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"Latar Belakang: Gangguan penglihatan adalah gejala kedua yang sering muncul pada tumor otak setelah nyeri kepala. Gejala gangguan penglihatan yang paling sering terjadi pada tumor otak adalah penurunan visus atau tajam penglihatan (low vision sampai kebutaan), sedang tanda yang paling sering dijumpai adalah atrofi n. optikus dan papilledema. Penurunan tajam penglihatan yang dialami penderita tumor otak dapat sangat berat hingga berupa kebutaan. Sampai saat ini belum terdapat data angka kejadian gangguan penglihatan sampai kebutaan pada tumor otak di Indonesia. Metode: Sebagai studi potong lintang analitik, dikumpulkanlah data pasien penderita tumor otak di atas usia 6 tahun yang datang berobat ke poliklinik Bedah Saraf FKUIRSCM pasien September 2013 hingga Februari 2014 dari catatan rekam medis. Hasil: Jumlah pasien tumor otak yang mengalami buta sebanyak 37 orang (34,6 %) dengan usia rata-rata 45,3 (SD 11,3 tahun). Sebesar 86,5 % penderita berada pada usia produktif 15-54 tahun. Dari 37 pasien tumor otak yang buta terlihat proporsi gejala penyerta terbesar adalah sefalgia (terutama sefalgia kronis), diikuti oleh gangguan oftalmologi lain. Data pemeriksaan funduskopi hanya ditemukan pada kurang dari 50 % penderita, dengan temuan yang terbanyak adalah papil atrofi. Kesimpulan: Besar angka kebutaan pada pasien tumor otak menunjukkan bahwa kondisi ini tidak hanya menjadi masalah medis saja tetapi juga masalah sosial yang serius. Banyaknya jumlah pasien tanpa data funduskopi menandakan masih lemahnya standar pemeriksaan neurooftalmologi ataupun pencatatan yang ada saat ini, padahal pemeriksaan funduskopi berperan sangat penting mendeteksi dini kejadian tumor otak pada pasien dengan gangguan penglihatan.

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Background: Vision impairment is the second most common symptom in brain tumor after headache, with decreased visual acuity or low vision as its most common manifestation, and optic nerve atrophy and papilledema as its most common sign. Blindness may be the final outcome of this impairment. Until now, there is no data regarding the prevalence of vision impairment in brain tumor patient in Indonesia.

Method: As a analytic cross-sectional study, data is collected from the medical record regarding brain tumor patient above the age of 6 years old who were seen in the neurosurgery facility in FKUI-RSCM from September 2013 to February 2014.

Result: As much as 37 patient (34,6%) brain tumor patient were found to be blind; mean age was 45,3 years old (SD 11,3 years old), with 86,5% patient was in the productive age 15-54 years old. The commonest related symptoms was headache (especially chronic headache), followed by other ophthalmologic symptoms. Funduscopy data was found only in less than 50% patient; the commonest finding was optic nerve atrophy.

Conclusion: Blindness rate in brain tumor patient is not just a medical issue, but also a social one. Funduscopy usage must be encouraged more to provide early detection for brain tumor patient with vision impairment."

