ROBSON LUIS OLIVEIRA DE AMORIM

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LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina

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  • article 1 Citação(ões) na Scopus
    Transcranial Doppler: A Useful Tool to Predict Brain Death Still Not Confirmed by Clinical Assessment
    (2021) RONCONI, Karla de Almeida Lins; AMORIM, Robson Luis Oliveira de; JR, Fernando Mendes Paschoal; OLIVEIRA, Marcelo de Lima; NOGUEIRA, Ricardo de Carvalho; PAIVA, Wellingson Silva; GONCALVES, Daniel Buzaglo; FARIAS, Stephanie Ramos de; BRASIL, Sergio Paulo; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
    Background. Diagnosing brain death (BD) with accuracy and urgency is of great importance because an early diagnosis may guide the clinical management, optimize hospital beds, and facilitate organ transplantation. The clinical diagnosis of nonreactive and irreversible coma can be confirmed with additional tests. Among the complimentary exams that may testify brain circulatory arrest, transcranial Doppler (TCD) can be an option. It is a real-time, bedside, inexpensive, noninvasive method that assesses cerebral blood flow. In patients with suspected BD, especially those who are under sedative drugs, early diagnosis is imperative. The aim of the present study was to evaluate the role of TCD in predicting BD. Methods. One hundred consecutive comatose patients with a Glasgow Coma Scale score of less than 5, owing to different etiologies, were included. TCD was performed in all patients. The TCD operator was blinded for clinical and neurologic data. This study is in compliance with the Declaration of Helsinki. Results. Sixty-nine patients with TCD-brain circulatory collapse were diagnosed later with BD. Of the 31 patients with brain circulatory activity, 8 (25.8%) were clinically brain dead and 23 (74.2%) were alive. TCD showing brain circulatory collapse had a sensitivity of 89.6%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 74.2%. Conclusion. TCD is highly specific (100%) and sensitive (89.6%) as a method to confirm the clinical diagnosis of BD, even in patients under sedation. The possibility of patients presenting with cerebral circulatory activity and clinical diagnosis of BD was demonstrated to occur.
  • article 5 Citação(ões) na Scopus
    Brainstem injury by penetrating head trauma with a knife
    (2012) PAIVA, Wellingson Silva; ANDRADE, Almir Ferreira De; AMORIM, Robson Luis; FIGUEIREDO, Eberval Gadelha; TEIXEIRA, Manoel Jacobsen
    The authors describe a rare case about a traumatic lesion of brain and brain stem with a knife. In this case the patient had good clinical condition, diagnosed with TBI by infectious complications. We have highlighted the unusual diagnosis, proximity of vascular structures, the technique used in the treatment and the good outcome of the injury.
  • article 6 Citação(ões) na Scopus
    Mismatch between midline shift and hematoma thickness as a prognostic factor of mortality in patients sustaining acute subdural hematoma
    (2021) SOUZA, Matheus Rodrigues de; FAGUNDES, Caroline Ferreira; SOLLA, Davi Jorge Fontoura; SILVA, Gustavo Carlos Lucena da; BARRETO, Rafaela Borin; TEIXEIRA, Manoel Jacobsen; AMORIM, Robson Luis Oliveira de; KOLIAS, Angelos G.; GODOY, Daniel; PAIVA, Wellingson Silva
    Background Acute subdural hematoma (ASDH) is a traumatic lesion commonly found secondary to traumatic brain injury. Radiological findings on CT, such as hematoma thickness (HT) and structures midline shift (MLS), have an important prognostic role in this disease. The relationship between HT and MLS has been rarely studied in the literature. Thus, this study aimed to assess the prognostic accuracy of the difference between MLS and HT for acute outcomes in patients with ASDH in a low-income to middle-income country. Methods This was a post-hoc analysis of a prospective cohort study conducted in a university-associated tertiary-level hospital in Brazil. The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis) statement guidelines were followed. The difference values between MLS and HT (Zumkeller index, ZI) were divided into three categories (<0.00, 0.01-3, and >3). Logistic regression analyses were performed to reveal the OR of categorized ZI in predicting primary outcome measures. A Cox regression was also performed and the results were presented through HR. The discriminative ability of three multivariate models including clinical and radiological variables (ZI, Rotterdam score, and Helsinki score) was demonstrated. Results A total of 114 patients were included. Logistic regression demonstrated an OR value equal to 8.12 for the ZI >3 category (OR 8.12, 95% CI 1.16 to 40.01; p=0.01), which proved to be an independent predictor of mortality in the adjusted model for surgical intervention, age, and Glasgow Coma Scale (GCS) score. Cox regression analysis demonstrated that this category was associated with 14-day survival (HR 2.92, 95% CI 1.38 to 6.16; p=0.005). A multivariate analysis performed for three models including age and GCS with categorized ZI or Helsinki or Rotterdam score demonstrated area under the receiver operating characteristic curve values of 0.745, 0.767, and 0.808, respectively. Conclusions The present study highlights the potential usefulness of the difference between MLS and HT as a prognostic variable in patients with ASDH.
