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"Tujuan: anak pasca ventrikullo-peritone (vp)shunt menghadapi berbagai masalah yang berkaitan dengan kualitas luaran hidupnya namun hal ini masih belum diteliti dengan baik sampai sekarang. Pengukuran luaran klinis anak pasca vpshunt dipengaruhi kondisi kesehatan fisik, sosial emosional dan fisik yang sering diabaikan. Kulkarni et al mengembangkan pengukuran luaran kesehatan secara kuantitatif berupa Hidrocephalus Outcome Questinnare (HOQ), yang dirancang khusus untuk anak pasca vpshunt yang dapat diselesaikan oleh orang tua. Tujuan penelitian ini adalah untuk mendapatkan luaran pada anak pasca vpshunt saat kunjungan ke poli klinik dengan menggunakan HOQ dan mencari hubungan nilai luaran kesehatan HOQ nya dengan faktor penyebab terjadinya hidrosefalus. Metode: Penelitian ini merupakan penelitian pendahuluan secara potong lintang yang dilakukan pada semua anak (5-16 tahun) pasca vpshunt periode Januari 2003 sampai Desember 2013, yang datang kontrol di klinik rawat jalan Bedah Saraf Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Nilai luaran anak diukur setelah orang tua pasien menyelesaikan HOQ. Faktor penyebab hidrosefalus dan faktor-faktor prediktor yang dapat mempengaruhi luaran pasien diambil dari catatan rekam medis pasien. Dilakukan analisis eksplorasi dengan menggunakan uji parametric dan non-parametrik untuk menentukan hubungan dan faktor mana yang dapat mempengaruhi luaran kesehatan anak yang lebih buruk . Hasil: Orang tua dari 30 anak pasca vpshunt saat kunjungan ke klinik rawat jalan berpartisipasi dalam penelitian ini. Usia rata-rata anak adalah 9,6 tahun ± 3,8 tahun ( rentang 6-16 ) dengan dominasi laki-laki ( 70 % ) . Rerata luaran kesehatan secara keseluruhan adalah 0,67 yang artinya secara umum hidrosefalus memberikan efek pada semua domain kesehatan. Luaran kesehatan fisik secara signifikan lebih baik pada kelompok etiologi pasca infeksi sebagai penyebab hidrosefalusnya dibandingkan dengan kelompok etiologi congenital ataupun neoplasma dengan nilai p 0,03. Kelompok pasien yang mengalami kejang pasca vpshunt memiliki luaran kesehatan lebih buruk pada semua domain kesehatan dibandingan kelompok yang tidak mengalami kejang dengan nilai p <0,05. Kesimpulan: Terdapat hubungan luaran kesehatan fisik yang lebih baik pada etiologi pasca infeksi sebagai penyebab hidrosefalus. Variable yang dapat mempengaruhi seluruh domain luaran kesehatan anak adalah kelompok anak yang mengalami kejang pasca vpshunt. HOQ merupakan instrumen sederhana dan berguna untuk menentukan luaran anak pasca vpshunt di klinik rawat jalan.

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Objective: Children with hydrocephalus face several quality of life (QOL) issues that have not been studied properly until now. In the measurement of clinical outcome in pediatric patients with hydrocephalus, the condition effects on a child’s physical, emotional, cognitive, and social health are frequently ignored. Kulkarni et al developed a quantitative health status measurement, the Hydrocephalus Outcome Questionnaire (HOQ), which is designed specifically for children with hydrocephalus and may be completed by the children's parents. The objective of this study is to provide current information on outcome in recently treated children with hydrocephalus, using the HOQ and assess the association between HOQ score in children with hydrocephalus and etiologic factors of hydrocephalus.

Methods: This is a preliminary cross-sectional study conducted to all children (5–16 years old) with treated hydrocephalus during period January 2003 to December 2012, who attended the neurosurgery outpatient clinic at the Cipto Mangunkusumo National Hospital. The patient’s QOL score was measured from the parent-completed HOQ. The etiologic and predictor variables were extracted from the medical records. An exploratory analysis was performed using parametric and non-parameteric test to determine which variables might be associated with worse health status.

Result: The parents of 30 children treated for hydrocephalus participated in the study. The mean age was 9.6 years ± 3,8 years (range 6-16) with predominance male (70%). The mean HOQ overall health score was 0.67, it means hydrocephalus effect overall child health status. HOQ physic score was significantly better in the ‘etiology of post infection’ group rather in ‘etiology of congenital or neoplasm’, with p value 0.03. Compared to the group of patients with no seizure, the group of patients with seizure after treated ventriculo-peritoneal shunt have significant worse overall HOQ health status score with p value <0.05.

Conclusion: There is association between the HOQ physic health status in children treated hydrocephalus with infection as the etiology of hydrocephalus. The only variable found to be associated significantly with health status in hydrocephalus patient treated with ventriculo-peritoneal shunt was seizure. The HOQ is a simple and useful measurement for determining outcome in pediatric hydrocephalus patient treated with ventrculo-peritoneal shunt."

