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"Abstract:Comprehensive in scope and packed with practical information, this book contains detailed coverage of this state-of-the-art technology from the pioneers who developed it. The authors provide"

"This book aims to provide the trainee and practicing minimally invasive neurological therapist with a comprehensive understanding of the background science and theory that forms the foundation of their work. The contents are based on the tutorial teaching techniques used at the University of Oxford and are authored by the MSc Course Director. The tutorial is a learning episode focussed on a particular topic and intended to guide the student/reader through the background literature, to highlight the research on which standard practices are based and to provide the insights of an experienced practitioner. Each chapter of the book covers a different topic to build a complete review of the subspecialty, with in-depth discussion of all currently used techniques. The literature is reviewed and presented in context to illustrate its importance to the practice of this rapidly expanding field of medical treatment."

"Focusing on important advances in neurosurgery, this volume presents detailed descriptions of standard operative procedures and in-depth reviews of established knowledge. Readers will find informative chapters written by specialists in the field."

"Frozen sections are performed while a patient is undergoing surgery as a basis for making an immediate diagnosis that will impact treatment decisions. Frozen section diagnosis is often a highly demanding situation for the pathologist who must render a diagnosis quickly, based on careful gross examination of specimens to select optimal areas for microscopic examination.The Frozen Section Library series will provide concise, user-friendly, site specific handbooks that are well illustrated and highlight the pitfalls, artifacts and differential diagnosis issues that arise in the hurried frozen section scenario."

"PURPOSES: Pancreatic fistula (PF) is a challenging complication of pancreaticoduodenectomy (PD). Soft pancreas is reported as a risk factor for PF; however, palpation by the surgeon is not an objective method of evaluating pancreatic texture. We conducted this study to investigate whether a texture analyzer called a Tensipresser can be used to quantify pancreatic tissue hardness and predict the development of postoperative PF.METHODS: We assessed pancreatic texture in 85 patients who underwent PD. After surgeons assessed the texture of the pancreas subjectively, the physical properties were measured on the pancreatic margin intraoperatively, by the two-bite method using the Tensipresser. The incidence and severity of PF were based on the definitions of the International Study Group on Pancreatic Fistula.RESULTS: Symptomatic PF (grade B and C) developed in 16% of the patients. Patients were divided into two groups based on the Tensipresser measurement: those with a soft and fragile pancreas with hardness < 2070 gw/cm2 and cohesiveness < 0.65 (SF group); and all other patients (non-SF group). In the univariate and multivariate analysis, a small pancreatic duct diameter (<4 mm), no conduction of preoperative chemoradiation therapy, and inclusion in the SF group were significant predictors of PF.CONCLUSION: The Tensipresser can evaluate pancreatic texture objectively, helping to define intraoperatively, those at risk of the development of PF."

"Dewasa ini akses vaskular hemodialisis dan segala permasalahannya masih menjadi penyebab perawatan di rumah sakit dan morbiditas pada pasien gagal ginjal kronik. Dibalik keutamaan dan superioritas penggunaan fistula arteriovenous (AVF) sebagai akses vaskular hemodialisis, kegagalan maturasi merupakan hambatan utama penggunaannya. Penelitian ini bertujuan mengkaji dapatkah bloodflow rate (BFR) yang diukur intraoperatif menggunakan ultrasonografi Doppler memprediksi maturasi AVF. Metode penelitian adalah potong lintang. Hasil didapatkan BFR intraoperatif menggunakan ultrasonografi Doppler sesaat setelah kreasi AVF brakiosefalika dapat memprediksi maturasi dengan nilai titik potong sebesar 245,5 mL/menit, didapatkan nilai sensitifitas sebesar 76,7% , spesifisitas 92,9%, nilai duga positif 95,8% dan nilai duga negatif 65% sehingga dapat menjadi acuan menentukan perlu tidaknya tindakan revisi saat intraoperatif yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi AVF.