  • article 0 Citação(ões) na Scopus
    Letter to the Editor Regarding ""Optimal Bone Flap Size for Decompressive Craniectomy for Refractory Increased Intracranial Pressure in Traumatic Brain Injury: Taking the Patient's Head Size into Account""
    (2020) GONCALVES, Daniel Buzaglo; COSTA, Laura Raquel da Silva; SANTOS, Maria Izabel Andrade dos; AMORIM, Robson Luis Oliveira de; PAIVA, Wellingson Silva
  • article 31 Citação(ões) na Scopus
    The Puzzling Olfactory Groove Schwannoma: A Systematic Review
    (2011) FIGUEIREDO, Eberval Gadelha; SOGA, Yougi; AMORIM, Robson Luis Oliveira; OLIVEIRA, Arthur Maynart Pereira; TEIXEIRA, Manoel Jacobsen
    We systematically reviewed the literature concerning the anterior cranial fossa schwannomas to understand their pathogenesis, determine their origin, and standardize the terminology. We performed a MEDLINE, EMBASE, and Science Citation Index Expanded search of the literature; age, gender, clinical presentation, presence or absence of hyposmia, radiological features, and apparent origin were analyzed and tabulated. Cases in a context of neurofibromatosis and nasal schwannomas with intracranial extension were not included. Age varied between 14 and 63 years (mean = 30.9). There were 22 male and 11 female patients. The clinical presentation included seizures (n = 15), headache (n = 16), visual deficits (n = 7), cognitive disturbances (n = 3), and rhinorrhea (n = 1). Hyposmia was present in 14 cases, absent in 13 cases (39.3%), and unreported in five. Homogeneous and heterogeneous contrast enhancement was observed in 14 and 15 cases, respectively. The region of the olfactory groove was the probable site in 96.5%. Olfactory tract could be identified in 39.3%. The most probable origin is the meningeal branches of trigeminal nerve or anterior ethmoidal nerves. Thus, olfactory groove schwannoma would better describe its origin and pathogenesis and should be the term preferentially used to name it.
  • article 44 Citação(ões) na Scopus
    Consensus statement from the international consensus meeting on post-traumatic cranioplasty
    (2021) IACCARINO, C.; KOLIAS, A.; ADELSON, P. D.; RUBIANO, A. M.; VIAROLI, E.; BUKI, A.; CINALLI, G.; FOUNTAS, K.; KHAN, T.; SIGNORETTI, S.; WARAN, V.; ADELEYE, A. O.; AMORIM, R.; BERTUCCIO, A.; CAMA, A.; CHESNUT, R. M.; BONIS, P. De; ESTRANEO, A.; FIGAJI, A.; FLORIAN, S. I.; FORMISANO, R.; FRASSANITO, P.; GATOS, C.; GERMANO, A.; GIUSSANI, C.; HOSSAIN, I.; KASPRZAK, P.; PORTA, F. La; LINDNER, D.; MAAS, A. I. R.; PAIVA, W.; PALMA, P.; PARK, K. B.; PERETTA, P.; POMPUCCI, A.; POSTI, J.; SENGUPTA, S. K.; SINHA, A.; SINHA, V.; STEFINI, R.; TALAMONTI, G.; TASIOU, A.; ZONA, G.; ZUCCHELLI, M.; HUTCHINSON, P. J.; SERVADEI, F.
    Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
  • article 9 Citação(ões) na Scopus
    Ultrasonography During Surgery to Approach Cerebral Metastases: Effect on Karnofsky Index Scores and Tumor Volume
    (2017) OLIVEIRA, Marcelo de Lima; PICARELLI, Helder; MENEZES, Marcos Roberto; AMORIM, Robson Luis; TEIXEIRA, Manoel Jacobsen; BOR-SENG-SHU, Edson
    BACKGROUND: The goals of treating a cerebral metastasis (CM) are to achieve local control of the disease and to improve patient quality of life. The aim of this study was to analyze the effect of conventional surgery supported by intraoperative ultrasound (IOUS) to approach a CM. To perform this analysis, we determined the postoperative Karnofsky Performance Status Scale (KPS) scores and tumor resection grades. METHODS: Patients with a CM diagnosis were included in this study. Surgical treatment was either supported or not by IOUS. Pre-and postoperative KPS scores were determined by the oncology team, and cerebral tumor volume was estimated through pre-and postoperative magnetic resonance imaging. The surgical team determined whether it was possible to perform a total CM resection. RESULTS: There were 78 patients treated using surgical management (35 with and 43 without IOUS). In the IOUS group, the postoperative KPS scores were higher (80 vs. 70, respectively; P = 0.045) and the KPS evolution was superior (P = 0.036), especially in the following subgroups: difficulty of tumor resection ranking score < 4 (P = 0.037), tumor in an eloquent area (P = 0.043), tumor not associated with vessels or nerves (P = 0.007), and solitary lesions (P = 0.038). The residual tumor volume was lower in the IOUS group (9.5% and 1.6 mm(3) vs. 30.8% and 9 mm(3), respectively; P = 0.05). In patients with a KPS score >= 70, 62% of them had <10% residual tumors (76% in the IOUS group and 45% in the non-IOUS group; P = 0.032; odds ratio, 3.8). CONCLUSIONS: IOUS may improve postoperative KPS scores and decrease residual tumor volumes in CM surgeries. These findings should be confirmed in future studies.
