
Bernardo Assumpcao de MonacoWashington University in St. Louis | WUSTL , Wash U · Department of Neurosurgery
Bernardo Assumpcao de Monaco
Doctor of Medicine
Clinical Fellow - Pediatric Neurosurgery - Washington University in St. Louis - MO
About
91
Publications
22,781
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356
Citations
Introduction
Additional affiliations
September 2016 - April 2021

Position
- Head of Faculty
Description
- Functional Neurosurgeon head of CDF - Clinica de Dor e Funcional - working with disabled children - spasticity - pain - myelomeningocele - tethered spinal cord - spinal cord injury - brain injury and others. More than 140 selective dorsal rhizotomies (SDR) performed in this institution.
Publications
Publications (91)
Cognitive losses resulting from severe brain trauma have long been associated with the focal region of tissue damage, leading to devastating functional impairment. For decades, researchers have focused on the sequelae of cellular alterations that exist within the perilesional tissues; however, few clinical trials have been successful. Here, we empl...
Persistent Spinal Pain Syndrome type 2 (PSPS-T2) poses a significant clinical challenge, demanding innovative therapeutic interventions. The integration of Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion Stimulation (DRG-S) is emerging as a potent synergistic strategy for comprehensive pain management. This single patient-blind proof of conc...
Cancer-related pain is a common and debilitating condition that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a...
Purpose
It is known that cerebral palsy (CP) children’s caregivers suffer from burden, depression, and stress, impairing their quality of life (QoL). The more severe the CP, the more burden the caregiver has. Psychosocial support, education, therapies, and financial support are inversely related to the level of stress of the caregiver. Most parents...
Traumatic brain injury (TBI) poses significant challenges for assessing fitness-to-drive (FTD) and determining the appropriate timing for return-to-driving (RTD) in civilian adults. This systematic review and meta-analysis protocol is designed to offer a comprehensive assessment of RTD timelines post-TBI, examining the effects of injury severity as...
Background
Spinal cord stimulation (SCS) is a cost‐effective option for treating refractory persistent spinal pain syndrome type‐2 (PSPS‐2). For patients with extensive spine instrumentation including the thoraco‐lumbar junction, percutaneous placement of SCS leads is usually not an option being paddle leads typically implanted anterograde. Paddle...
10.1016/j.neuri.2023.100147
Purpose of review
High-cervical spinal cord stimulation can alter cortical activity and cerebral metabolism. These effects are potentially beneficial for disorders of consciousness. A better understanding of the effects of clinical application of stimulation is needed. We aimed to evaluate the existing literature to determine the state of available...
Robotic assistance in stereoelectroencephalography (SEEG) holds promising potential for enhancing accuracy, efficiency, and safety during electrode placement and surgical procedures. This systematic review and meta-analysis, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and International Prospectiv...
BACKGROUND AND OBJECTIVES
Bedside procedures are often helpful for neurosurgical patients, especially in neurocritical care. Portable drills with technological advancements may bring more safety and efficiency to the bedside. In this study, we compared the safety and efficiency of a new cordless electric drill with smart autostop (“HD”—Hubly Crania...
reduced edema and improved neurological function at 24 h, 72 h, and 28 days after SBI. The VPC regime also significantly reduced in-traoperative bleeding. Our findings also confirmed the mechanistic nature of SBI and the role of PLA2, as injection of PLA2 and 5-LOX inhibitors (manolide and zileuton) nullified the protective benefit of VPC. These fi...
Bedside craniostomies using portable devices are essential in neuro- critical care but may present complications.
We analyzed the safety and efficiency of a new cordless electric portable hand drill (HD) with smart auto-stop for bedside craniostomy and compared it to a standard traditional (ST) neurosurgical cranial perforator used for burr-holes....
Fahr syndrome, or bilateral striatopallidodentate calcinosis, is a very rare syndrome that can confound interpretation of traumatic brain injury (TBI) seen on computed tomography of the head (CTH). Un- derstanding that this syndrome presents with diffuse calcified lesions will assist clinicians in determining the primary injury of concern when eval...