"Latar belakang. Laktat awalnya dianggap sebagai produk berbahaya dari metabolisme anaerobik, namun bukti terbaru menunjukkan laktat dapat melindungi neuron dan memperbaiki luaran. Dalam studi ini, kami mencari korelasi antara kadar laktat darah dan luaran pascaoperasi pasien dengan cedera otak traumatika (traumatic brain injury, TBI). Metode. Studi kohort prospektif ini mengambil sampel dari pasien dengan TBI terisolasi yang menjalani operasi di Departemen Bedah Saraf RSUPN dr. Cipto Mangunkusumo dari April 2020 hingga Juni 2021. TBI dikategorikan menjadi ringan (GCS 13-15), sedang (GCS 9-12), dan berat (GCS 3-8). Kadar laktat darah diambil dari vena perifer sebelum dan pada hari ke-3 pascaoperasi. Luaran klinis dievaluasi berdasarkan perubahan (D) GCS pada hari ke-7 pascaoperasi dengan preoperasi, lalu dibagi menjadi 3 kelompok: membaik, tidak berubah, dan memburuk. Hasil. Dari 72 subjek dalam penelitian ini, ditemukan terdapat korelasi yang signifikan (p = 0,019, r = 0,275) antara kadar laktat preoperatif dengan D GCS, dimana semakin tinggi kadar laktat preoperatif maka D GCS akan semakin positif. Berdasarkan analisis dengan kurva receiver operating characteristics (ROC) dan Chi-square, ditemukan bahwa subjek dengan kadar laktat >=2,35 mmol/L memiliki kemungkinan 1,64 kali lebih besar untuk mengalami peningkatan GCS pascaoperasi. Kesimpulan. Laktat dapat dijadikan suatu faktor prognostik luaran baik pascaoperasi pasien TBI.

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Background. Lactate was initially thought to be a harmful product of anaerobic metabolism, but recent evidence suggests it can protect neurons and improve outcomes. Therefore, we sought a correlation between blood lactate levels and the postoperative outcome of patients with traumatic brain injury (TBI). Method. This prospective cohort study took samples from patients with isolated TBI who underwent surgery at the Department of Neurosurgery, Cipto Mangunkusumo National Hospital from April 2020 to June 2021. Blood lactate levels were taken from peripheral veins before surgery and on the 3rd postoperative day. The clinical outcome was evaluated based on the change (D) of GCS from before surgery and on the 7th postoperative day, then categorized into 3 groups: improved, unchanged, and worsen. Results. From 72 subjects in this study, significant correlation (p = 0.019, r = 0.275) was found between preoperative lactate levels and D GCS, where the higher preoperative lactate levels, the more positive D GCS would be. Based on the analysis using ROC curve and Chi-square, subjects with lactate levels >=2.35 mmol/L were 1.64 times more likely to experience an increase in postoperative GCS. Conclusion. Lactate can be used as a favorable prognostic factor in TBI patients."

"LATAR BELAKANG Pembedahan merupakan pengobatan utama tumor spinal pada umumnya. Pembedahan minimal invasif menjadi trend karena menghasilkan cidera jaringan minimal dengan tujuan operasi tetap tercapai. Laminektomi unilateral merupakan salah satu teknik yang memenuhi pilar dasar operasi minimal invasif. Penulis mengevaluasi efektivitas dan efisiensi teknik laminektomi unilateral removal tumor serta perbandingan terhadap teknik konvensional.METODE Disain studi deskriptif analitik dengan data rekam medis periode Januari 2015 – Juni 2020. Skor fungsional (VAS, KPS, Recovery rate/Hirabayashi, Nurick) dihitung saat pra dan pascaoperasi 1, 3, 6, 12, dan 24 bulan. Efisiensi teknik laminektomi unilateral dievaluasi melalui lama operasi, jumlah perdarahan, lama rawat. Efektivitas dievaluasi melalui resektabiltas intraoperasi dan MRI kontrol tulang belakang pasca operasiHASIL Terdapat 26 pasien, rerata usia (44.17 ± 14.4) tahun, lelaki 12 (46.1%) dan perempuan 14 (53.8%). Skor fungsional pra operasi (Median VAS 4 (0-8), Nurick 4.5 (1-6), JOA servikal 5 (2-10), Torakal 3.5 (2-9), lumbal 19 (14-23) dan KPS 60 (40-80). Follow up 24 bulan pascaoperasi VAS (0) 94%, recovery rate excellent 81%, Nurick (< 3) 87% dan KPS (> 70%) 87%. Median perdarahan intraoperasi 175 (50-1200) ml, lama operasi 180 (120-540) menit dan lama rawat 6.5 (4-42) hari. Gross total resection 76.9%. Terdapat satu komplikasi pseudomeningocele pada follow up 3 bulan pascaoperasi yang menghilang tanpa intervensi pada follow up MRI kontrol 6 bulan pascaoperasi.SIMPULAN Laminektomi unilateral memungkinkan gross total resection dengan recovery rate baik, trauma operasi dan komplikasi lebih kecil terhadap teknik konvensional.