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Currently, vaskular access for haemodialysis and its assocoiated problems is the leading cause for hospital admission and morbidity in patients with chronic kidney failure. Arteriovenous fistula (AVF) is the preferred vaskular access for haemodialysis, however its use is impeded by issues of maturation. This cross sectional study aims to evaluate whether bloodflow rate (BFR), measured intraoperatively using Doppler ultrasonography, can predict AVF maturation. The result from this study showed that intraoperative BFR measured using Doppler ultrasonography right after the creation of the brachiocephalic fistula can predict the fistula’s maturation. The intraoperative BFR cut-off value was 245,5 mL/min, with sensititivity of 76,7%, specificity 92,9%, positive predictive value of 95,8% and negative predictive value 65%. Therefore, the intraoperative BFR may be used as a guide to decide whether or not a corrective procedure was needed to repair the brachiocephalic AVF, and consequently, help in reducing the rate of AVF maturation failure.

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"Latar Belakang ; Pelayanan medis di instalasi bedah sentral membutuhkan biaya yang besar dan melibatkan sumber daya manusia (SDM) dari berbagai bidang ilmu meliputi SDM medis maupun SDM non medis. Adanya keterlambatan akan mengakibatkan peningkatan biaya dan mempengaruhi keselamatan pasien.Metode : Penelitian ini bertujuan menganalisa waktu pelayanan menggunakan metode metode kuantitatif dan kualitatif dengan desain retrospektif. Data kuantitatif didapatkan dari telaah dokumen dengan jumlah sampel 547 kasus operasi bedah saraf (358 kasus operasi kranial, 189 kasus operasi spinal), sedangkan data kualitatif didapatkan melalui wawancara mendalam dengan delapan informan penelitian. Analisis data dilakukan secara kuantitatif dengan uji Mann Whitney.Hasil : Didapatkan adanya keterlambatan dalam pelayanan ruang operasi bedah saraf operasi kranial 54 menit dan operasi spinal 48 menit. Didapatkan perbedaan waktu klinis, waktu non klinis dan waktu keterlambatan non klinis antara operasi kranial dan spinal. Keterlambatan dalam pelayanan ruang operasi disebabkan oleh faktor SDM, sarana prasarana dan kebijakan.Simpulan : Keterlambatan dalam pelayanan ruang operasi IBS RSPON terjadi dalam tahap proses anestesi, pemasangan monitoring saraf intraoperasi, positioning pasien, draping pasien, dan pembedahan. Keterlambatan dalam pelayanan ruang operasi IBS RSPON disebabkan oleh faktor SDM, sarana prasarana, dan kebijakan

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Background : Medical services at a central surgical installation require a large amount of money and involve human resources (HR) from various fields of knowledge including medical and non-medical human resources. Delays in the operating room causes increased costs and impacts patient safety.

Methods: This study aims to analyze the service time using quantitative and qualitative method with a retrospective design. Quantitative data was obtained from a document review with a sample of 547 cases of neurosurgery (358 cases of cranial surgery, 189 cases of spinal surgery), while qualitative data was obtained through in-depth interviews with eight research informants. Data analysis was carried out quantitatively with the Mann Whitney test.

Result: Delays found in the neurosurgery operating room service for cranial surgery and spinal surgery was 54 minutes and 48 minutes respectively. There were differences in clinical time, non-clinical time, and non-clinical time delay between cranial and spinal surgery. Delays in the OR were caused by human resource factors, equipment, and hospital policies.