"Pendahuluan: Sindrom Disfungsi Hiperaktivitas Nervus Kranialis (SDHNK) merupakan gejala dan tanda yang ditimbulkan karena kontak pada pangkal saraf kranial di dekat batang otak. Neuralgia trigeminal merupakan contoh SDHNK berupa nyeri episodik unilateral pada nervus trigeminus yang menyebabkan nyeri hebat, cepat, dan sensasi tersetrum terutama jika dipicu oleh sentuhan. Diagnosis klinis masih merupakan baku standar dalam penegakkan diagnosis SDHNK. Demi meningkatkan ketepatan diagnosis, penelitian yang menilai pemeriksaan preoperasi semakin meningkat dan terutama difokuskan pada pencitraan resonansi magnetik (magnetic resonance imaging, MRI) dan pengolahan data. Tujuan: Menelaah pemeriksaan MRI preoperasi yang mendeskripsikan kelainan pada struktur anatomi yang menjadi penyebab SDHNK. Metode: Penelitian dengan desain potong lintang ada pasien dengan SDHNK yang menjalani dekompresi mikrovaskular di Departemen Bedah Saraf RSUPN Cipto Mangunkusumo selama periode Januari 2014 sampai Juli 2014. Hasil: Dalam pelayanan Bedah Saraf RSUPN Cipto Mangunkusumo selama periode April 2012 sampai April 2014 telah dilakukan operasi dekompresi mikrovaskular pada 19 pasien SDHNK dengan kasus Neuralgia Trigeminal sebanyak 12 pasien dan Spasme Hemifasial 7 pasien. Usia pasien berkisar antara 49-74 tahun (rerata 56 tahun). Sebaran gender terbagi rata untuk SDHNK dengan rasio laki-laki berbanding perempuan 1:0,9. Dilakukan uji diagnostik dalam menilai adanya offending artery antara MRI preoperatif dengan temuan saat operasi. Sensitivitas didapatkan sebesar 47,4%. Keluaran pasca operasi pada kasus neuralgia trigeminal segera dirasakan pasien pasca operasi dengan tingkat keberhasilan 100%, pada kasus spasme hemifasial 58 % mengalami kesembuhan total dan sisanya 42% reduksi hingga tidak mengganggu, setelah dilakukan operasi dekompresi mikrovaskular. Kesimpulan: Pemeriksaan MRI dengan prosedur standar untuk evaluasi SDHNK di RSCM memiliki sensitivitas 47,4%, dimana cukup tinggi sebagai pemeriksaan penyaring. Operasi dekompresi mikrovaskuler merupakan prosedur aman, memiliki tingkat keberhasilan tinggi dan rekurensi rendah.n MRI dengan prosedur standar untuk evaluasi SDHNK di RSCM memiliki sensitivitas 47 4 dimana cukup tinggi sebagai pemeriksaan penyaring Operasi dekompresi mikrovaskuler merupakan prosedur aman memiliki tingkat keberhasilan tinggi dan rekurensi rendah.

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Introduction: Hyperactive Dysfunction Syndrome of the Cranial Nerve (HDSCN) is the syndrome caused by cranial nerve root contact near the brainstem. Trigeminal neuralgia is one of the HDSCN with the severe, fast, tingling sensation, and unilateral episodic pain, especially when touched. In order to increase the diagnosis acuracy, the study to evaluate preoperative evaluation is increasing, particularly focusing in magnetic resonance imaging (MRI) and data processing.

Objectives: Evaluating preoperative MRI potency in describing anatomical abnormality, which cause HDSCN.

Methods: We used cross sectional study to evaluate the preoperative MRI, intraoperative findings, and outcomes to patients who came to Neurosurgery Department, Cipto Mangunkusumo Hospital in periods January 2012 to July 2014.

Results: There was 19 patients with HDSCN (12 with trigeminal neuralgia and 7 with hemifacial spasm) who seek medical attention to Cipto Mangunkusumo Hospital from April 2012 to April 2014 and performed microvascular decompression. The mean age of them were 56 years old with male-female ratio 1 : 0.9. Diagnostic study was performed to evaluate the finding of offending artery between preoperative MRI and intraoperative findings. The sensitivity of MRI found in this study was 47.4%. Post operative outcome in trigeminal neuralgia was 100% pain free episode, and 58% free spasm episode in hemifacial spasm. The 42% of the hemifacial spasm patient got the symptoms reduced and could perform daily activity normally.

Conclusions: Standard proceudre of MRI to evaluate HDSCN in Cipto Mangunkusumo Hospital has sensitivity 47.4%. This value was quite high to be used as screening tools. Microvascular decompression was a safe procedure with high success rate and low recurrence rate."

"Pendahuluan: APCD yaitu Acquired Prothrombin Complex Deficiency merupakan gangguan hemostasis yang sering terjadi pada bayi baru lahir. Manifestasi paling berat adalah terjadinya perdarahan intrakranial. Tatalaksana penderita perdarahan intracranial pada APCD membutuhkan kerjasama antara disipln hematologi anak dan bedah saraf untuk mengusuhakan prognosis yang optimal. Tujuan: Mengetahui profil klinis dan luaran terutama terkait intervensi pembedahan pada penderita perdarahan intracranial terkait Acquired Prothromin Complex Deficiency di Rumah Sakit CiptoMangunkusumo pada kurun waktu 2009 hingga 2013. Metode: Studi potong lintang deskriptif analitik pada rekam medis pasien-pasien yang mengalami perdarahan intracranial terkait APCD di RSCM pada kurun waktu 2009-2013. Karakteristik dasar, intervensi pembedahan dan faktor luaran dievaluasi dan dianalisis. Hasil: Terdapat 21 pasien dengan perdarahan intracranial terkait APCD di RSCM selama kurun waktu 2009-2013. Terdapat 4 pasien yang meninggal (22.2%) dan 6 pasien (33.3%) yang mengalami morbiditas neurologis saat pulang rawat. Rasio jenis kelamin laki-laki dibandingkan perempuan adalah 2 : 1. Mayoritas pasien berusia kurang dari 2 bulan (57.1%) dengan puncak kejadian pada usia 1 bulan. Semua kecuali dua pasien terindikasi operasi namun hanya 18 pasien yang dilakukan tindakan. Jenis tindakan mayoritas berupa burrhole (72.8%). Tidak terdapat hubungan yang bermakna antara karakteristik dasar maupun intervensi pembedahan dengan luaran. Kesimpulan: Tidak terdapat perbedaan bermakna antara jenis tindakan bedah saraf dibandingkan luaran pada pasien perdarahan intracranial terkait APCD berdasarkan penelitian ini. Dibutuhkan penelitian dengan desain lebih baik dan sampel yang lebih banyak di masa mendatang.