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BACKGROUND Pembedahan merupakan pengobatan utama tumor spinal pada umumnya. Pembedahan minimal invasif menjadi trend karena menghasilkan cidera jaringan minimal dengan tujuan operasi tetap tercapai. Laminektomi unilateral merupakan salah satu teknik yang memenuhi pilar dasar operasi minimal invasif. Penulis mengevaluasi efektivitas dan efisiensi teknik laminektomi unilateral removal tumor serta perbandingan terhadap teknik konvensional.

METHOD Design of study is analytic descriptive using medical records period January 2015 – June 2020. Functional Scores (VAS, KPS, Recovery rate/Hirabayashi, Nurick) achieved pre and postoperation 1,3,6,12,and 24 months. Efficiency is observed from operative time, intraoperative bleeding, length of stay. Effectivity is observed from resectability during intraoperative and MRI control post operation.

RESULT There are 26 patients, mean age ( 44.17 ± 14.4) years, male 12 (46.1%), female 14 (53.8%). Functional score pre operation (median VAS 4 (0-8), Nurick 4.5 (1-6), JOA cervical 5 (2-10), Thoracal 3.5 (2-9), lumbar 19 (14-23) and KPS 60 (40-80). At Follow up 24 months after operation there are 94% with no pain, 81% excellent recovery rate, 87% Nurick <3 and 87% KPS >70%. Median of estimated blood loss 175 (50-1200) ml, operative time 180 (120-540) min and length of stay 6.5 (4-42) days. Gross total resection are 20 (76.9)% cases. There are one complication pseudomeningocele which detected in MRI control after 3 month surgery, then resolved without surgery by the 6 months control.

CONCLUSION Gross total resection maybe achieved by unilateral laminectomy and produces less complication and trauma compare to conventional technique."

"LATAR BELAKANG: Waktu tunggu menuju operasi pengangkatan tumor intrakranial elektif di Indonesia masih belum diketahui. Penulis bertujuan mengetahui waktu tunggu menuju operasi pengangkatan tumor intrakranial elektif di Departemen Bedah Saraf FKUI/RSUPNCM dan menganalisis hubungannya dengan luaran fungsional 3 bulan pascaoperasi menurut skala performa Karnofsky. METODE: Penelitian retrospektif ini didasarkan pada data rekam medis dan register pasien neuroonkologi yang menjalani operasi pengangkatan tumor intrakranial elektif pada tahun 2016. Analisis regresi logistik multivariabel dipakaiuntuk mengetahui kemaknaan statistik dari hubungan antara waktu tunggu menuju operasi pengangkatan tumor intrakranial elektif dengan luaran fungsional dependen, ditandai oleh skor KPS 0-70 3 bulan pascaoperasi, dengan mempertimbangkan usia, jenis kelamin, skor KPS praoperasi, volume tumor pradan pascaoperasi, persentase pengangkatan tumor, patologi dan grading tumor.HASIL: Median (min-maks) waktu tunggu secara umum adalah 35 (0-529) hari. Tampak hubungan bermakna antara waktu tunggu menuju operasi pengangkatan tumor intrakranial elektif dengan luaran fungsional pada analisis univariabel (OR [95%CI]: 1,004 [1,001-1,007], tetapi tidak pada analisis multivariabel. Nilai kolinearitas volume tumor pra-operasi, pascaoperasi dan persentase pengangkatan tumor dengan waktu tunggu masing-masing adalah sebesar 5,92, 5,69, dan 3,2. SIMPULAN: Tidak terdapat hubungan bermakna secara statistik antara waktu tunggu menuju operasi pengangkatan tumor elektif dengan skor KPS 3 bulan pascaoperasi. Terdapat korelasi kuat antara waktu tunggu dengan volume tumor pra- dan pascaoperasi serta persentase pengangkatan tumor.

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BACKGROUND: The waiting time to elective intracranial tumor removal surgery in Indonesia is unknown. The author aimed to identify the waiting time to elective intracranial tumor removal surgery in the Department of Neurosurgery FMUI/RSUPNCM, and to analyze its association with functional outcome 3, defined by Karnofsky Performance Scale (KPS), in 3 months after surgery.

METHODS: This retrospective study was based on medical record and the registry of neuro-oncology patient who underwent elective intracranial tumor removal surgery in 2016. Multivariable logistic regression analyses were utilized to

investigate statistical significance of waiting time to elective intracranial tumor removal surgery and poor functional outcome, defined by 3-months follow-up KPS of 0-70, adjusting for age, sex, pre-operative KPS score, pre and post-operative

tumor volume, percentage of tumor removal, tumor histopathology and grading. RESULTS: Overall median (min-max) of waiting time to elective intracranial tumor removal surgery was 35 (0-529) days. Significant statistical association between waiting time to elective intracranial tumor removal surgery and poor functional outcome was identified in univariable analysis (OR [95%CI]: 1,004 [1,001- 1,007]), but not in multivariable analysis. The collinearity value of pre- and postoperative tumor volume, percentage of tumor removal with waiting time were,

respectively, 5,92, 5,69, and 3,2. CONCLUSION: There was no significant statistical association identified between

waiting time to elective intracranial tumor removal surgery and KPS 3 months after surgery. Strong correlations were identified between pre- and post-operative tumor volume, percentage of tumor removal and waiting time to elective intracranial tumor removal surgery"