Limited therapies are available for severe cerebral palsy children (CP) with complex movement disorders, especially when both dystonia and spasticity are present. In this publication, we present the improvement of a child with severe CP after intracerebroventricular baclofen therapy. The treatment can impact not just the movement disorders but also...
Sacral stimulation is a well-established therapy for urologic neuromodulation. After the advent of dorsal root ganglion (DRG) stimulation, pain surgeons have started to reach this target mostly for pelvic and sacral pain. For those without good surgical experience, sacral foramen puncture, especially S3 and S4, can be a challenge, due to its entry...
Gunshot head injuries are increasingly prevalent in the urban setting and carry complex technical and clinical decision-making challenges to practicing neurosurgeons. Here, we present a unique case of a patient who suffered a gunshot injury and presented to the emergency department with an intraventricular bullet lodgment without significant neurol...
Introduction: The treatment of spasticity is essential for the function and quality of life of cerebral palsy (CP) children improvement. Those submitted to selective dorsal rhizotomy (SDR) present functional gains, aiming the lower limbs treatment of spasticity and improve also indirect neurological achievements, such as improvement in gait, balanc...
Background:
Burr hole evacuation is a well-established treatment for symptomatic cases with chronic subdural hematoma (cSDH). Routinely postoperative catheter is left in the subdural space to drain the residual blood. Drainage obstruction is commonly seen, and it can be related to suboptimal treatment.
Methods:
Two groups of patients submitted t...
Cuidados paliativos em neurocirurgia - como a neurocirurgia pode auxiliar as demais especialidades nos cuidados ao paciente onde não há intenção de cura, mas sim de paliação.
Fahr syndrome, or bilateral striatopallidodentate calcinosis, is a very rare syndrome that can confound interpretation of traumatic brain injury (TBI) seen on computed tomography of the head (CTH). Understanding that this syndrome presents with diffuse calcified lesions will assist clinicians unfamiliar with Fahr syndrome when evaluating diffuse hy...
Autosomal dominant polycystic kidney disease (ADPKD) is a connective tissue disease with vascular abnormalities involving multiple organs. The prevalence of ADPKD associated with a spontaneous subdural hematoma (SDH) is very low, with less than 10 cases reported in the literature to date. Symptomatic chronic SDH is classically treated with a twist...
Trigeminal neuralgia (TN) is a facial pain disorder that can be a source of significant disability. Percutaneous balloon compression (PBC) has low cost, high efficacy, and minimal invasiveness. Complications can occur due to the balloon inflation or the needle placement itself. In this paper, we describe for the first time the clinical use of robot...
Large acute component in chronic subdural hematoma (cSDH) typically requires craniotomy. Open surgery can be associated to increased morbidity and is not always possible due systemic conditions. We present the dramatic case of a 58 y/o patient that presented with GCS 3 and fixed pupils, with remaining brainstem reflexes present. Brain CT showed a l...
Chronic subdural hematoma (cSDH) burr hole evacuation is a well‐established treatment for symptomatic cases with associated mass effect. Routinely postoperative drain is left in the subdural space to account for residual blood. Drainage obstruction is not rare to occur requiring catheter flushing. The maneuver can be unsuccessful and potentially in...
The large acute component in a chronic subdural hematoma (cSDH) typically requires a craniotomy. Open surgery can be associated with increased morbidity and is not always possible due to systemic conditions. We present the case of a 58-year-old patient who presented with a Glasgow Coma Scale (GCS) of three fixed pupils, but remaining brainstem refl...
Neuromodulation techniques for pain treatment have been used since ancient Rome, but knowledge about the interaction of electricity and drugs with the central nervous system (electrical and chemical neuromodulation) was not clear until the middle of the twentieth century. It was only then that the advent of neuromodulatory techniques allowed for mo...