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Introduction: Acquired Prothrombin Complex Deficiency is an acquired hemostatic disorder which manifests in the newborn period. The most devastating sign is Intracranial Hemrrhage. Treatment for this disorder requires swift cooperation between pediatric hematologist and neurosurgery to ensure optimal outcome.

Objectives: To obtain the clinical profile and outcome especially related to neurosurgical intervention in patients with intracranial hemorrhage related to Acquired Prothrombin Complex Deficiency in CiptoMangunkusumo Hospital during 2009-2013.

Methods: Cross sectional descriptive analytic study using medical records of patients with intracranial hemorrhage related to APCD in RSCM during 2009-2013. Baseline characteristic, surgical intervention and outcomes are evaluated.

Results: There are 21 patients with intracranial hemorrhage related to APCD in RSCM during 2009-2013. There are 4 mortality (22.2%) and 6 patients with immediate neurologic morbidity (33.3%) during hospital discharge. Ratio of male to female are 2 :1. Majority of patients are under 2 months of age (57.1%) with peak incidence at 1 month. All but two patients are indication for neurosurgical intervention but ultimately only 18 patients are operated. Majority of surgery was burrhole (72.8%) There are no significant relationship statistically between all baseline characteristic or intervention with outcome.

Conclusions: There are no significant different in the type of neurosurgical intervention related to outcome in patients with intracranial hemorrhage related to APCD. Study with better design and larger samples is needed in the future to confirm this finding."