"Prosedur Trombektomi Mekanik (MT) pada stroke iskemik akut telah dilakukan sejak tahun 2017 di RSUPN Dr. Cipto Mngunkusumo. Tujuan dari penelitian ini adalah untuk menentukan ahli radiologi dan hasil klinis MT pada stroke iskemik akut dan faktor terkait lainnya. Studi observasional retrospektif memperoleh pasien telah menjalani MT pada Mei 2017-Desember 2020. Analisis univariat dan multivariat dilakukan untuk mengevaluasi hubungan antara demografi pasien, skor NIHSS pra trombektomi dan hasil seperti pasca trombektomi, skor mTICI pasca trombektomi, dan skor MRS pasca aksi. Dalam pemodelan multivariat p<0,05 digunakan untuk signifikansi statistik. Sebanyak 33 pasien dimasukkan. Pada analisis univariat demografi dan gambaran klinis didominasi oleh laki-laki, dengan rata-rata usia 55,8 tahun, GCS pra tindakan 11,9 hemiparesis, pra tindakan NIHSS 14,52, skor ASPECT 7,36, lokasi oklusi MCA, pemberian alteplase, MRS (90-day modified ranking scale: 3 sampai 6), onset rekanalisasi > 6 jam, MTICI post thrombectomy 2B-3 SICH, dan 39,4% meninggal dunia. Hubungan yang signifikan antara keberhasilan rekanalisasi dan mortalitas, dan waktu onset ke rekanalisasi secara rumit. Trombektomi mekanik di RSUPN Dr. Cipto Mangunkusumo selama 2 tahun terakhir masih memberikan hasil luaran yang buruk.

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The Procedure of Mechanical Trombectomy (MT) in acute ischemic stroke has been done since 2017 in RSUPN Dr. Cipto Mngunkusumo. The aim of this study are to detemining radiologist and clinical  outcome MT in the acute ischemic stroke and the other related factors. The retrospective observational study acquiring patient’s had undergone MT in May 2017-December 2020. Univariate and multivariate analysis were conducted to evaluate the relationship between patient’s demography, NIHSS score pre trombectomy and the outcomes such as post trombectomy, mTICI score post trombectomy, and MRS score post action. In multivariate modelling p<0.05 was used for statistical significance.  A total of 33 patients were included. On univariate analysis demography and clinical description were dominated by men, with 55.8 years age average, GCS pre action 11,9 hemiparesis, NIHSS pre action 14.52, ASPECT score 7.36, MCA occlusion location, given alteplase, MRS (90-day modified rank of scale: 3 to 6), onset to recanalization> 6 hours, MTICI post thrombectomy 2B-3 SICH, and 39.4% passed away. The significance association between recanalization success and mortality, and onset-to-recanalisation time complicationally. Mechanical thrombectomy in RSUPN Dr. Cipto Mangunkusumo for in the recent past 2 year still giving the poor outcomes result. "

"ABSTRAKTujuanTindakan bedah saraf, diduga dapat mengentikan atau memperlambat cedera otak sekunder, yang berhubungan dengan proses neuroinflamasi. Peneliti bertujuan untuk mengetahui peranan neuroinflamasi (Il-6) terhadap prognosis pasien cedera otak dan untuk mengetahui hubungan tindakan operasi dengan kondisi neuroinflamasi.MetodePenelitian ini bersifat prospektif observasional dengan desain cross sectional. Dari 40 pasien cedera otak yang dilakukan tindakan operasi, dilakukan pemeriksaan kadar Il-6 sebelum operasi dan 1 hari pasca tindakan operasi. GCS dinilai saat di UGD (GCS awal) dan sesudah tindakan operasi (GCS hari ke-7). GOS dinilai setelah bulan ke-1 dan bulan ke-3 pasca trauma. Kadar IL-6 sebelum operasi dan 1 hari pasca tindakan operasi dihubungkan dengan nilai GCS awal, GCS hari ke-7, GOS bulan ke-1 dan GOS bulan ke-3 untuk mengetahui hubungan tindakan operasi dengan proses neuroinflamasi dan nilai prognostiknya terhadap pasien cedera otak.GCS awal. GCS hari ke-7 dikelompokkan menjadi GCS <=8 dan GCS >8. GOS bulan ke-1 dan bulan ke-3 dikelompokkan menjadi GOS favorable (>3) dan unfavorable <=3.HasilKadar Il-6 awal berhubungan bermakna dengan GCS awal (p: 0.001) dengan OR 11.4 --> pasien dengan kadar Il-6 >100 pg/ml memiliki peluang 11.4 kali mendapatkan nilai GCS <=8. Terdapat perbedaan nilai median kadar Il-6 pasca operasi dibandingkan dengan pre operasi, dengan kecenderungan kadar Il-6 pasca operasi (median=35.55 pg/ml) lebih rendah daripada kadar Il-6 awal (median=76.74 pg/ml)Kadar Il-6 pasca operasi berhubungan bermakna dengan GCS hari ke-7 (p=0.006), dengan OR 24 --> pasien dengan Il-6 pre op <= 100 pg/ml memiliki peluang 24 kali memperoleh nilai GCS hari ke-7 >8. Kadar Il-6 pasca operasi berhubungan bermakna dengan GOS bulan ke-3 (nilai p= 0.016) dengan OR 11.6 --> pasien dengan kadar Il-6 <=100 pg/ml memiliki peluang sebesar 11.6 kali mencapai GOS bulan ke-3 favorable.SimpulanProses neuroinflamasi memiliki nilai prognostik pada pasien cedera otak, di mana maikin tinggi kadar Il-6 serum awal, makin buruk GCS awal pasien.Tindakan bedah saraf dapat menurunkan proses neuroinflamasi dan berhubungan dengan outcome GCS hari ke-7 (status kesadaran) pasca operasi dan GOS bulan ke-3 (kualitas hidup) yang lebih baik.