Intraventricular pumps can be used to treat severe pain secondary to cancer or spastic dystonia. First reports of the intraventricular route usage for this purpose involved Ommaya reservoirs with single bolus infusions. After favorable initial results, mechanical pumps were coupled to the reservoir for intermittent boluses. With the advancement of...
Neuromodulation implants are currently one of the most successful techniques in the treatment of chronic pain, a condition that affects more and more patients each year, leading to reduced quality of life as well as economic losses.
Neuromodulation implants for pain are a relatively new technique and are being increasingly used around the globe. Ho...
Motor cortex stimulation via surgically implanted electrodes has been used as an off-label treatment for chronic neuropathic pain, but its efficacy has not been fully established. We aimed to objectively study the efficacy of motor cortex stimulation and characterize potential predictors of response.
In this randomized, double-blind, sham-controlle...
Purpose
The current assessment of patients with craniofacial asymmetries is accomplished by physical examination, anamnesis and radiological imaging. We propose a semi-automated, computer-assisted craniofacial evaluation (SymMetric v 1.0) based on orthogonal photography of the patient’s head in 3 positions. The system is simple, low-cost, no-radiat...
Purpose:
Brainstem lesions comprise 10-20% of all pediatric brain tumors. Over the past years, the benefits of stereotactic biopsy versus the use alone of MRI features to guide treatment have been controversial.
Methods:
Retrospective study with pediatric patients submitted to stereotactic brainstem biopsies between 2008 and 2018. Demographic, c...
Purpose: The current assessment of patients with craniofacial asymmetries is accomplished by physical examination, anamnesis and radiological imaging.
We propose a semi-automated, computer-assisted craniofacial evaluation (SymMetric v 1.0) based on orthogonal photography of the patient's head in 3 positions. The system is simple, low-cost, no-radia...
Since 1967 the treatment of chronic pain has been done through the implantation of medullary electrodes, being used and improved to the present day for many situations. Now we know that there are two clear indications for this procedure: chronic pain
syndrome after surgical failure for the treatment of pain and the regional complex pain syndrome. O...
Spinal cord stimulation (SCS) has been used for the treatment of chronic pain for nearly five decades. With a high degree of efficacy and a low incidence of adverse events, it is now considered to be a suitable therapeutic alternative in most guidelines. Experimental studies suggest that SCS may also be used as a therapy for motor and gait dysfunct...
Dorsal root entry zone (DREZ) lesioning is still used as a choice of treatment for some painful conditions as well as spasticity in selected patients. The most commonly used techniques to perform DREZotomy are the microsurgical one and DREZ radiofrequency (RF) coagulation. The technical difficulties using punctures to perform RF lesions include com...
To report the efficiency and safety of intraventricular baclofen therapy (IVB) in dystonic-spastic patients.
We evaluated efficiency (measured by Modified Ashworth Scale - MAS) and safety (assessed by postoperative complications) of intraventricular infusion in three patients for whom intrathecal therapy was infeasible.
Spasticity is often refractory in spinal cord injure (SCI) ASIA A patients besides drug therapies and
physical rehabilitation. Interventional therapies are also always insufficient to complete alleviate spasticity.
For these patients, percutaneous rhizotomy can be a good alternative to intrathecal baclofen pump,
selective dorsal rhizotomy, DREZotom...
The most used intrathecal therapy for spasticity is baclofen one. In Brazil, the public health system does not provide intrathecal baclofen, so, other medications are used intrathecally to promote spasticity improvement, like morphine.
We aim to report efficacy and efficiency of intrathecal morphine therapy for spasticity treatment in eleven patien...
Neuromodulação invasiva em para tratamento de dores oncológicas
Capitulo em português falando sobre neuromodulação para tratamento da dor, desde métodos não invasivos, até os métodos invasivos.
Objectives: To describe a new application of intraoperative real-time ultrasound (US) image to guide radiofrequency DREZ lesions Methods: A 38 year-old man suffered with traumatic brain injury due to diffuse axonal lesioning, evolving to severe encephalic spasticity and dystonia in upper and lower limbs after the accident. Despite best medical trea...