"ABSTRAK Operasi dekomprasi vaskular mikro telah diterima sebagai tatalaksana definitif pada berbagai keluhan akibat kompresi mekanik pada kompleks neurovaskular. Tindakan eksplorasi fossa posterior diketahui berhubungan dengan komplikasi gangguan fungsi serebellar dan saraf kranial. Diperlukan adanya evaluasi pasca operasi yang mengintegrasikan aspek pemulihan atas keluhan, dan komplikasi terkait tindakan, dalam menilai luaran pasien secara menyeluruh.TujuanMenilai luaran pasca operasi dekompresi vaskular mikro pada penderita sindrom kompresi kompleks neurovaskular yang dikelola Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo periode Januari 2011-Oktober 2015 menggunakan efficacy, complication, total score (ECT score) serta faktor-faktor yang mempengaruhi luaran.MetodePenelitian ini merupakan penelitian historikal prospektif terhadap pasien pasca operasi dekompresi vaskular mikro dengan sindrom kompresi kompleks neurovaskular yang dikelola Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo periode Januari 2011-Oktober 2015. Sebagai pembanding digunakan data luaran menurut publikasi ECT score orisinil. Data penelitian ini diperoleh melalui catatan rekam medis.HasilSejak Januari 2011 sampai dengan Oktober 2015, didapatkan 21 pasien trigeminal neuralgia primer dan 11 pasien hemifasial spasme primer yang dilakukan tindakan microvascular decompression. Sebanyak 15 pasien trigeminal neuralgia telah melalui periode lebih dari satu tahun pasca operasi dengan hasil luaran excellent (T-0) 13 pasien (87%), good (T-1) 1 pasien (6%), fair (T-2) 0 pasien, poor (T3-5) 1 pasien (6%). Sebanyak 11 pasien hemifasial spasme primer telah melalui periode lebih dari satu tahun pasca operasi dengan hasil luaran excellent (T-0) 5 pasien (62,5%), good (T-1) 2 pasien (25%), fair (T-2) 0, poor (T3-5) 1 pasien (12,5%). Penelitian ini memiliki jumlah sampel yang terbatas dan tidak didapatkan faktor yang mempengaruhi luaran KesimpulanSkor ECT terbukti bermanfaat dalam menilai luaran pasien paska MVD di RSCM. Jumlah pasien trigeminal neuralgia primer yang sembuh sempurna tanpa komplikasi (T0) di RSCM didapatkan 13 pasien dari 15 pasien. Jumlah luaran pasien hemifasial spasme primer yang sembuh sempurna tanpa komplikasi (T0) di RSCM didapatkan 5 pasien dari 8 pasien. ABSTRACTOutcome of Neurovascular Compression Syndrome Based on Efficacy Complication Total Score in FKUI-RSUPNCM, 2011-2015BackgroundMicrovascular decompression has been administered as neurosurgical armamentary as definitive treatment of mechanical compression of neurovascular. Posterior fossa approach also related to post operative cerebellar and cranial nerve dysfunction. An integrated evaluation combining efficacy and complication of surgical exploration is crucial to determine a comprehensive outcome of post surgical patients.PurposeTo evaluate outcome of microvascular decompression surgery in patient diagnosed with neurovascular compression syndrome managed by Department of Neurosurgery RSUPN Dr. Cipto Mangunkusumo, January 2011-October 2015 based on efficacy, complication, total score (ECT score) and related factors.MethodA historical prospective study on patients diagnosed with neurovascular compression syndrome managed by Department of Neurosurgery RSUPN Dr. Cipto Mangunkusumo, January 2011-October 2015 based on efficacy, complication, total score (ECT score). The result is compared with the original publication of ECT score outcome. Research data was obtained through medical records.ResultsTwenty one patients diagnosed with trigeminal neuralgia and 11 patients diagnosed with hemifacial spasm were treated by microvascular decompression surgery since January 2011 - October 2015. In trigeminal neuralgia group shown fifteen patients with more than one year post operative period with categorized outcome : 13 patients (87%) excellent (T-0), 1 patient (6%) good (T-1), 0 patient fair (T-2), 1 patient (6%) poor (T3-5). In hemifacial spasm group shown 11 patient with more than one year post operative period with categorized outcome : 5 patient (62,5%) excellent (T-0), 2 patient (25%) good (T-1), 0 patient fair (T-2), 1 patient (12,5%) poor (T3-5). Sample size of research were limited and related to insignificant findings of related factors. ConclusionEfficacy complication total score is efficient in evaluating post microvascular decompression surgery outcome. Trigeminal neuralgia group shown 13 of 15 patients with excellent outcome (T0). Hemifacial spasm group shown 5 of 8 patients with excellent outcome (T0).;TitleOutcome of Neurovascular Compression Syndrome Based on Efficacy Complication Total Score in FKUI-RSUPNCM, 2011-2015BackgroundMicrovascular decompression has been administered as neurosurgical armamentary as definitive treatment of mechanical compression of neurovascular. Posterior fossa approach also related to post operative cerebellar and cranial nerve dysfunction. An integrated evaluation combining efficacy and complication of surgical exploration is crucial to determine a comprehensive outcome of post surgical patients.PurposeTo evaluate outcome of microvascular decompression surgery in patient diagnosed with neurovascular compression syndrome managed by Department of Neurosurgery RSUPN Dr. Cipto Mangunkusumo, January 2011-October 2015 based on efficacy, complication, total score (ECT score) and related factors.MethodA historical prospective study on patients diagnosed with neurovascular compression syndrome managed by Department of Neurosurgery RSUPN Dr. Cipto Mangunkusumo, January 2011-October 2015 based on efficacy, complication, total score (ECT score). The result is compared with the original publication of ECT score outcome. Research data was obtained through medical records.ResultsTwenty one patients diagnosed with trigeminal neuralgia and 11 patients diagnosed with hemifacial spasm were treated by microvascular decompression surgery since January 2011 - October 2015. In trigeminal neuralgia group shown fifteen patients with more than one year post operative period with categorized outcome : 13 patients (87%) excellent (T-0), 1 patient (6%) good (T-1), 0 patient fair (T-2), 1 patient (6%) poor (T3-5). In hemifacial spasm group shown 11 patient with more than one year post operative period with categorized outcome : 5 patient (62,5%) excellent (T-0), 2 patient (25%) good (T-1), 0 patient fair (T-2), 1 patient (12,5%) poor (T3-5). Sample size of research were limited and related to insignificant findings of related factors. ConclusionEfficacy complication total score is efficient in evaluating post microvascular decompression surgery outcome. Trigeminal neuralgia group shown 13 of 15 patients with excellent outcome (T0). Hemifacial spasm group shown 5 of 8 patients with excellent outcome (T0).;TitleOutcome of Neurovascular Compression Syndrome Based on Efficacy Complication Total Score in FKUI-RSUPNCM, 2011-2015BackgroundMicrovascular decompression has been administered as neurosurgical armamentary as definitive treatment of mechanical compression of neurovascular. Posterior fossa approach also related to post operative cerebellar and cranial nerve dysfunction. An integrated evaluation combining efficacy and complication of surgical exploration is crucial to determine a comprehensive outcome of post surgical patients.PurposeTo evaluate outcome of microvascular decompression surgery in patient diagnosed with neurovascular compression syndrome managed by Department of Neurosurgery RSUPN Dr. Cipto Mangunkusumo, January 2011-October 2015 based on efficacy, complication, total score (ECT score) and related factors.MethodA historical prospective study on patients diagnosed with neurovascular compression syndrome managed by Department of Neurosurgery RSUPN Dr. Cipto Mangunkusumo, January 2011-October 2015 based on efficacy, complication, total score (ECT score). The result is compared with the original publication of ECT score outcome. Research data was obtained through medical records.ResultsTwenty one patients diagnosed with trigeminal neuralgia and 11 patients diagnosed with hemifacial spasm were treated by microvascular decompression surgery since January 2011 - October 2015. In trigeminal neuralgia group shown fifteen patients with more than one year post operative period with categorized outcome : 13 patients (87%) excellent (T-0), 1 patient (6%) good (T-1), 0 patient fair (T-2), 1 patient (6%) poor (T3-5). In hemifacial spasm group shown 11 patient with more than one year post operative period with categorized outcome : 5 patient (62,5%) excellent (T-0), 2 patient (25%) good (T-1), 0 patient fair (T-2), 1 patient (12,5%) poor (T3-5). Sample size of research were limited and related to insignificant findings of related factors. ConclusionEfficacy complication total score is efficient in evaluating post microvascular decompression surgery outcome. Trigeminal neuralgia group shown 13 of 15 patients with excellent outcome (T0). Hemifacial spasm group shown 5 of 8 patients with excellent outcome (T0)."