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ABSTRACTObjectivesNeurosurgical procedures are performed to stop or slow down the secondary brain injury. This study is aimed to determine the association of neuroinflammation with the prosnosis of brain injury patients and the association of neurosurgical procedure with the neuroinflammation.MethodThe study design is a prospective observation of 40 brain injuty patients who were operated. Examination were carried out top measured Il-6 serum level of pre and one day post operation on brain injury patients, and to analize therir association with GCS,GOS and neurosurgical procedures.ResultsThe Il-6 serum level pre surgery was significantly associated with initial GCS (p value=0.001 and OR 11.4). There was significant median difference of Il-6 post surgery compared with pre surgery, with a downward trend of Il-6 post surgery.The post operative Il-6 level was significantly associated with GCS 7 days post surgery (p=0.006), with OR 24, meaning that patients with post surgery level of Il-6 <= 100 pg/ml had 24 times chance of getting GCS 7 days post trauma >8. The post operative Il-6 serum was significantly associated with GCA 3 months post trauma (p value= 0.016) with OR 11.6, meaning that the patients with post operative Il-6 level <= 100 pg/ml has 11.6 times as much chance of reaching the 3 months post trauma GOS favorable.ConclusionNeuroinflammation may have prognostic values in brain injured patients. Neurosurgical procedures can decrease the neuroinflammation process and was associated with better conciousness state (GCS) and neurological outcome (GOS)."

