Clinical Focus

  • Neurosurgery

Academic Appointments

Professional Education

  • Residency:Hospital das Clinicas of University of Sao Paulo (2010) Brazil
  • Medical Education:University of Sao Paulo School of Medicine (2004) Brazil

Research & Scholarship

Current Research and Scholarly Interests

Dr. Mandel obtained his medical degree from the University of São Paulo Medical School, Brazil. He received the ?Prof. Dr. Edmundo Vasconcelos Award? as the best student on all surgical disciplines upon completion of medical school. He subsequently completed his neurosurgical residency at the Hospital das Clinicas of University of Sao Paulo Medical School, Brazil.

After his residency, Dr. Mauricio started a busy private practice at Hospital Israelita Albert Einstein, Sao Paulo, Brazil.

His clinical and research interests are focused on minimally invasive neurosurgery. Dr. Mauricio attended a Ph.D. program at the University of Sao Paulo, Brazil, where he discussed a doctoral thesis entitled ?Employment of minimally invasive neurosurgical techniques for treatment of unruptured brain aneurysms of the anterior circulation.? During his Ph.D. thesis, he described an innovative minimally invasive approach for the treatment of middle cerebral artery aneurysms (transpalpebral ?eyelid? approach). He has published several peer-reviewed articles and has presented his work at different international conferences.

As Clinical Instructor at Stanford, Dr. Mauricio is currently concentrating on gaining operative exposure to cerebral revascularization procedures with Dr. Gary Steinberg.

Dr. Mandel, along with his wife Suzana, enjoys running, hiking and traveling. He also enjoys playing the cello. He has been a cellist in several university symphony orchestras in Sao Paulo.


All Publications

  • Neurogenic neuroprotection: clinical perspectives. Functional neurology Mandel, M., Talamoni Fonoff, E., Bor-Seng-Shu, E., Teixeira, M. J., Chadi, G. ; 27 (4): 207?16


    Neurogenic neuroprotection is a promising approach for treating patients with ischemic brain lesions. In rats, stimulation of the deep brain nuclei has been shown to reduce the volume of focal infarction. In this context, protection of neural tissue can be a rapid intervention that has a relatively long-lasting effect, making fastigial nucleus stimulation (FNS) a potentially valuable method for clinical application. Although the mechanisms of neuroprotection induced by FNS remain partially unclear, important data have been presented in the last two decades. A 1-h electrical FNS reduced, by 59%, infarctions triggered by permanent occlusion of the middle cerebral artery in Fisher rats. The acute effect of electrical FNS is likely mediated by a prolonged opening of potassium channels, and the sustained effect appears to be linked to inhibition of the apoptotic cascade. A better understanding of the neuronal circuitry underlying neurogenic neuroprotection may contribute to improving neurological outcomes in ischemic brain insults.

    View details for PubMedID 23597434

    View details for PubMedCentralID PMC3861344

  • Smartphone-assisted minimally invasive neurosurgery. Journal of neurosurgery Mandel, M., Petito, C. E., Tutihashi, R., Paiva, W., Abramovicz Mandel, S., Gomes Pinto, F. C., Ferreira de Andrade, A., Teixeira, M. J., Figueiredo, E. G. 2018; 130 (1): 90?98


    In BriefThe authors present a new surgical tool in which a smartphone is integrated with an endoscope by using a specially designed adapter, thus eliminating the need for a separate video system. This paper demonstrates that use of smartphones with endoscopes is a safe and efficient new method of performing endoscope-assisted neurosurgery, which also may increase surgeon mobility and reduce equipment costs.

    View details for DOI 10.3171/2017.6.JNS1712

    View details for PubMedID 29529913

  • Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy. Operative neurosurgery (Hagerstown, Md.) Mandel, M., Figueiredo, E. G., Mandel, S. A., Tutihashi, R., Teixeira, M. J. 2017; 13 (1): 2?14


    Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes.To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance.A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe.The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars.The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.

    View details for DOI 10.1227/NEU.0000000000001179

    View details for PubMedID 28931250

  • Minimally Invasive Transpalpebral ''Eyelid'' Approach to Unruptured Middle Cerebral Artery Aneurysms. Operative neurosurgery (Hagerstown, Md.) Mandel, M., Tutihashi, R., Mandel, S. A., Teixeira, M. J., Figueiredo, E. G. 2017; 13 (4): 453?64


    Although recent technological advances have led to successful endovascular treatment, middle cerebral artery (MCA) aneurysms are still prone to surgery. Because minimally invasive options are limited and possess several functional and cosmetic drawbacks, a transpalpebral approach is proposed as a new alternative.To describe and assess surgical results of the minimally invasive transpalpebral approach in patients with MCA aneurysms.The data of 25 patients with unruptured MCA aneurysms from 2013 to 2016 were included in a cohort prospective database. We describe modifications of the approach and technique for MCA aneurysm clipping, in a step-by-step manner. The outcome was based on complications, procedural morbidity and mortality, and clinical and angiographic outcomes.All procedures were successfully performed in a standardized way, and no major complications related to the new approach were observed. Twenty-two patients were discharged the day after surgery (88%). The majority of aneurysms were 5 to 6 mm in diameter (mean, 7 mm; range 4-21 mm). All patients underwent postoperative angiographic control, which showed no significant residual neck. A 3-mo follow-up was sufficient to show no visible scars with excellent cosmetic results. The mean duration of follow-up was 16 mo.The transpalpebral approach comes as a minimally invasive, safe, definitive, and cosmetically adequate solution for MCA aneurysms at the present time.