Conclusion: Delays in RSPON IBS operating room services occur in the stages of the anesthesia process, installation of intraoperative nerve monitoring, patient positioning, patient draping, and surgery. Delays in RSPON IBS operating room services were caused by human resource factors, infrastructure, and policies"

"Latar Belakang Tumor otak adalah neoplasma intrakranial di dalam otak atau di kanal tulang belakang pusat. Tumor otak ganas primer mempengaruhi sekitar 200.000 orang di seluruh dunia setiap tahun. Tumor otak disebabkan oleh pembelahan sel yang abnormal dan tidak terkontrol. Penanganan tumor otak di Indonesia masih belum terintegrasi baik dari segi promotif, preventif, maupun kuratif. Tumor otak sendiri dapat menyebabkan berbagai komplikasi sampai kematian. Oleh karena itu, pada penelitian kali ini dilakukan studi mengenai keterkaitan jenis, letak, dan ukuran tumor dengan skor fungsional berupa skor KPS yang didapatkan pasien pre dan post tindakan serta hubungannya dengan tingkat resektabilitas tumor pasien saat dilakukan operasi. Skor KPS dapat berfungsi sebagai salah satu faktor prognosis kualitas hidup pasien.MetodePenelitian ini akan menggunakan metode kohort retrospektif dengan melihat rekam medis pasien tumor otak dari tahun 2021 sampai 2022 yang ditatalaksana di RSCM. Rekam medis akan diambil secara consecutive sampling.HasilTerdapat hubungan antara jenis tumor dengan skor KPS pre operasi dimana nilai median untuk semua jenis adalah 80 namun, adenoma mendapatkan mean skor KPS tertinggi (84,59) dan jenis tumor lain mendapatkan mean skor KPS terendah (73,73). Ukuran tumor dan skor KPS pre operasi tidak didapatkan hubungan korelasi yang kuat yaitu hanya sebesar -0,194 (CI 95% -0,313 - -0,069). Letak tumor dengan skor KPS pre operasi didapatkan ada hubungannya dengan hasil tumor supratentorium memiliki median skor KPS pre operasi lebih tinggi dibandingkan tumor infratentorium. Hasil ini berbeda dengan studi-studi lainnya sehingga diperlukan penelitian lebih lanjut. Demikian juga dengan tingkat resektabilitas dengan skor KPS post operasi dimana didapatkan hasil signifikansi sebesar p=0,107 sehingga hubungannya tidak signifikan. Namun jika dilihat mediannya, (Gross Total Resection) GTR memiliki skor KPS post operasi yang lebih baik dibandingkan dengan (SubTotal Resection) STR yaitu 85 dan 80 secara berurut.KesimpulanPerbedaan jenis tumor mempengaruhi skor KPS pre operasi. Semakin besar ukuran tumor yang dialami pasien, maka semakin rendah skor KPS pre operasi yang didapatkan. Selain itu, skor KPS pre operasi juga berhubungan dengan letak tumor yang dialami pasien. Sedangkan, skor KPS post operasi pada penelitian ini tidak menunjukkan hubungan yang signifikan dengan tingkat resektabilitas tumor pada pasien yang dioperasi.

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Introduction

Brain tumors are intracranial neoplasms within the brain or in the central spinal canal. Primary malignant brain tumors affect around 200,000 people worldwide each year. Brain tumors are caused by abnormal and uncontrolled cell division. Management of brain tumors in Indonesia is still not integrated in terms of promotive, preventive and curative. Brain tumors themselves can cause various complications up to death. Therefore, In this study, an investigation was carried out to explore the correlation between the type, location, and size of the tumor and its impact on the functional score, measured by the KPS score, obtained from patients before and after surgery. Additionally, the study examined the association between the level of resectability and the type of tumor. KPS score can be used as one prognostic factor for patient quality of life.

Method

This study will use a retrospective cohort method by looking at the medical records of brain tumor patients from 2021 to 2022 who were treated at RSCM. Medical records will be taken by consecutive sampling.

Results

A correlation exists between tumor types and preoperative KPS scores, with a median value of 80 for all types. Adenomas achieve the highest mean KPS score (84.59), while other tumor types have the lowest mean KPS score (73.73). A weak correlation is observed between tumor size and preoperative KPS scores, with a coefficient of only - 0.194 (95% CI -0.313 to -0.069). There is a relationship between tumor location and preoperative KPS scores, as supratentorial tumors have a higher median preoperative KPS score compared to infratentorial tumors. These findings differ from other studies, suggesting the need for further research. Similarly, the level of resectability and postoperative KPS scores show a non-significant relationship with a p-value of 0.107. However, when looking at the medians, Gross Total Resection (GTR) is associated with a higher postoperative KPS score compared to Subtotal Resection (STR), namely 85 and 80, respectively.

