LUCIANO HENRIQUE LOPES FORONI
Projetos de Pesquisa
Unidades Organizacionais
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
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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- 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.
- 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 OttoBACKGROUND: 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.
- Treatment of radiation-induced brachial plexopathy with omentoplasty(2020) OLIVEIRA, Adilson José Manuel de; CASTRO, João Paulo de Souza; FORONI, Luciano Henrique; SIQUEIRA, Mário Gilberto; MARTINS, Roberto SérgioABSTRACT Radiation-induced brachial plexus neuropathy (RIBPN) is a rare and delayed non-traumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, and/or axilla in previously treated patients with cancer. The incidence of RIBPN is more common in patients treated for carcinoma of the breast and Hodgkin lymphoma. With the improvement in radiation techniques, the incidence of injury to the brachial plexus following radiotherapy has dramatically reduced. The currently reported incidence is 1.2% in women irradiated for breast cancer. The progression of symptoms is gradual in about two-thirds of cases; the patients may initially present with paresthesia followed by pain, and later progress to motor weakness in the affected limb. We present the case of a 68-year-old female patient with breast cancer submitted to surgery, chemotherapy, and radiotherapy in the year 2000. Eighteen years later, she developed symptoms and signs compatible with RIBPN and was successfully submitted to omentoplasty for pain control. Omentoplasty is an alternative treatment for RIBPN refractory to conservative treatment, which seems to be effective in improving neuropathic pain. However, postoperative worsening of the motor strength is a real possibility, and all candidates for this type of surgery must be informed about the risk of this complication.
- Diagnostic accuracy of imaging studies for diagnosing root avulsions in post-traumatic upper brachial plexus traction injuries in adults(2020) BORDALO-RODRIGUES, Marcelo; SIQUEIRA, Mario G.; KURIMORI, Ceci O.; CARNEIRO, Ana Carolina R.; MARTINS, Roberto S.; FORONI, Luciano; OLIVEIRA, Adilson J. M.; SOLLA, Davi J. F.Background There is no consensus about which type of imaging study, computed tomography myelography (CTM) or magnetic resonance imaging (MRI), provides better information concerning root avulsion in adult brachial plexus injuries. Methods Patients with upper brachial plexus traumatic injuries underwent both CTM and MRI and surgical exploration. The imaging studies were analyzed by two independent radiologists and the data were compared with the intraoperative findings. The statistical analysis was based on dichotomous classification of the nerve roots (normal or altered). The interobserver agreement was assessed using Cohen's Kappa. The accuracy of CTM and MRI in comparison with the intraoperative findings was evaluated using the same methodology. Results Fifty-two adult patients were included. CTM tended to yield slightly higher percentages of alterations than MRI The interobserver agreement was better on CTM than on MRI for all nerve roots: C5, 0.9960 (strong) vs. 0.145 (poor); C6, 0.970 (strong) vs. 0.788 (substantial); C7, 0.969 (strong) vs. 0.848 (strong). The accuracy regarding the intraoperative findings was also higher on CTM (moderate, kappa 0.40-0.59) than on MRI (minimal, kappa 0.20-0.39) for all nerve roots. Accordingly, the overall percentage concordance (both normal or both altered) was superior in the CTM evaluation (approx. 70-75% vs. 60-65%). CTM was superior for both sensitivity and specificity at all nerve roots. Conclusion CTM had greater interobserver agreement and higher diagnostic accuracy than MRI in adult patients with root avulsions due to brachial plexus injury.