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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- 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.
- Effectiveness of the histamine test for diagnosing root avulsion in patients with traumatic brachial plexus injury(2020) STERMAN-NETO, H.; HEISE, C. O.; SIQUEIRA, M. G.; MARTINS, R. S.; TAVARES, P. L.; FORONI, L. H.Objectives: Making the diagnosis of root avulsion in traumatic brachial plexus injuries is important but sometimes difficult. The histamine test for differentiating between pre- and post-ganglionic lesions is a simple, fast and low-cost procedure. We conducted a study on patients with traumatic brachial plexus injury in order to evaluate the effectiveness of this test. Patients and methods: A total of 60 patients were initially evaluated. The subjects underwent clinical examination, myelo-CT and myelo-MRI, as well as the histamine test. The latter was applied to dermatomes C5 to T1, and occurrences of secondary neurogenic erythema were noted. The results were compared with surgical and imaging findings. Results: No statistical significance could be found for C5 and C6 roots, compared with surgical evaluation. The results for C5 showed that this may be useful for determining avulsion. Although significant results were found between the histamine test and imaging findings for all roots except for C6, the specificity of 0% for C8 and T1 is not helpful in clinical practice. Conclusion: Histamine test seems to be useful for C5 root assessment, since neurophysiological assessment of that root is difficult. There was no significance for C6 root and disappointing specificity for the C8-T1 level.
- 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.
- Restoration of shoulder external rotation by means of the infraspinatus muscle reinnervation with a radial nerve branch transfer(2020) TAVARES, Paulo L.; SIQUEIRA, Mario G.; MARTINS, Roberto S.; ZACCARIOTTO, Monise; FORONI, Luciano; HEISE, Carlos O.; SOLLA, DaviBackground: Although reinnervation of the suprascapular nerve is frequently obtained through brachial plexus surgery, reestablishment of infraspinatus muscle function is rarely achieved. Methods: The viability of transfer of the radial nerve to the nerve branch to the infraspinatus muscle was determined anatomically, including histomorphometrical analysis on 30 adult cadavers. Eleven adult patients were then treated using the proposed nerve transfer. Results: The branch to the medial head was more suitable for the nerve transfer. In one cadaver, nerve transfer was impossible because there was no donor of sufficient length. According to axon counts, the branches to the lateral and medial heads had sufficient numbers of axons (means = 994.2 +/- 447.6 and 1030.8 +/- 258.5, respectively) for reinnervation of the branch to the infraspinatus (means = 830.2 +/- 241.2 axons). In the surgical series, one patient was lost in the follow-up and only two patients achieved a good result from the transfer. Recovery of external shoulder rotation started 14 months after surgery in one patient and 8 months in the other. The first patient reached 90 degrees of external rotation 6 months later and the second, achieved 120 degrees of shoulder external rotation 6 months after surgery . Four other patients recovered small amounts of movement: 20, 35, 40 and 45 degrees. Conclusions: Although anatomically feasible, the proposed nerve transfer resulted in a small number of good clinical outcomes.