"ABSTRAKDi berbagai literatur, tumor meningioma sphenoid wing memiliki dua nama, yaitu meningioma en-plaque sphenoid wing dan meningioma spheno-orbita. Meningioma di regio sphenoorbita itu adalah tumor kompleks meliputi sphenoid wing, orbita, sinus cavernosus yang merupakan penyulit terhadap reseksi total. Presentasi klinis adalah klasik trias yaitu proptosis, gangguan visual, paresis okuler. Meningioma sphenoid wing ditemukan tersering adalah jenis en-plaque. Meningioma en-plaque adalah suatu subkelompok morfologis yang didefinisikan sebagai lesi tipis, menyebar luas, menyerupai karpet atau lembaran, yang menginfiltrasi dura dan terkadang menginvasi tulang dan tumbuh didalamnya sebagai tumor intraosseus sehingga menyebabkan hiperostosis. Meningioma juga memproduksi enzim yang mana diketahui secara tidak langsung menghasilkan proses penulangan. Berdasarkan literatur, dari seluruh tumor meningioma terdapat 15-20% yang ditemukan di sphenoid wing disertai hiperostosis pada regio frontotemporal-lateral orbita. Antara Januari 2010 dan Januari 2012, sebanyak 60 pasien meningioma di sphenoid wing atau sekitar 46,1% dari jumlah keseluruhan temuan meningioma intrakranial (130 pasien) menjalani operasi reseksi di departemen Bedah Saraf RSUPN Cipto Mangunkusumo, Jakarta. Hiperostosis merupakan perubahan pada tulang cranium yang paling banyak ditemukan yang berhubungan dengan meningioma khususnya di regio sphenoid wing. Beberapa teori mengemukakan bahwa hiperostosis ini merupakan kejadian sekunder dari proses pembentukan tumor dan timbulnya dengan atau tanpa invasi tumor ke tulang. Banyaknya kasus pasien yang dikonsulkan oleh departemen Mata dengan keluhan proptosis yang datang ke departemen Bedah Saraf FKUI-RSUPN Cipto Mangunkusumo menjadikan hal tersebut menarik uuntuk diperhatikan dan untuk diketahui lebih jauh deskripsi datanya. Obyektif Studi ini bertujuan melakukan evaluasi lebih lanjut mengenai meningioma sphenoid wing yang disertai hiperostosis mengenai data demografisnya. Studi ini ingin melihat tentang hubungan antara banyaknya insiden dengan sebaran usia, jenis kelamin dan keterkaitan dugaan penyebabnya, jenis tumor. Selain itu, studi ini ingin mengevaluasi hubungannya dengan pemakaian kontrasepsi khususnya KB suntik, hasil operasi serta komplikasi dan angka rekurensinya.Metode Studi ini adalah studi retrospektif dilakukan berdasarkan status rekam medis berupa data riwayat penyakit pasien, manifestasi klinis yang ada, tanda-tanda neurooradiologis dan teknik operasi, pada 60 pasien yang menjalani pembedahan secara kraniotomi dan lateral orbitotomi dari Januari 2010 sampai Januari 2012. Populasi sampel diambil dari pasien di departemen Bedah Saraf RSUPN Cipto Mangunkusumo, Jakarta. Kriteria inklusi adalah semua pasien yang didiagnosa dengan meningioma sphenoid wing disertai hiperostosis periode Januari 2010 - Januari 2012. Kriteria ekslusi adalah tumor meningioma di luar regio sphenoid wing dan meningioma sphenoid wing tanpa adanya hiperostosis. Hasil Pada studi ini terdapat rentang usia pasien: 31-60 tahun dengan rerata usia 44 tahun, jenis kelamin diantaranya 2 (3%) laki-laki dan 58 (96,7%) perempuan. Keluhan utama adalah proptosis yang progresif, penurunan tajam penglihatan disertai hiperostosis. Seluruh pasien dilakukan pembedahan melalui lateral orbitotomi dan kraniotomi fronto-temporal disertai dekompresi orbita. Pemantauan dilakukan terhadap derajat luas reseksi tumor dan komplikasi postoperatif. Semua pasien dengan meningioma sphenoid wing disertai hiperostosis pada lateral orbita telah menjalani pembedahan dengan reseksi subtotal atau parsial. Pemeriksaan patologi menunjukkan sebanyak 33 (55%) pasien adalah meningioma meningoteliomatosa. Setelah pembedahan, proptosis dilaporkan membaik secara klinis pada 54 (90%) pasien, tajam pengihatan meningkat secara klinis pada 18 (30%) pasien, perihal paresis okuler sulit didapatkan datanya. Lama follow-up adalah 3 bulan sampai 1 tahun, didapatkan rekurensi tumor pada 4 (6,6%) pasien dan 2 (3,3%) pasien menjalani pembedahan kedua. Sebanyak 2 (3,3%) pasien tidak terpantau. Ditemukan 51 (85%) pasien dengan riwayat penggunaan kontrasepsi KB yang menahun, non pengguna 4 (6,6%), tidak diketahui 4 (6,6%) pasien. Dari jumlah 51 (85%) pasien pengguna KB, diantaranya 46 (90,2%) pasien menggunakan kontrasepsi suntik, 4 (7,8%) pasien dengan pil, 1 (1,9%) pasien dengan susuk. Sebanyak 41 (89,1%) pasien menggunakan kontrasepsi KB suntik selama lebih dari 10 tahun dan 5 (10,8%) pasien kurang dari 10 tahun. Meningioma pada sphenoid wing kebanyakan berjenis meningioma meningotelial dan neoplasma jenis ini cenderung menyebabkan hiperostosis setempat serta memiliki gambaran radiologi yang khas. Semua hiperostosis yang ditemukan pada sphenoid wing harus diangkat untuk mencegah rekurensi. Pengangkatan tumor secara luas disertai dekompresi tulang sphenoid wing memberi hasil fungsional dan kosmetik yang memadai. Tidak ada hubungan bermakna dari data meningioma sphenoid wing disertai hiperostosis dengan usia dan jenis kelamin. Terdapat hubungan bermakna antara KB dengan jenis meningioma yaitu meningoteliomatosa. Kerjasama yang baik antara dokter bedah saraf dan dokter mata adalah penting untuk kelainan ini. Riwayat penggunaan alat kontrasepsi KB suntik banyak didapat pada pasien meningioma sphenoid wing disertai hiperostosis.

