Surgery is a decision. Before it, evidence.

Neurosurgery for tumours of the nervous system, skull base lesions, traumatic brain injury, hydrocephalus and paediatric neurosurgery. A surgical indication is built on the neurological examination, on imaging read in clinical context, and on what the literature shows about outcome — never on an isolated finding.

Dra. Lorenna Gonzalez-Reyes
The approach

Evidence-based medicine, practised as it is meant to be

The patient before the scan

An MRI does not close a diagnosis: degenerative findings are common in people with no symptoms at all. Management begins with the neurological examination and the history — imaging confirms or refutes what was already formulated at the bedside.

Indication, not offer

Every indication is tested against what the studies show about benefit, risk and the natural history of the disease. When conservative treatment yields the same outcome, that is the recommendation — and it is said plainly.

Shared decision

Risks, alternatives and uncertainties in numbers, in language that can be understood. A second opinion is welcome: a sound surgical decision withstands another colleague’s scrutiny.

Why evidence matters

In neurosurgery, the cost of a wrong indication is the patient

Evidence-based medicine is not following protocol out of obligation: it is recognising that clinical impression alone errs with predictable frequency. A surgeon’s experience counts dozens of cases; a well-conducted trial counts thousands, with outcomes measured and followed over time. When the two diverge, it is the larger series that is usually right — and ignoring it means repeating an error already documented.

Evidence is also what makes it possible to say no. A good share of imaging findings does not explain the patient’s symptom, and many conditions improve without surgery. Knowing what the literature shows about natural history, surgical risk and real benefit is what separates a necessary indication from an avoidable procedure. That criterion underpins every decision here: evidence applied to the case at hand, with clinical judgement and the patient’s values weighing in.

Areas of practice

Neuro-oncology

Intracranial and spinal cord tumours, with management defined in multidisciplinary discussion alongside oncology and radiation therapy.

Skull base

Lesions of complex anatomy, where preoperative planning and the choice of approach determine the outcome.

Traumatic brain injury

Care guided by established neurotrauma protocols: monitoring, timely surgical indication and control of secondary injury.

Hydrocephalus

Investigation of disordered cerebrospinal fluid circulation and the choice between shunting and an endoscopic route according to aetiology.

Paediatric neurosurgery

Malformations, tumours and hydrocephalus of childhood, with the care a developing child requires.

Second opinion

Review of a surgery already indicated: reading of the studies, comparison against the guidelines and a written opinion.

The surgeon

Dra. Lorenna Gonzalez-Reyes

Neurosurgeon trained in the residency programme of Hospital Regional de Presidente Prudente, practising in neuro-oncology, skull base surgery, neurotrauma, hydrocephalus and paediatric neurosurgery. Consultations are held at Instituto Cérebro Coluna.

Practice follows what the evidence supports: current guidelines, multidisciplinary case discussion and critical reading of the literature before changing a course of treatment. Risks, alternatives and uncertainties are presented to the patient in numbers — including the option not to operate.

Dra. Lorenna Gonzalez-Reyes
Scientific work

Those who rely on the literature also produce it

Published and congress-presented work, listed as it appears in the indexing databases.

Peer-reviewed articles

  1. 01 Da Costa MDS, Lima JVF, Zanini MA, Hatamoto Filho PT, Naufal RFF, Reyes L, Goes P, Miguez CA, Bastos FA, Lopes DF, Dellaretti M, Buzartti I, Machado Filho MAS, Sako EA, Wainberg RC, Ferreira DS, Moura ALA, Chaddad-Neto F. Risks for Oculomotor Nerve Palsy and Time to Recovery After Surgical Clipping of Pcom Aneurysms: A Multicenter Retrospective Cohort Study. Neurosurgery, 2023.
  2. 02 Gaia F, Gonzalez-Reyes L, Belfort MA, Medeiros RGB, Bendinid JD, Barbosa GF. Analyzing giant pituitary adenomas: An 8-year review (2012–2020) at a reference center in Brazil. Clinical Neurology and Neurosurgery, 213:107138, 2022.

Congress presentations

  1. 03 Cavalcante Filho JRM, Gaia F, Reyes LICMG, Nai GA, Zymberg ST, Cruz OLM. Avaliação preditiva da consistência de adenomas hipofisários: análise da intensidade de sinal em ressonância magnética e dimensão fractal histopatológica. 2023.
  2. 04 Reyes LICMG, Almeida SK, Fabrin RP. Sarcoma de Ewing: relato de caso. 2022.
  3. 05 Cavalcante Filho JRM, Reyes LICMG, Malveira AS. Pneumoencéfalo como complicação pós-operatória de DVP: tratamento endoscópico endonasal. 2022.
  4. 06 Gaia FFP, Reyes LICMG, Silva ARF, Belfort MAG, Betonico CCR, Nascimento IMD, Barros CV. Perfil epidemiológico e clínico de pacientes com diagnóstico de adenoma hipofisário operados por via endoscópica transesfenoidal em um hospital universitário. Congresso Paranaense de Avanços em Neurocirurgia, 2018.

Awards and distinctions

  1. 2022 Seventh highest score in Brazil in the neurosurgery board examination — Brazilian Society of Neurosurgery.
  2. 2018 Ricardo Ramina Award — Paraná Congress of Advances in Neurosurgery.
  3. 2015 Third-ranked graduate of the XIX medical class — UNOESTE.

The question is not whether surgery is possible. It is whether surgery is the best thing that can be offered to this patient, now.

Training and credentials

Medical schoolMedicine — Universidade do Oeste Paulista (2009–2015)

ResidencyNeurosurgery — Hospital Regional de Presidente Prudente (2016–2021)

BoardSpecialist in Neurosurgery — Brazilian Society of Neurosurgery (2022)

Fellowship courseSkull Base Approaches — Weill Cornell Medical College (2022)

LicenceCRM-SP 173777 · RQE 94247

PracticeInstituto Cérebro Coluna — Presidente Prudente, SP, Brazil

Continuing education

Courses and hands-on training

Continuing training in microsurgical anatomy and skull base surgery.

  • 2022 Skull Base ApproachesWeill Cornell Medical College — United States
  • 2019 Microsurgical Anatomy of the Cerebral Sulci, Gyri and VentriclesUNIFESP
  • 2019 Fibre Dissection of the Sulci and Gyri and its Practical ApplicationsUNIFESP
  • 2014 Case Discussion, Department of NeurosurgeryHospital Regional de Presidente Prudente

Bring your scans and your questions

Appointments by phone or WhatsApp.

Phone and WhatsApp+55 18 3918 9898

OfficeInstituto Cérebro ColunaAv. Cel. José Soares Marcondes, 3300

LocationJardim BongiovaniPresidente Prudente — SP, 19050-230

AvailabilityConsultations by appointment