ROBSON LUIS OLIVEIRA DE AMORIM
Projetos de Pesquisa
Unidades Organizacionais
LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Consensus statement from the international consensus meeting on post-traumatic cranioplasty(2021) IACCARINO, C.; KOLIAS, A.; ADELSON, P. D.; RUBIANO, A. M.; VIAROLI, E.; BUKI, A.; CINALLI, G.; FOUNTAS, K.; KHAN, T.; SIGNORETTI, S.; WARAN, V.; ADELEYE, A. O.; AMORIM, R.; BERTUCCIO, A.; CAMA, A.; CHESNUT, R. M.; BONIS, P. De; ESTRANEO, A.; FIGAJI, A.; FLORIAN, S. I.; FORMISANO, R.; FRASSANITO, P.; GATOS, C.; GERMANO, A.; GIUSSANI, C.; HOSSAIN, I.; KASPRZAK, P.; PORTA, F. La; LINDNER, D.; MAAS, A. I. R.; PAIVA, W.; PALMA, P.; PARK, K. B.; PERETTA, P.; POMPUCCI, A.; POSTI, J.; SENGUPTA, S. K.; SINHA, A.; SINHA, V.; STEFINI, R.; TALAMONTI, G.; TASIOU, A.; ZONA, G.; ZUCCHELLI, M.; HUTCHINSON, P. J.; SERVADEI, F.Background Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach. Methods The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP. Results The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations. Conclusions This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
- New perspectives on assessment and understanding of the patient with cranial bone defect: a morphometric and cerebral radiodensity assessment(2024) OLIVEIRA, Arthur Maynart Pereira; ANDRADE, Almir Ferreira De; PIPEK, Leonardo Zumerkorn; IACCARINO, Corrado; RUBIANO, Andres M.; AMORIM, Robson Luis; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground Skull defects after decompressive craniectomy (DC) cause physiological changes in brain function and patients can have neurologic symptoms after the surgery. The objective of this study is to evaluate whether there are morphometric changes in the cortical surface and radiodensity of brain tissue in patients undergoing cranioplasty and whether those variables are correlated with neurological prognosis.Methods This is a prospective cohort with 30 patients who were submitted to cranioplasty and followed for 6 months. Patients underwent simple head CT before and after cranioplasty for morphometric and cerebral radiodensity assessment. A complete neurological exam with Mini-Mental State Examination (MMSE), modified Rankin Scale, and the Barthel Index was performed to assess neurological prognosis.Results There was an improvement in all symptoms of the syndrome of the trephined, specifically for headache (p = 0.004) and intolerance changing head position (p = 0.016). Muscle strength contralateral to bone defect side also improved (p = 0.02). Midline shift of intracranial structures decreased after surgery (p = 0.004). The Anterior Distance Difference (ADif) and Posterior Distance Difference (PDif) were used to assess morphometric changes and varied significantly after surgery. PDif was weakly correlated with MMSE (p = 0.03; r = -0.4) and Barthel index (p = 0.035; r = -0.39). The ratio between the radiodensities of gray matter and white matter (GWR) was used to assess cerebral radiodensity and was also correlated with MMSE (p = 0.041; r = -0.37).Conclusion Morphological anatomy and radiodensity of the cerebral cortex can be used as a tool to assess neurological prognosis after DC.
- Improvement in neurological outcome and brain hemodynamics after late cranioplasty(2021) OLIVEIRA, Arthur Maynart Pereira; AMORIM, Robson Luis Oliveira; BRASIL, Sergio; GATTAS, Gabriel Scarabotolo; ANDRADE, Almir Ferreira de; PASCHOAL JUNIOR, Fernando Mendes; BOR-SENG-SHU, Edson; IACCARINO, Corrado; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson SilvaBackground Early cranioplasty has been encouraged after decompressive craniectomy (DC), aiming to reduce consequences of atmospheric pressure over the opened skull. However, this practice may not be often available in low-middle-income countries (LMICs). We evaluated clinical improvement, hemodynamic changes in each hemisphere, and the hemodynamic balance between hemispheres after late cranioplasty in a LMIC, as the institution's routine resources allowed. Methods Prospective cohort study included patients with bone defects after DC evaluated with perfusion tomography (PCT) and transcranial Doppler (TCD) and performed neurological examinations with prognostic scales (mRS, MMSE, and Barthel Index) before and 6 months after surgery. Results A final sample of 26 patients was analyzed. Satisfactory improvement of neurological outcome was observed, as well as significant improvement in the mRS (p = 0.005), MMSE (p < 0.001), and Barthel Index (p = 0.002). Outpatient waiting time for cranioplasty was 15.23 (SD 17.66) months. PCT showed a significant decrease in the mean transit time (MTT) and cerebral blood volume (CBV) only on the operated side. Although most previous studies have shown an increase in cerebral blood flow (CBF), we noticed a slight and nonsignificant decrease, despite a significant increase in the middle cerebral artery flow velocity in both hemispheres on TCD. There was a moderate correlation between the MTT and contralateral muscle strength (r = - 0.4; p = 0.034), as well as between TCD and neurological outcomes ipsilateral (MMSE; r = 0.54, p = 0.03) and contralateral (MRS; p = 0.031, r = - 0.48) to the operated side. Conclusion Even 1 year after DC, cranioplasty may improve cerebral perfusion and neurological outcomes and should be encouraged.