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ABSTRACTSphenoid wing meningioma has two names, such as meningioma en plaque sphenoid wing and spheno-orbital meningiomas. Meningiomas in the sphenoorbita has its complex, includes sphenoid wing, orbit, cavernous sinus, which could complicate the total resection. Clinical presentation is the classic triad of proptosis, visual disturbance, and occular paresis. The most common sphenoid wing meningioma is en-plaque meningioma. En-plaque meningioma is a morphological subgroup defined as thin lession, widely spread, like carpet or sheet, which infiltrated dura and sometimes invading bone and grows inside the tumor intraosseus thus causing hyperostosis. Meningiomas are also produce enzymes, which indirectly cause calcification. Fifteen to twenty percent of meningiomas are found in sphenoid wing with hyperostosis in frontotemporal-lateral orbital region. Fourty six percents from all of intracranial meningioma patient cases were sphenoid wing meningioma with hyperostotic during Period January 2010 to January 2012. Hyperostotic is a change in the skull bones are most commonly found associated with meningioma especially in the region of the sphenoid wing. Some theories suggest this event is secondary to the process of tumor formation and could occur with or without tumor invasion to bone. Many cases of patients with proptosis who are consulted by ophtalmologists that come into the department of Neurological Surgery School of Medicine-Cipto Mangunkusumo, makes it interesting to be observed and explored further. Objective This study is performed to conduct further evaluation of the sphenoid wing meningioma with hyperostosis, regarding the demographic data. The study wanted to see the relationship between the number of incidents with the distribution of age, sex, causes, and the type of tumor. In addition, this study evaluated the relationship between the usage of injectable contraceptives in particular family planning, operating results, and the rate of complications and recurrence. Methods This study was a retrospective study conducted by collecting medical records of patients’ medical history, clinical manifestations, the neurooradiological sign, and engineering operations, in 60 patients who underwent surgery for a craniotomy and lateral orbitotomi from January 2010 until January 2012. Population samples were taken from patients in the department of Neurosurgery Cipto Mangunkusumo. Inclusion criteria were all patients diagnosed with sphenoid wing meningioma with hyperostosis in the periods of January 2010 - January 2012. Exclusion criteria were meningioma tumor in the sphenoid wing and the outer region of the sphenoid wing meningioma without hyperostosis. In this study there were patients with age range from 31-60 years with the average age of 44 years old.There were 2 (3%) men and 58 (96.7%) female. The chief complaint is progressive proptosis and visual impairment. All of the patient undergo surgery through lateral orbitotomi and fronto-temporal craniotomy accompanied by orbital decompression. Monitoring on a wide degree of tumor resection and postoperative complications is performed. All patients with sphenoid wing meningioma with hyperostosis in lateral orbita have operated with subtotal or partial resection. Pathological examination showed 33 (55%) patients are meningothelial meningioma. After surgery, proptosis reduced in 54 (90%) patients, and increasing visus in 18 (30%) patients. Three months to one year follow-up found the tumorrecurred in 4 (6.6%) patients and 2 (3.3%) patients, who underwent a second surgery. Two (3.3%) patients were not monitored. No history of chronic use of contraception. A total of 42 (89.36%) patients using injectable contraception for more than 10 years and 5 (10.6%) patients less than 10 years. Reported contraceptive device users in52 patients (86%) patients, non-users in 4 (6.6%), and unknown in 4 (6.6%) patients. From a total of 52 (86%) patients with contraceptive users, 47 of them (90.38%) used injectable contraception, 4 (7.69%) consumed oral contraceptive pill, dan 1 (1.92%) patient with the implant contraception. Conclusion The most common type of sphenoid wing meningioma were menignothelial meningioma. This tumor is the most diversified and is tend to cause local hyperostosis and has a picture of a typical radiology. All hyperostosis found on the sphenoid wing must be removed to prevent recurrence. Wide removal of the tumor with decompression sphenoid wing bones gives the adequate functional and cosmetic results. There is no significant correlation of the data sphenoid wing meningioma with hyperostosis with age and sex. However, there was a significant relationship between the meningothelial meningioma with injecting contraception. Good cooperation between neurosurgeons and ophthalmologists is important for this disorder. History of the use of injectable contraception is obtained in patients with sphenoid wing meningioma with hyperostosis."

"Latar belakang: Seorang neurointervensionis untuk melakukan Tindakan neuroendovaskular harus mengetahui pasti struktur karotis dan serebrovaskular, hal ini menentukan keberhasilan tindakan. Bentuk dan perubahan anatomi pembuluh darah menentukan jenis kateter yang digunakan dalam intervensi diagnostik maupun terapetik. Keadaan anatomi yang berbeda-beda dipengaruhi beberapa faktor seperti jenis kelamin, usia, dan kondisi komorbid. Tujuan penelitian ini untuk menentukan faktor predisposisi yang ada, dan dapat memprediksi jenis kateter yang tepat untuk digunakan. Metode: Penelitian deskriptif analitik dengan 57 sampel, dilakukan di Cathlab Pusat Jantung Terpadu (PJT) Rumah Sakit Pusat Nasional Dr. Cipto Mangunkusumo dari Desember 2018 sampai Desember 2021. Faktor-faktor predisposisi dan kondisi komorbid diukur pada setiap pasien. Analisis data dilakukan secara bivariat dan multivariat. Hasil: Variasi lengkung aorta tipe I berjumlah 38, tipe II berjumlah 9 dan tipe III berjumlah 10. Analisis bivariat menunjukkan usia (p<0,001), jenis kelamin (p=0,256), hipertensi (p=0,089), diabetes melitus (p=0,179), riwayat strok (p=0,882), obesitas (p=0,455), kelainan pembuluh darah intrakranial (p=0,608), letak percabangan arteri karotis komunis (p=0,069), jenis kateter yang digunakan (p=0,425). Analisis multivariat menunjukkan (p=0,026; R2=43%) dengan model usia yang menentukan jenis kateter (p=0,015). Simpulan: Usia adalah faktor prediktor yang dapat memprediksi pemilihan jenis kateter pada pemeriksaan diagnostik maupun terapeutik pasien.