    View details for DOI 10.1093/ons/opx021

    View details for PubMedID 28838124

  • Endoscopic-assisted removal of traumatic brain hemorrhage: case report and technical note. Journal of surgical case reports Nascimento, C. N., Amorim, R. L., Mandel, M., do Espírito Santo, M. P., Paiva, W. S., Andrade, A. F., Teixeira, M. J. 2015; 2015 (11)


    The endoscopic technique has been described as a minimally invasive method for spontaneous hematoma evacuation, as a safe and effective treatment. Nevertheless, to our knowledge, there is no description of a technical report of traumatic intracerebral hematoma removal using the neuroendoscope. A 47-year-old man was admitted sustaining 13 points in Glasgow coma scale with brain computed tomography (CT) scan showing a temporal contusion. Guided by a 3D reconstructed CT, using the program OsiriX®, the posterior limit of the hematoma was identified. A burr hole was placed at the posterior temporal region, and we used the neuroendoscope to assist the hematoma evacuation. The postoperative tomography showed adequate hematoma removal. He was discharged from hospital 48 h after surgery. Two weeks later, he was conscious and oriented temporally. This endoscopic-assisted technique can provide safe removal of traumatic hematomas of the temporal lobe.

    View details for DOI 10.1093/jscr/rjv132

    View details for PubMedID 26537390

    View details for PubMedCentralID PMC4631953

  • 3D preoperative planning in the ER with OsiriX®: when there is no time for neuronavigation. Sensors (Basel, Switzerland) Mandel, M., Amorim, R., Paiva, W., Prudente, M., Teixeira, M. J., Andrade, A. F. 2013; 13 (5): 6477?91


    The evaluation of patients in the emergency room department (ER) through more accurate imaging methods such as computed tomography (CT) has revolutionized their assistance in the early 80s. However, despite technical improvements seen during the last decade, surgical planning in the ER has not followed the development of image acquisition methods. The authors present their experience with DICOM image processing as a navigation method in the ER. The authors present 18 patients treated in the Emergency Department of the Hospital das Clínicas of the University of Sao Paulo. All patients were submitted to volumetric CT. We present patients with epidural hematomas, acute/subacute subdural hematomas and contusional hematomas. Using a specific program to analyze images in DICOM format (OsiriX(®)), the authors performed the appropriate surgical planning. The use of 3D surgical planning made it possible to perform procedures more accurately and less invasively, enabling better postoperative outcomes. All sorts of neurosurgical emergency pathologies can be treated appropriately with no waste of time. The three-dimensional processing of images in the preoperative evaluation is easy and possible even within the emergency care. It should be used as a tool to reduce the surgical trauma and it may dispense methods of navigation in many cases.

    View details for DOI 10.3390/s130506477

    View details for PubMedID 23681091

    View details for PubMedCentralID PMC3690066

  • Bilateral subthalamic nucleus stimulation for generalized dystonia after bilateral pallidotomy. Movement disorders : official journal of the Movement Disorder Society Fonoff, E. T., Campos, W. K., Mandel, M., Alho, E. J., Teixeira, M. J. 2012; 27 (12): 1559?63


    Thalamotomies and pallidotomies were commonly performed before the deep brain stimulation (DBS) era. Although ablative procedures can lead to significant dystonia improvement, longer periods of analysis reveal disease progression and functional deterioration. Today, the same patients seek additional treatment possibilities.Four patients with generalized dystonia who previously had undergone bilateral pallidotomy came to our service seeking additional treatment because of dystonic symptom progression. Bilateral subthalamic nucleus DBS (B-STN-DBS) was the treatment of choice. The patients were evaluated with the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and the Unified Dystonia Rating Scale (UDRS) before and 2 years after surgery.All patients showed significant functional improvement, averaging 65.3% in BFMDRS (P = .014) and 69.2% in UDRS (P = .025).These results suggest that B-STN-DBS may be an interesting treatment option for generalized dystonia, even for patients who have already undergone bilateral pallidotomy.

    View details for DOI 10.1002/mds.25127

    View details for PubMedID 23038611

  • Stereotactic biopsies of brain lesions. Arquivos de neuro-psiquiatria Teixeira, M. J., Fonoff, E. T., Mandel, M., Alves, H. L., Rosemberg, S. 2009; 67 (1): 74?77


    In the majority of cases, the correct treatment of brain lesions is possible only when the histopathological diagnosis is made. Several deep-seated lesions near eloquent areas are not safely approached by the classical neurosurgical procedures. These patients can get benefit by a minimally invasive procedure.We present a series of 176 consecutive patients submitted to stereotactic biopsies due to a great variety of brain lesions.Histological diagnosis found in this series: glioma in 40.1% of the patients, other neoplasms in 12.2% and infectious or inflammatory diseases in 29.1 %. The result was inconclusive in 5.2% of the procedures. One patient died (0.6%) and two (1.2%) presented operative complications. The criteria, advantages and risks of the stereotactic biopsies are discussed.The efficacy of the method is adequate and morbid-mortality rates were low.

