Background: Meningiomas are the most common primary brain tumors. One known risk factor for meningioma is exposure to estrogen hormone. Body mass index (BMI) and high body fat percentage have been found to be associated with increased production of estrogen hormone particularly among menopausal women. This study was conducted to determine the effect of BMI and body fat percentage with increased risk of meningioma in menopausal women.

Methods: This was a cross-sectional study which selected its subject using consecutive non-probability sampling method at Neurosurgery Department of Dr. Hasan Sadikin Hospital Bandung from December 2018 to November 2019. A total of 50 subjects were categorized into two groups, the menopausal and premenopausal groups consisting of 25 subjects each.

Results:  Menopausal women whose BMI was above the normal reference range had a 2.95 times greater risk of suffering from meningioma compared to those with normal BMI, and 1.312 times greater risk (95% CI 0.934-1.84) when compared to premenopausal women having higher-than-normal BMI. High body fat percentage in menopausal women was found to increase the risk of developing meningioma for up to 2.49 times compared with those with normal body fat percentage and had 1.36-time greater risk (95% CI 0.901 – 2.051) compared to premenopausal women with normal body percentage.

Conclusion: Menopausal women with higher BMI and body fat percentage were at increased risk of developing meningioma for up to 1.3 times compared to premenopausal women with higher BMI and body fat percentage and nearly 2.5 – 3 times higher risk compared to menopausal women with normal BMI and body fat percentage.

Keywords: body mass index, body fat percentage, menopause, meningioma

Introduction: Foramen magnum meningiomas (FMMs) arise from meningothelial cells of arachnoid layer in the craniospinal junction. FMMs are rare and comprise only 1.8 to 3.2% of all meningiomas. Patients with FMMs generally have vague symptoms and are often misdiagnosed. Surgical management of FMMs poses a challenge because foramen magnum is a highly complex territory of the skull base and contains many important and vital structures. Up until this date, the surgical approaches for FMMs that arise anterolaterally remain varied. We aimed to present a case of anterolateral FMM that was successfully managed through posterior suboccipital midline approach.

Case presentation: A 49-year-old female presented with chief complaint of tetra paresis for the past 4 months. Initially, she was experiencing tingling and numbness on her right neck radiating to her right hand. Her symptoms were worsened, radiating to all of her four extremities along with progressive motor weakness that made her unable to walk. Whole spine MRI was performed and anterior meningioma extending to the right side at the level of foramen magnum was found. The posterior suboccipital midline approach with C1 laminectomy and C2 partial superior laminectomy was performed. The patient made a good recovery immediately after the surgery and there was no recurrence of her symptoms during 4 months follow-up.

Conclusion: Surgical approaches for FMM remain varied according to several studies. However, the surgical strategy should be patient-tailored to achieve the maximal resection and prevent morbidity. As for our case, posterior suboccipital midline approach is safe and feasible surgical procedure to treat anterolateral FMM.

Keywords: foramen magnum, meningioma, suboccipital midline approach

Introduction: Acquired prothrombin complex deficiency (APCD) is a spontaneous hemorrhage due to decreased activity of vitamin K dependent coagulation factor (factor II, VII, IX, and X). Many factors lead to vitamin K deficiency in newborns. We reported case reports of APCD which were successfully managed with APCD guidelines.

Case presentation: First case was baby aged 1 month who came to emergency ward due to seizure four times. Seizures were occurred for 30 minutes and reported unconscious between episode of seizure. Head computed tomography (CT) scan examination revealed crescent shape appearance which suggested subdural hematoma (SDH). Second case was a 2 months old baby came to emergency department unconsciously since two days before. Patient has no history of vomiting and seizures. Non-contrast head CT scan showed appearance of crescent shape, which suggested presence of SDH. Both patients were managed according to APCD guidelines and had improved.

Conclusion: Mild APCD has good prognosis and showing improvement in 24 hours after vitamin K injection. The mortality rate is very high in case of severe bleeding in intracranial, intrathoracic, and intraabdominal.

Background: Post-surgical evaluation is important for spina bifida patients with low-lying medullary cone including measurement of medullary cone position after being treated. This study aimed to evaluate contributing factors of medullary cone ascending following reconstruction surgery.

Methods: This was a descriptive study including low-lying medullary cone spina bifida patients who underwent reconstructive surgery at the Department of Neurosurgery, Cipto Mangunkusumo Hospital, Jakarta, from May 2015 to May 2016. Preoperative and postoperative medullary cone position were evaluated using 1.5 Tesla Magnetic Resonance Imaging (MRI).

Results: Eight low-lying medullary cone spina bifida patients who had reconstructive or untethering surgery were included in this study. We found six patients (75%) who had shifting of medullary cone level after surgery. Ascending of medullary cone level to L2 was found in 1 patient (12.5%) of pre-school age group, between 3 – 5 years old. All patients had intradural scar which were shown on post-operative MRI. Primary closure of duramater was performed to all patients. Post-operative MRI assessment at 6 months showed ascending of medullary cone 2 to 3 levels in most patients compared to those who had post-operative MRI assessment in less than 6 months.

Conclusion: Age at surgery, surgical technique using primary closure of duramater, and timing of post-operative radiological examination affects shifting of medullary cone position following reconstructive surgery.

Keywords: low-lying medullary cone, spina bifida, untethering