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Background: A neurointerventionist to perform neuroendovascular procedures must know for sure the carotid and cerebrovascular structures. Anatomically, this determines the success of the action. Anatomical changes determine the type of catheter used in diagnostic and therapeutic interventions. Different anatomical conditions are influenced by several factors. The purpose of this study was to determine the predisposing factors that can predict the type of catheter used.

Methods: Analytical descriptive study with 57 patients, conducted at the Cathlab Center in Dr. National Central Hospital Cipto Mangunkusumo from December 2018 to December 2021. Predisposing factors were measured for each patient. Data analysis was done by bivariate and multivariate.

Results: The aortic arch variations of type I were 38, type II was 9 and type III was 10. Bivariate analysis showed age (p<0.001), sex (p=0.256), hypertension (p=0.089), diabetes mellitus (p= 0.179), history of stroke (p=0.882), obesity (p=0.455), intracranial blood vessel abnormalities (p=0.608), location of the branching of the common carotid artery (p=0.069), type of catheter used (p=0.425). Multivariate analysis showed (p=0.026; R2=43%) with the age model determining the type of catheter (p=0.015).

Conclusion: Age is a predictor factor that can predict the choice of catheter type in diagnostic and therapeutic examinations of patients."

"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)."

"Pendahuluan: Perdarahan Intraventrikel Intraventricular Hemorrhage / IVH merupakan perdarahan spontan yang terjadi di dalam sistem ventrikel, 30-45 sering berhubungan dengan Intracerebral Hemorrhage ICH . Evaluasi aktifitas sehari-hari yang akurat dan tepat pada pasien pasca stroke sangat penting untuk kualitas perawatan dan pengukuran luaran pasca perawatan stroke. Modified Rankin Scale mRS merupakan skala pengukuran disabilitas yang dipakai secara global untuk evaluasi pemulihan dari stroke. Tujuan: Menelaah data luaran penderita perdarahan intraventrikel yang dilakukan operasi di Departemen Bedah Saraf Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo berdasarkan mRS. Metode: Penelitian ini merupakan penelitian retrospektif dengan desain potong lintang cross sectional . Adapun variabel independent yaitu lokasi lesi perdarahan intraserebral, IVH-skor, GCS awal, dan variabel dependent yaitu luaran berdasarkan skoring mRS. Subjek penelitian adalah semua pasien penderita perdarahan intraventrikel yang dikelola Departemen Bedah Saraf RSUPN Cipto Mangunkusumo selama periode Januari 2010 sampai dengan Agustus 2016. Jumlah sampel pada penelitian ini didapatkan 23 sampel. Data penelitian diperoleh melalui catatan rekam medis, subjek dihubungi via telepon, kemudian subjek atau keluarga diwawancara untuk menilai status fungsionalnya dengan mRS. Data diolah dengan menggunakan program SPSS 21. Hasil: Luaran 6 bulan IVH dengan menggunakan mRS secara keseluruhan didapatkan independent 11 pasien 47,8 dependent 4 pasien 17,3 dan 8 pasien meninggal 34,9 . IVH sebagian besar berusia di bawah 60 tahun 60,8 dan 39,2 yang berusia diatas 60 tahun, dari penelitian didapatkan IVH skor terbanyak adalah >15 sebanyak 15 pasien 65,2 . GCS rata-rata 7,6 2,14 . MAP terbanyak adalah >100 dengan jumlah 20 pasien 87 , dan faktor resiko yang mengalami hipertensi sebanyak 19 pasien 82,6. Diskusi: mRS dapat digunakan sebagai standar penilaian luaran IVH.

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Introduction: Intraventricular hemorrhage IVH is a spontaneous hemorrhage occurring within the ventricular system, 30 40 often associated with Intracerebral hemorrhage ICH, Accurate and precise daily evaluating activity in post stroke patients is critical for the quality of care and measurement of post stroke outcomes. Modified Rankin Scale mRS is a global disability measurement scale used for the evaluation of stroke recovery.

Aims: Configuring outcome data of patient with intraventricle hemorrhage operated at neurosurgery departmen of cm hospital based on mRS.

Methods This was an observational study with cross sectional design. The independent variables are location of intracerebral hemorrhage lesion, IVH score, initial GCS, and dependent variable is outcome based on mRS scores. Subjects of research were all patients with intraventricular hemorrhage administered by Department of Neurosurgery Cipto Mangunkusumo Hospital during January 2010 until August 2016 period. The number of samples in this study were obtained 23 samples. Research data was obtained through medical record and transferred into data entry format, patients was contacted by telephone, then patients or family were interviewed to assess their functional status with Modified Rankin Scale. Data is processed by using SPSS 21 program.

Results: 6 months IVH overall outcomes are 11 independent patients 47.8 4 dependent patients 17.3 and 8 patients died 34.9. IVH were mostly under 60 years old 60,8 and 39,2 were aged over 60 years, from the study obtained IVH most scores were 15 as many as 15 patients 65.2. GCS averages 7.6 2.14 . Most MAPs were 100 with 20 patients 87, and hypertension risk factors were 19 patients 82.6.

Discussion: mRS can be used as standard outcome assessment of IVH."