LUCIANO HENRIQUE LOPES FORONI

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Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina

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  • article 9 Citação(ões) na Scopus
    Elective amputation of the upper limb is an option in the treatment of traumatic injuries of the brachial plexus?
    (2017) SIQUEIRA, Mario Gilberto; MARTINS, Roberto Sergio; HEISE, Carlos Otto; FORONI, Luciano
    The treatment of complete post-traumatic brachial plexus palsy resulting in a flail shoulder and upper extremity remains a challenge to peripheral nerve surgeons. The option of upper limb amputation is controversial and scarcely discussed in the literature. We believe that elective amputation still has a role in the treatment of select cases. The pros and cons of the procedure should be intensely discussed with the patient by a multidisciplinary team. Better outcomes are usually achieved in active patients who strongly advocate for the procedure.
  • article 3 Citação(ões) na Scopus
    Prognostic value of thumb pain sensation in birth brachial plexopathy
    (2012) HEISE, Carlos O.; MARTINS, Roberto S.; FORONI, Luciano H.; SIQUEIRA, Mario G.
    Objective: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. Methods: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6). The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. Results: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. Conclusion: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.
  • article 8 Citação(ões) na Scopus
    Nerve transfers for acute flaccid myelitis: a case series
    (2021) HEISE, C. O.; OLIVEIRA, A. J. de; BHERING, T.; MARTINS, R. S.; STERMAN-NETO, H.; FORONI, L.; SIQUEIRA, M. G.
    Background Acute flaccid myelitis (AFM) syndrome consists of loss of lower motor neurons following a viral infection, with preserved sensory function. It usually affects the upper limbs asymmetrically, with proximal more than distal muscle involvement. Methods Five cases were surgically treated with nerve transfers: spinal accessory to suprascapular nerve transfer (4 patients), branch of radial nerve to axillary nerve transfer (Somsak's procedure) (2 patients), and transfer of a fascicle of the ulnar nerve to the motor branch to the biceps (Oberlin's procedure) (1 patient). Results Motor improvement was seen in three cases. Widespread motor involvement was associated with poor outcome. Conclusion This small series of cases reinforces that nerve transfers are a reliable option for treatment of selected children with AFM.
  • article 52 Citação(ões) na Scopus
    A Prospective Study Comparing Single and Double Fascicular Transfer to Restore Elbow Flexion After Brachial Plexus Injury
    (2013) MARTINS, Roberto Sergio; SIQUEIRA, Mario Gilberto; HEISE, Carlos Otto; FORONI, Luciano; TEIXEIRA, Manoel Jacobsen
    BACKGROUND: The recovery of elbow flexion in upper brachial plexus injury can be achieved by the reinnervation of the biceps muscle (single reinnervation), but concomitant restoration of brachialis and biceps function (double reinnervation) has been recommended to improve elbow flexion strength. OBJECTIVE: To prospectively compare morbidity and outcomes of single or double muscle reinnervation in restoring elbow flexion following incomplete injury to the brachial plexus. METHODS: Forty consecutive patients were prospectively submitted to single or double muscle reinnervation. Elbow flexion strength was evaluated with a push-and-pull dynamometer 12 months after surgery. Hand morbidity related to the procedures was evaluated by the Semmes-Weinstein monofilaments test, quantification of static 2-point discrimination, and measurements of handgrip and lateral pinch strength in serial evaluations up to the final follow-up. RESULTS: Similar results for the strength of elbow flexion were observed in both groups. A worsening of sensibility, measured by using Semmes-Weinstein monofilaments, was identified in 8 patients, all of whom showed recovery during follow-up. No worsening of 2-point discrimination was observed. A decrease in handgrip and lateral pinch strength was identified in 8 and 9 patients, respectively, which improved during follow-up. There was no difference between the groups in the incidence of hand motor morbidity parameters. CONCLUSION: The strength of elbow flexion did not differ significantly between the groups treated with single or double muscle reinnervation. Deterioration of handgrip, lateral pinch strength, and sensibility measured by using Semmes-Weinstein monofilaments, was temporary, resulting in low morbidity for both techniques.