Resumo
A espasticidade é uma desordem motora que leva a um quadro de resistência ao movimento articular passivo. A paralisia cerebral é a mais importante causa de espasticidade e pode ser causada por diversos fatores, tais como gestações múltiplas, alcoolismo, infecções, hemorragias, afogamento, lesões cerebrais traumáticas, entre outros. Existem m...
Background: Aspergillosis infection of the central nervous system (CNS) is a rare disease and corticosteroid use has increased the number of cases. It presents a high lethality rate and has to be aggressively treated. Methods: A review of literature was done and 38 cases were identified involving cerebral aneurysms caused by this fungus to date. Co...
Neurogenic Pulmonary Edema (NPE) is defined as the acute onset of dyspnea or a decrease in PaO2/FiO2 ratio, following an acute central nervous system (CNS) insult, in the absence of other obvious causes of lung injury. The most important cause of NPE is subarachnoid hemorrhage (SAH), followed by cerebraltrauma and epilepsy. The incidence of NPE aft...
Background:
Motor cortex stimulation (MCS) is routinely used for the treatment of chronic neuropathic pain but its effect on quality of life remains uncertain.
Obejctive:
To systematically review the published literature on MCS and quality of life and report the effects of this therapy in a series of patients prospectively followed in our center...
There are several unleashing factors associated with spasticity worsening such as infection, pain, immobility, emotional factors, and others. Baclofen pumpis a standard treatment for selected severe spasticity cases. The authors report a case of a suspected baclofen pump malfunctioning in a paraplegic spastic patient secondary to spinal cord injury...
En Español - Terapia intratecal para el tratamiento del dolor
Unlabelled:
We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively retur...
Ablative Surgeries for Spasticity Treatment - in Portuguese
Neurodegeneration with brain iron accumulation type 1 (NBIA-1) is a rare disorder characterized by progressive extrapyramidal dysfunction and dementia. NBIA-1 encompasses typical iron brain accumulation, mostly in the globus pallidus with secondary dementia, spasticity, rigidity, dystonia, and choreoathetosis. Treatment remains mostly symptomatic a...
Spasticity treatment - in Portuguese.
Background: Implantable pumps for intrathecal opioid therapy in the last decades emerged as one of the most effective treatment for chronic non-malignant pain (CNMP) in selected patients. This study analyses reliability of intrathecal infusion morphine therapy for chronic and refractory pain not related to malignancy using an implantable constant f...
The treatment of uncomplicated osteoma consists of an en bloc resection, or curettage, of the tumor, followed by cranioplasty. Here, we present a case report of a patient treated for a parietal osteoma, followed by a calcium phosphate cranioplasty, with early resorption after 3 months, which was presented by a sinking flap above the resection area....
Optimal treatment of oncologic pain is a challenge to all professionals who deal with cancer and its complications. The management of upper abdominal pain is usually difficult and it is often refractory to conservative therapies. In this context, celiac plexus neurolysis (CPN) appears to be an important and indispensable tool because it alleviates...
The authors provide a review of brain arteriovenous malformations, initially reviewing epidemiological and etiological aspects in addition to the pathophysiology and risk factors associated with bleeding. The emphasis of this review is directed to the clinical and care should be taken since the diagnosis of this pathology, intraoperative management...
Rev Med (São Paulo). 2012;91(ed. esp.):54-5.
ISSN 1679-9836
Lesions of lumbar plexus are uncommon and descriptions of surgical access are derived from vertebral spine approaches.
The extraperitoneal anterolateral approach to the lumbar plexus was performed in six adult fresh cadavers. The difficulties on dissection were related.
An exposure of all distal elements of lumbar plexus was possible, but a cranial...
Penetrating injury of the skull and brain are relatively uncommon events, representing about 0.4% of all head injuries. Transorbital penetrating brain injury is an unusual occurrence in emergency practice and presents with controversial management. We report the case of a 10-year-old boy who fell forward on a bamboo stick while playing with other c...