"Perdaharan intra serebral (intra cerebral hemorrhage/ICH) spontan adalah perdarahan pada parenkim otak yang disebabkan selain trauma. Perdarahan intra serebral menyumbang 10-13% dari keseluruhan kasus stroke dengan angka mortalitas mencapai 20-70%. Tatalaksana perdarahan intraserebral spontan hingga saat ini masih menimbulkan berbagai kontroversi. Penanganan perdarahan intraserebral spontan di RSUPN Cipto Mangunkusumo meliputi berbagai pihak yang mempengaruhi basil akhir. Hal ini mencakup penatalaksanaan awal di ruang gawat darurat, pemeriksaan penunjang, pemilihan tatalaksana yang optimal dan perawatan di ruangan ICU dan di bangsal perawatan. Hingga saat ini Departemen bedah saraf RSUPN Ciptomangunkusumo belum memiliki data mengenai pasien perdarahan intraserebral spontan yang menjalani tatalaksana operasi. Hal ini diperlukan untuk mengevaluasi dan memberi masukan untuk tatalaksana perdarahan intraserebral spontan di departemen bedah saraf RSUPN Ciptomangunkusumo dan departemen lain yang terlibat dalam penatalaksanaan pasien-pasien tersebut.

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Intracerebral hemorrhage (ICH) is spontaneous bleeding of the brain parenchyma caused by other than trauma. Intra-cerebral haemorrhage accounts for I 0- I 3% of all stroke cases with a mortality rate reaches 20-70%. Management of spontaneous intracerebral hemorrhage is still having a controversy. Management of spontaneous intracerebral hemorrhage in Cipto Mangunkusumo National Hospital include various parties that affect the final result. This includes initial management in the emergency room, investigation, patient selection and optimal management of care in ICU and ward care. Until now the department of neurosurgery RSUPN Ciptomangunkusumo not yet have data on patients with spontaneous intracerebral hemorrhage who underwent management of operations. It is necessary to evaluate and provide input for the management of spontaneous intracerebral hemorrhage in the department of neurosurgery RSUPN Ciptomangunkusumo and other departments involved in the management of such patients."