CARLOS OTTO HEISE
Índice h a partir de 2011
14
Projetos de Pesquisa
Unidades Organizacionais
LIM/15 - Laboratório de Investigação em Neurologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- True neurogenic thoracic outlet syndrome: late outcomes from a surgical series(2022) MARTINS, Roberto Sergio; ZACCARIOTTO, Monise; SIQUEIRA, Mario Gilberto; HEISE, Carlos Otto; NETO, Hugo Sterman; TEIXEIRA, Manoel JacobsenBackground True neurogenic thoracic outlet syndrome (TNTOS) is rare, and evaluation of surgical treatment is limited to a few studies in the literature. The purpose of this study is to present the results from a surgical series of 21 patients with TNTOS. Methods Retrospective analysis on 21 patients diagnosed with TNTOS who underwent surgery. Demographic data and neurological status were characterized, and patients were classified in accordance with a pre-established scale for assessing the severity of hand impairment before and after surgery. Neuropathic pain was assessed using a visual analogue scale (VAS) and functional disability was quantified using the QuickDASH questionnaire. The results from before and after surgery were compared using the Wilcoxon test, and the significance level was taken to be 5%. Results There was a significant difference in VAS values from before to after the operation (Wilcoxon test: p = 0.0001; r = 0.86). Most patients (90%) improved after surgery, and in 85% of these patients, the VAS improvement was greater than 50%. Improvement in hand function occurred in seven patients (33.3%), and in most of these cases (28.6%), this improvement was classified as mild. Most patients (93.3%) showed moderate to very severe functional disability at the end of the follow-up. Conclusion After surgery, only one-third of the cases showed improvement in motor function and most patients had significant functional disability. However, the improvement regarding pain was significant. Surgery to control this symptom should be recommended, even in cases of late presentation and severe motor impairment.
- 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.
- 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, HugoPurpose 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.
- 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 JacobsenOBJECTIVE 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.
- 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.
- Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor(2017) FORONI, Luciano; SIQUEIRA, Mario Gilberto; MARTINS, Roberto Sergio; HEISE, Carlos Otto; STERMAN NETO, Hugo; IMAMURA, Adriana YorikoObjective: Restoration of the sensitivity to sensory stimuli in complete brachial plexus injury is very important. The objective of our study was to evaluate sensory recovery in brachial plexus surgery using the intercostobrachial nerve (ICBN) as the donor. Methods: Eleven patients underwent sensory reconstruction using the ICBN as a donor to the lateral cord contribution to the median nerve, with a mean follow-up period of 41 months. A protocol evaluation was performed. Results: Four patients perceived the 1-green filament. The 2-blue, 3-purple and 4-red filaments were perceptible in one, two and three patients, respectively. According to Highet's scale, sensation recovered to S3 in two patients, to S2+ in two patients, to S2 in six patients, and S0 in one patient. Conclusion: The procedure using the ICBN as a sensory donor restores good intensity of sensation and shows good results in location of perception in patients with complete brachial plexus avulsion.
- Self-biting behavior in patients with neonatal brachial plexus palsy(2022) HEISE, Carlos Otto; ZACCARIOTTO, Monise; MARTINS, Roberto S.; STERMAN-NETO, Hugo; SIQUEIRA, Mario G.Purpose Self-biting behavior in patients with neonatal brachial plexus palsy (NBPP) has been associated with finger amputation. Our objective is to describe the incidence of this complication, risk factors, and clinical management. Methods We retrospectively analyzed 612 patients with NBPP. There were 303 males and 309 females. 51.8% of patients had C5-C6 lesions, 28.9% had C5-C7, 18.9% had C5-T1, and 0.3 had C7-T1 involvement. Results We identified 15 patients with self-biting behavior (2.5%). Ten patients had C5-T1 lesions, and five had C5-C7 lesions. Eight patents were submitted to brachial plexus surgery and seven were not. This behavior appeared between 8 and 46 months of life (mean 23.5), and it was always temporary. There was no difference between operated and non-operated patients (p > 0.05), and no correlation between age at surgery and age of appearance of self-biting behavior (p > 0.05). Physical restriction was effective in treating this complication and we had no case of finger amputation. Conclusion Self-biting behavior is a rare complication of NBPP, and it is usually associated with severe motor involvement. The behavior duration is limited to a few months. This condition can be effectively treated with physical restriction to prevent hand biting.
- Bilateral radial nerve compression neuropathy in the newborn(2014) SIQUEIRA, Mario G.; SCARAMUZZI, Vinicius; HEISE, Carlos Otto; MARTINS, Roberto S.; STERMAN, HugoThis study aims to discuss the diagnosis and management of radial nerve compression neuropathy in the newborn. A personal case is presented, followed by a review and analysis of clinically similar cases identified via a PubMed search of published medical literature. We report a case of a term newborn with bilateral radial neuropathy at the humerus level. Despite severe axonal involvement in the electrophysiological evaluation, the patient showed complete bilateral recovery after 3 months of follow-up. Isolated radial nerve palsy is a rare event in the newborn. The condition does not require surgical treatment and usually proceeds to full and rapid spontaneous recovery.