: case report of a rare complication Clara Sanches Bueno, Eduardo Carvalhal Ribas, Eduardo Noda Kihara, Andre Felix Gentil, Arthur Werner Poetscher Einstein Sao Paulo Brazil, 2025 Mammoplasty is commonly performed under epidural anesthesia combined with intravenous sedation; however, this carries a risk of dural puncture and post-dural puncture headache. Successful treatment is often achieved with opioids, non-steroidal anti-inflammatory drugs, and caffeine. When conservative treatment fails, an epidural blood patch should be performed; this procedure has a high resolution rate. We report the case of a patient who developed a post-dural puncture headache 25 days after elective breast implant replacement performed under thoracic epidural anesthesia combined with intravenous sedation. The post-dural puncture headache was refractory to conservative treatment and the first epidural blood patch was unsuccessful. This case represents an exceptionally rare presentation of post-dural puncture headache, marked by a delayed onset of nearly four weeks and requiring a second epidural blood patch for symptom resolution.
Tranexamic acid in the management of traumatic brain injury: a systematic review and meta-analysis with trial sequential analysis Thiago Gebrin, Júlia Pinho Neodini, André Felix Gentil, Eduardo Carvalhal Ribas, Mario Lenza, Arthur Werner Poetscher Einstein Sao Paulo Brazil, 2025 Introduction Traumatic brain injury is a leading cause of death and disability. Tranexamic acid, an antifibrinolytic agent, holds the potential for managing intracranial hemorrhages secondary to traumatic brain injury. However, its efficacy and safety remain subjects of ongoing debate. Objective To better clarify the efficacy and safety of tranexamic acid in that context and to evaluate the need for further studies. Methods We conducted a comprehensive search of seven electronic databases, eight study repositories, and tertiary sources between January 2021 and 2022 for randomized controlled trials involving victims of traumatic brain injury aged 15 or older who received tranexamic acid versus placebo or standard care. The primary outcomes were all-cause mortality and hemorrhagic complications during treatment. This review incorporated elements of PRISMA guidelines, Cochrane’s Risk of Bias assessment, and GRADE to assess evidence quality. Sensitivity analyses were also conducted. Results Out of 6,958 references retrieved, 14 of the 17 randomized controlled trials were analyzed, encompassing a total of 15,017 patients. Analyses for all-cause mortality did not reach statistical significance (RR= 0.95, 95%CI= 0.88-1.02 | trial sequential analysis RR= 0.95, 95%CI= 0.87-1.03). However, the analysis of hemorrhagic complications during treatment showed statistical significance for progressive intracranial hemorrhage (RR= 0.82, 95%CI= 0.68-0.99 | trial sequential analysis RR= 0.82, 95%CI= 0.38-1.78). Analyses of secondary outcomes, namely unfavorable neurological outcome and other adverse effects, did not demonstrate statistical significance. Conclusion Tranexamic acid use did not demonstrate efficacy based on all-cause mortality but showed a favorable safety profile. Additional clinical trials may shed light on remaining clinical uncertainties. Prospero database registration: CRD42021221949.
White Matter Pathways Guilherme Carvalhal Ribas, Andre Felix Gentil, Eduardo Carvalhal Ribas Cambridge Textbook of Neuroscience for Psychiatrists, 2023
The Temporal Lobes Guilherme Carvalhal Ribas, Andre Felix Gentil, Eduardo Carvalhal Ribas Cambridge Textbook of Neuroscience for Psychiatrists, 2023
The Frontal Lobes Guilherme Carvalhal Ribas, Andre Felix Gentil, Eduardo Carvalhal Ribas Cambridge Textbook of Neuroscience for Psychiatrists, 2023
The Basal Ganglia Guilherme Carvalhal Ribas, Andre Felix Gentil, Eduardo Carvalhal Ribas Cambridge Textbook of Neuroscience for Psychiatrists, 2023
General Principles of Awake Neurosurgery Eduardo Carvalhal Ribas, Cristiana Pinheiro Protasio, Sang Ken Kim, Hannah Keeble, Christian Brogna Neurocritical Care for Neurosurgeons Principles and Applications, 2021
BRAIN MAPPING AND NEURO-MONITORING IN LOW GRADE GLIOMA SURGERY: CURRENT CHALLENGES AND FUTURE PERSPECTIVES Encyclopedia of Surgery Volume 1 22 Volume Set, 2020
Head positioning for anterior circulation aneurysms microsurgery Feres Chaddad-Neto, Hugo Leonardo Doria-Netto, José Maria de Campos-Filho, Eduardo Santamaria Carvalhal Ribas, Guilherme Carvalhal Ribas, Evandro de Oliveira Arquivos De Neuro Psiquiatria, 2014
Ventriculoatrial shunt catheter displacement by a central venous catheter: A rare complication Journal of Neurosurgical Sciences, 2014
