MARIO GILBERTO SIQUEIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
21 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 21
- 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, LucianoThe 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.
- 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.
- Traumatic injuries of peripheral nerves: a review with emphasis on surgical indication(2013) MARTINS, Roberto Sergio; BASTOS, Dhiego; SIQUEIRA, Mario Gilberto; HEISE, Carlos Otto; TEIXEIRA, Manoel JacobsenTraumatic peripheral nerve injury is a dramatic condition present in many of the injuries to the upper and lower extremities. An understanding of its physiopathology and selection of a suitable time for surgery are necessary for proper treatment of this challenging disorder. This article reviews the physiopathology of traumatic peripheral nerve injury, considers the most used classification, and discusses the main aspects of surgical timing and treatment of such a condition.
- Influence of Suture on Peripheral Nerve Regeneration and Collagen Production at the Site of Neurorrhaphy: An Experimental Study(2011) MARTINS, Roberto Sergio; TEODORO, Walcy Rosolio; SIMPLICIO, Hougelle; CAPELLOZI, Vera Luiza; SIQUEIRA, Mario Gilberto; YOSHINARI, Natalino Hajime; PLESE, Jose Pindaro Pereira; TEIXEIRA, Manoel JacobsenBACKGROUND: Restoration of nerve continuity and effective maintenance of coaptation are considered fundamental principles of end-to-end peripheral nerve repair. OBJECTIVE: To evaluate the influence of the number of stitches on axonal regeneration and collagen production after neurorrhaphy. METHODS: Thirty male Wistar rats were equally divided into 3 groups and were all operated on with the right sciatic nerve exposed. In 2 groups, the nerve was sectioned and repaired by means of 3 (group B) or 6 (group C) epineurium sutures with 100 monofilament nylon. One group (group A) was used as a control. Each animal from groups B and C underwent electrophysiological evaluation with motor action potential recordings before nerve section and again at an 8-week interval after neurorrhaphy. Nerve biopsy specimens were used for histomorphometric assessment of axonal regeneration and quantification of collagen at the repair site. RESULTS: Animals from group C had significantly lower motor action potential conduction velocities compared with control animals (P = .02), and no significant difference was seen between groups B and C. Parameters obtained from morphometric evaluation were not significantly different between these 2 groups. Type I collagen and III collagen in the epineurium were significantly higher in group C than in either the control group (P = .001 and P = .003) or group B (P = .01 and P = .02). No differences were identified for collagen I and III in the endoneurium. CONCLUSION: Using 6 sutures for nerve repair is associated with worse electrophysiological outcomes and higher amounts of type I and III collagen in the epineurium compared with control. Neurorraphy with 6 stitches is also related to a significant increase in epineurium collagen I and III compared with 3-stitch neurorraphy.
- 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 JacobsenBACKGROUND: 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.
- Interdigital direct neurorrhaphy for treatment of painful neuroma due to finger amputation(2015) MARTINS, Roberto Sergio; SIQUEIRA, Mario Gilberto; HEISE, Carlos Otto; YENG, Lin Tchia; ANDRADE, Daniel Ciampi de; TEIXEIRA, Manoel JacobsenPainful neuroma following amputation is a disabling condition for which treatments are not usually satisfactory. The aim of this study is to retrospectively evaluate the results of interdigital neurorrhaphy after neuroma resection as an option for the surgical treatment of painful digital neuroma. We retrospectively analyzed data from seven patients submitted to interdigital neurorrhaphy for treatment of digital neuroma. For evaluation of the results, the visual analog scale (VAS) for pain assessment, measurements with Simmens-Weinstein filaments and a handgrip dynamometer, and quantification of the Disabilities of the Arm, Shoulder and Hand (DASH) score were all performed. The mean improvements on the VAS and DASH scores were calculated. The mean follow-up was 28.3 months. All patients presented some degree of improvement in upper limb functionality and pain, and handling the affected finger was possible in all cases. The mean improvement on the VAS and DASH scores was 29.8 and 55.5 %, respectively. No patients presented long-term complications. Although this study was based on a small number of patients, it indicates that interdigital neurorrhaphy seems to be a feasible surgical treatment for painful digital neuroma.
- Conservative therapeutic management of carpal tunnel syndrome(2017) MARTINS, Roberto Sergio; SIQUEIRA, Mario GilbertoCarpal tunnel syndrome is the most prevalent nerve compression and can be clinically or surgically treated. In most cases, the first therapeutic alternative is conservative treatment but there is still much controversy regarding the most effective modality of this treatment. In this study, we critically evaluated the options of conservative treatment for carpal tunnel syndrome, aiming to guide the reader through the conventional options used in this therapy.
- 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
- 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.
- Clinical Results of Transferring a Motor Branch of the Tibial Nerve to the Deep Peroneal Nerve for Treatment of Foot Drop(2013) FLORES, Leandro Pretto; MARTINS, Roberto Sergio; SIQUEIRA, Mario GilbertoBACKGROUND: Foot drop is a very debilitating condition affecting patients' daily activities, and its treatment has been a challenge for neurosurgeons. Grafting the peroneal or sciatic nerve usually results in poor outcomes. Our previous anatomic study demonstrated the feasibility of transferring a motor branch of the tibial nerve to the deep peroneal nerve at the level of the popliteal fossa. OBJECTIVE: To demonstrate the outcomes obtained after the transfer of a branch of the tibial nerve to the peroneal nerve for recovery of foot drop. METHODS: A retrospective review of 13 patients with foot drop caused by injuries to a lumbar root or the sciatic or peroneal nerve, who underwent a transfer of the nerve of the soleus muscle to the deep peroneal nerve. The results were evaluated using the British Medical Research Council grading system. RESULTS: Three patients were lost to follow-up. Of the remaining 10 patients, the outcomes were considered good (Medical Research Council grade M3 or M4) in 2 patients (20%) concerning ankle dorsiflexion and in 2 patients concerning toe extension (20%). One patient reported a reduced calf circumference. CONCLUSION: The transfer of the nerve of the soleus muscle to the deep peroneal nerve demonstrated poor results in most of the patients, although favorable outcomes were observed in a few subjects. Due to the inconsistency of the results, we do not favor the routine use of this technique for the treatment of foot drop.
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