    View details for PubMedID 19330216

  • The value of cranial computed tomography in high-risk, mildly head-injured patients. Surgical neurology de Andrade, A. F., de Almeida, A. N., Bor-Seng-Shu, E., Lourenço, L., Mandel, M., Marino, R. 2006; 65 Suppl 1: S1:10?11:13


    The purpose of this article was to assess if high-risk, mildly head-injured patients with normal CT scan present an outcome similar to the group with "low-risk MHI."A total of 379 hospital charts of inpatients with Glasgow Coma Scale scores of 13, 14, and 15 were reviewed. Information regarding age, fGCS, trauma mechanism, cranial CT scan findings, hospital course, and follow-up using the GOS were obtained from all patients.Patients were separated in 3 groups: fGCS 13 (46 patients), fGCS 14 (138 patients), and fGCS 15 (195 patients). The groups with different scores on fGCS did not differ regarding CT scan abnormalities, surgical treatment, or outcome. Patients were also separated in 2 groups based on CT scan findings: 266 patients had CT interpreted as abnormal and 113 had CT interpreted as normal. The 2 groups differed statistically regarding surgical treatment and scores on GOS (P < .05). There was no statistically significant difference between the 2 groups regarding sex, trauma mechanism, fGCS, or age.Our findings support the idea that a normal cranial CT scan in patients with fGCS scores of 13 or higher ascertain a low-risk MHI outcome and, therefore, such patients must be included in this category of traumatic brain injury. On the other hand, patients with cranial CT scan abnormalities should be included in the group with moderate head injury.

    View details for DOI 10.1016/j.surneu.2005.11.034

    View details for PubMedID 16427436

  • Epidural hematomas of the posterior cranial fossa. Neurosurgical focus Bor-Seng-Shu, E., Aguiar, P. H., de Almeida Leme, R. J., Mandel, M., Andrade, A. F., Marino, R. 2004; 16 (2): ECP1


    The authors present their experience in the management of posterior fossa epidural hematoma (PFEDH), which involved an aggressive diagnostic approach with the extensive use of head computerized tomography (CT) scanning.The authors treated 43 cases of PFEDH in one of the largest health centers in Brazil. Diagnosis was established in all patients with the aid of CT scanning because the clinical manifestations were frequently nonspecific. Cases were stratified by clinical course, Glasgow Coma Scale score, and their radiological status. Based on clinical and radiological parameters the patients underwent surgical or conservative management.Compared with outcomes reported in the available literature, good outcome was found in this series. This is primarily due to the broad use of CT scanning for diagnostic and observational purposes, which, in the authors' opinion, led to early diagnosis and prompt treatment.

    View details for PubMedID 15209492

  • Acute neurogenic pulmonary edema: case reports and literature review. Journal of neurosurgical anesthesiology Fontes, R. B., Aguiar, P. H., Zanetti, M. V., Andrade, F., Mandel, M., Teixeira, M. J. 2003; 15 (2): 144?50


    Neurogenic pulmonary edema (NPE) is an underdiagnosed clinical entity. Its pathophysiology is multifactorial but largely unknown. We report two cases of NPE and review the literature on NPE cases reported since 1990. A 21-year-old man had a seizure episode following cranioplasty. He became increasingly dyspneic, and clinical and laboratory signs of respiratory failure were evident. Chest radiography and computed tomography showed bilateral diffuse infiltrates. After supportive measures were taken, complete respiratory recovery occurred in 72 hours. A 52-year-old woman had several seizure episodes following subarachnoid hemorrhage due to a cavernoma. She became increasingly dyspneic upon arrival at the hospital. After tracheostomy and oxygen support were established, chest radiography showed bilateral diffuse infiltrates. Respiratory recovery was excellent, and the patient was eupneic with normal results of chest radiography 48 hours later. Fourteen reports (21 cases) were found. Thirteen patients were female, and the mean age of the patients was 31.6 years. The most frequent underlying factor was subarachnoid hemorrhage (42.9%). Symptom onset occurred <4 hours after the neurologic event in 71.4% of cases. One third of the patients presented with pink frothy sputum. Chest radiography showed bilateral diffuse infiltrates in 90.5% of cases. Supportive measures included oxygen support and vasoactive drugs. Recovery was usually very rapid: 52.4% of patients recovered in <72 hours. Almost 10% of patients died of NPE. Our two cases had clinical and laboratory features in common with most NPE cases. Physicians should remember NPE when neurologic patients suddenly become dyspneic. The mortality rate is high, but surviving patients usually recover very quickly.

    View details for PubMedID 12658001

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