  • article 1 Citação(ões) na Scopus
    Expanded endonasal approach to skull base meningiomas
    (2013) MONACO, Bernardo Assumpcao de; RAMOS, Henrique Faria; GOMES, Marcos Queiroz Telles; SANTO, Marcelo Prudente do Espirito; FORONI, Luciano; SENNES, Luiz Ubirajara; TEIXEIRA, Manoel Jacobsen
  • article 2 Citação(ões) na Scopus
    Perineurioma of the posterior interosseous nerve: surgical treatment
    (2013) MENENDEZ, Djalma Felipe da Silva; MARTINS, Roberto Sergio; SIQUEIRA, Mario Gilberto; SILVA, Igor Araujo Ferreira da; CAVALCANTE, Livia Barreiro; FALZONI, Roberto; FORONI, Luciano Henrique Lopes; TEIXEIRA, Manoel Jacobsen
  • article 10 Citação(ões) na Scopus
    Distal nerve transfer versus supraclavicular nerve grafting: comparison of elbow flexion outcome in neonatal brachial plexus palsy with C5-C7 involvement
    (2017) HEISE, Carlos O.; SIQUEIRA, Mario G.; MARTINS, Roberto S.; FORONI, Luciano H.; STERMAN-NETO, Hugo
    Purpose Ulnar and median nerve transfers to arm muscles have been used to recover elbow flexion in infants with neonatal brachial plexus palsy, but there is no direct outcome comparison with the classical supraclavicular nerve grafting approach. Methods We retrospectively analyzed patients with C5-C7 neonatal brachial plexus palsy submitted to nerve surgery and recorded elbow flexion recovery using the active movement scale (0-7) at 12 and 24 months after surgery. We compared 13 patients submitted to supraclavicular nerve grafting with 21 patients submitted to distal ulnar or median nerve transfer to biceps motor branch. We considered elbow flexion scores of 6 or 7 as good results. Results The mean elbow flexion score and the proportion of good results were better using distal nerve transfers than supraclavicular grafting at 12 months (p < 0.01), but not at 24 months. Two patients with failed supraclavicular nerve grafting at 12 months showed good elbow flexion recovery after ulnar nerve transfers. Conclusion Distal nerve transfers provided faster elbow flexion recovery than supraclavicular nerve grafting, but there was no significant difference in the outcome after 24 months of surgery. Patients with failed supraclavicular grafting operated early can still benefit from late distal nerve transfers. Supraclavicular nerve grafting should remain as the first line surgical treatment for children with neonatal brachial plexus palsy.
  • article 1 Citação(ões) na Scopus
    Fascicular Anatomy of the Musculocutaneous Nerve in Its Origin in Lateral Cord. Could It Be Used for Better Surgical Results?
    (2021) FORONI, Luciano; OLIVEIRA, Adilson Jose Manuel de; SIQUEIRA, Mario Gilberto; MARTINS, Roberto Sergio; HEISE, Carlos Otto
    BACKGROUND: Though anatomy of the brachial plexus is well known, its fascicular anatomy is still a challenge. In case of themusculocutaneous nerve (MCN), the position of the motor branches at its terminations is well known; however, their position in the lateral cord has been rarely investigated. OBJECTIVE: To describe the position of motor branches of the MCN at its origin in the lateral cord. METHODS: The MCN of 26 adult nonfixed cadavers was dissected from its terminal branches in the medial aspect of the arm to its origin from the lateral cord of the brachial plexus (from distal to proximal) on the right side, removed, and fixed. Intraneural longitudinal fascicular dissectionwas performed using microsurgical techniques, withmeticulous removal of connective tissue and subsequent identification and tracking of fibers of each MCN branch. RESULTS: At the origin of the nerve, biceps and brachialis muscle fiberswere concentrated in the lateral portion of the nerve (100%), and the sensory fiberswere preferentially located in the medial portion (78%). CONCLUSION: At its origin, the lateral portion of the MCN is the best location to coapt. donor nerves in order to improve motor results.
  • article 2 Citação(ões) na Scopus
    Critical analysis of extra peritoneal antero-lateral approach for lumbar plexus
    (2011) MARTINS, Roberto Sergio; MONACO, Bernardo Assumpcao; SIQUEIRA, Mario Gilberto; FORONI, Luciano; HEISE, Carlos Otto; TEIXEIRA, Manoel Jacobsen
    Lesions of lumbar plexus are uncommon and descriptions of surgical access are derived from vertebral spine approaches. Method: The extraperitoneal anterolateral approach to the lumbar plexus was performed in six adult fresh cadavers. The difficulties on dissection were related. Results: An exposure of all distal elements of lumbar plexus was possible, but a cranial extension of the incision was needed to reach the iliohypogastric nerve in all cases. Ligation of vessels derived from common iliac artery was necessary for genitofemoral and obturator nerves exposure in two cases. The most proximal part of the lumbar roots could be identified only after dissection and clipping of most lumbar vessels. Conclusion: The extraperitoneal anterolateral approach allows appropriate exposure of terminal nerves of lumbar plexus laterallly to psoas major muscle. Cranial extension of the cutaneous incision may be necessary for exposure of iliohypogastric nerve. Roots exposure increases the risk of vascular damage.
  • article 0 Citação(ões) na Scopus
    The nerve to the levator scapulae muscle as donor in brachial plexus surgery: an anatomical study and case series
    (2021) MARTINS, Roberto Sergio; SIQUEIRA, Mario Gilberto; HEISE, Carlos Otto; FORONI, Luciano; NETO, Hugo Sterman; TEIXEIRA, Manoel Jacobsen
    OBJECTIVE Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series. METHODS Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength. RESULTS The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade >= 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer. CONCLUSIONS The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.