Conclusion

The type of tumor affects preoperative KPS scores. The larger the tumor size, the lower the preoperative KPS score. Additionally, preoperative KPS scores are also associated with tumor location. However, postoperative KPS scores in this study do not show a significant relationship with the resectability of tumors in operated patients."

"Pendahuluan: Lesi serebral intrakranial, khususnya tumor, awalnya dapat muncul sebagai gejala oftalmik akibat adanya massa dan/atau peningkatan tekanan intrakranial yang mengganggu jalur penglihatan, jaringan mata, dan saraf. Diagnosis dini tumor otak penting untuk mencegah gangguan penglihatan dan/atau kebutaan yang tidak dapat disembuhkan. Namun, rendahnya kesadaran pasien tentang pentingnya manajemen bedah saraf yang tepat waktu sering mengakibatkan keterlambatan diagnosis dan pengobatan.Metode: Penelitian ini menggunakan desain cross-sectional analitik untuk mengetahui kebutaan akibat tumor otak. Data dari 54 pasien pada tahun 2020, dikelompokkan berdasarkan karakteristik demografi, dianalisis untuk mengeksplorasi hubungan antara durasi dari timbulnya gejala hingga kunjungan medis pertama dan terjadinya kebutaan pada pasien tumor otak.Hasil: 35 (64,81%) pasien tumor otak ditemukan mengalami kebutaan. Temuan penelitian ini mengungkapkan adanya hubungan antara kebutaan pada pasien tumor otak dan durasi dari timbulnya gejala hingga kunjungan medis pertama dan konsultasi bedah saraf. Pasien yang mengalami keterlambatan dalam berkonsultasi dengan dokter layanan primer dan/atau bedah saraf sejak gejala awal menunjukkan insiden kebutaan yang lebih tinggi, hal ini menunjukkan pentingnya mencari pertolongan medis segera.Kesimpulan: Penelitian ini menggarisbawahi pentingnya intervensi medis yang tepat waktu dan konsultasi bedah saraf khusus untuk mengurangi kejadian kebutaan di antara pasien tumor otak. Hal ini menekankan perlunya peningkatan kesadaran masyarakat, sistem rujukan yang efisien, dan pertolongan medis yang cepat untuk meringankan beban kebutaan pada populasi pasien tumor otak.

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Introduction: Intracranial cerebral lesions, particularly tumours, can initially present as ophthalmic symptoms due to masses and/or elevated intracranial pressure disturbing the visual pathway, ocular tissues, and nerves. Early diagnosis of brain tumours is crucial to prevent irreversible visual impairment and/or blindness. However, low patient awareness about the importance of timely neurosurgical management often results in delayed diagnosis and treatment.

Methods: This study utilized an analytic cross-sectional design to investigate blindness related to brain tumours. Data from 54 patients in 2020, stratified by demographic characteristics, were analyzed to explore the association between the duration from symptom onset to the first medical visit and the occurrence of blindness in brain tumor patients.

Results: 35 (64.81%) brain tumour patients were found to be blind. The study findings revealed an association between blindness in brain tumour patients and the duration from symptom onset to both the first medical visit and neurosurgery consultation. Patients experiencing delays in consulting a primary care physician and/or a neurosurgeon from the initial onset of symptoms exhibited a higher incidence of blindness, highlighting the importance of seeking prompt medical attention.

Conclusion: This study underscored the critical need for timely medical intervention and specialized neurosurgical consultation to mitigate the incidence of blindness among brain tumour patients. It emphasized the necessity for increased public awareness, efficient referral systems, and prompt medical attention to alleviate the burden of blindness in patients with brain tumour."