  • article 15 Citação(ões) na Scopus
    Safety and costs analysis of early hospital discharge after brain tumour surgery: a pilot study
    (2020) NEVILLE, Iuri Santana; URENA, Francisco Matos; QUADROS, Danilo Gomes; SOLLA, Davi J. F.; LIMA, Mariana Fontes; SIMOES, Claudia Marquez; VICENTIN, Eduardo; RIBEIRO JR., Ulysses; AMORIM, Robson Luis Oliveira; PAIVA, Wellingson Silva; TEIXEIRA, Manoel Jacobsen
    Background A daily algorithm for hospital discharge (DAHD) is a key point in the concept of Enhanced Recovery After Surgery (ERAS) protocol. We aimed to evaluate the length of stay (LOS), rate of complications, and hospital costs variances after the introduction of the DAHD compared to the traditional postoperative management of brain tumour patients. Methods This is a cohort study with partial retrospective data collection. All consecutive patients who underwent brain tumour resection in 2017 were analysed. Demographics and procedure-related variables, as well as clinical outcomes, LOS and healthcare costs within 30 days after surgery were compared in patients before/pre-implementation and after/post-implementation the DAHD, which included: stable neurological examination; oral feeding without aspiration risk; pain control with oral medications; no intravenous medications. The algorithm was applied every morning and discharge was considered from day 1 after surgery if criteria was fulfilled. The primary outcome (LOS after surgery) analysis was adjusted for the preoperative performance status on a multivariable logistic regression model. Results A total of 61 patients were studied (pre-implementation 32, post-implementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS decreased significantly (median 5 versus 3 days; p = 0.001) and the proportion of patients who were discharged on day 1 or 2 after surgery increased (44.8% vs 3.1%; p < 0.001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day follow-up were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group (US$2135 vs US$2765, p = 0.043), mainly due to a reduction in median ward costs (US$922 vs US$1623, p = 0.009). Conclusions Early discharge after brain tumour surgery appears to be safe and inexpensive. The LOS and hospitalization costs were reduced without increasing readmission rate or postoperative complications.
  • conferenceObject
    Decreased Cerebral Blood Flow in the Central Core of Malignant MCA Stroke in Patients Submitted to Decompressive Craniectomy is Associated with Late Recovery of Consciousness
    (2015) AMORIM, Robson; SHU, Edson; ANDRADE, Almir; GATTAS, Gabriel; PAIVA, Wellingson; TEIXEIRA, Manoel
  • article 16 Citação(ões) na Scopus
    The Evolving Concept of Damage Control in Neurotrauma: Application of Military Protocols in Civilian Settings with Limited Resources
    (2019) RUBIANO, Andres M.; MALDONADO, Miguel; MONTENEGRO, Jorge; RESTREPO, Claudia M.; KHAN, Ahsan Ali; MONTEIRO, Ruy; FALEIRO, Rodrigo M.; CARRENO, Jose N.; AMORIM, Robson; PAIVA, Wellingson; MUNOZ, Erick; PARANHOS, Jorge; SOTO, Alvaro; ARMONDA, Rocco; ROSENFELD, Jeffrey V.
    OBJECTIVE: The aim of the present review was to describe the evolution of the damage control concept in neurotrauma, including the surgical technique and medical postoperative care, from the lessons learned from civilian and military neurosurgeons who have applied the concept regularly in practice at military hospitals and civilian institutions in areas with limited resources. METHODS: The present narrative review was based on the experience of a group of neurosurgeons who participated in the development of the concept from their practice working in military theaters and low-resources settings with an important burden of blunt and penetrating cranial neurotrauma. RESULTS: Damage control surgery in neurotrauma has been described as a sequential therapeutic strategy that supports physiological restoration before anatomical repair in patients with critical injuries. The application of the concept has evolved since the early definitions in 1998. Current strategies have been supported by military neurosurgery experience, and the concept has been applied in civilian settings with limited resources. CONCLUSION: Damage control in neurotrauma is a therapeutic option for severe traumatic brain injury management in austere environments. To apply the concept while using an appropriate approach, lessons must be learned from experienced neurosurgeons who use this technique regularly.