Background: Metastases of breast cancer in areas of the central nervous system will have a poor prognosis. Therefore, knowledge about the management of metastases to the central nervous system, especially leptomeningeal becomes very important. This study aimed to evaluate therapy to support the evidence that intrathecal chemotherapy with Ommaya is a promising therapy for leptomeningeal metastasis of breast cancer.

Case presentation: Three cases were presented. The first case was a 49 years old female with a KPS of 80 at the beginning of methotrexate (MTX) chemotherapy via Ommaya and intravenous chemotherapy. The second case was a 54 years old female with a KPS of 90 who underwent MTX chemotherapy via Ommaya and Whole Brain Radiation Therapy. The KPS became 100. The third case was a 45 years old female with liver, lung, bone, and leptomeningeal metastatic breast cancer. Initial KPS was 70; NANO score was 2, given MTX chemotherapy via Ommaya and intravenous chemotherapy. When the general condition improved, chemotherapy via Ommaya was continued 12 times. The KPS improved to 90 and the NANO score improved to 0.

Conclusion: Intrathecal chemotherapy via Ommaya can increase the life expectancy and quality of life of breast cancer patients with leptomeningeal metastases when combined with systemic chemotherapy. The KPS before chemotherapy, patient compliance in carrying out therapy, and control of general conditions including infection status and radiation before intrathecal chemotherapy were prognostic factors that affect the success of chemotherapy via Ommaya.

Keywords: breast cancer, leptomeningeal metastases, Ommaya shunt

Background: Otitis media (OM) is a common otologic condition in pediatric and adult populations. Brain abscess (BA) is commonly considered the second most common intracranial complication of OM after meningitis. It has been reported that 25% of BA in children were otogenic. Otogenic BA often manifests as a single lesion. A systematic review showed most otogenic BA was located in the temporal lobe (55%). Other includes the cerebellum (28%), frontal lobe, parietal lobe, subdural locations (5%), and not-specified (11%). Since multiple BAs due to otogenic infections are rarely reported, we are interested in reporting a case in our hospital in Kalimantan Timur.

Case presentation: A 4-month-old female infant was admitted with continuous high fever, generalized tonic-clonic convulsion, a progressive increase in head circumference, and bilateral transient downward eye deviation with a history of pus discharging from the left ear. Attic perforation was found on the left tympanic membrane. An emergency head computed tomography (CT) showed multiple rim-enhancing lesions with wide vasogenic edema on the right frontal region accompanied by a dilatation of the lateral, third, and fourth ventricles. A burr hole aspiration was done on the largest abscess and obtained 200 cc of pus that showed Methicillin-Resistant Staphylococcus aureus (MRSA) as a causative agent. Because of the findings, BA formation via hematogenous must be suspected. Several tests including blood culture, interferon (IFN)-gamma release assay, and echocardiography were performed. However, tests showed normal results.

Conclusion: Delay in diagnosis and treatment of otogenic infection may lead to multiple BA formations. Although the direct spread of otogenic infection occurs in multiple BA, suspicion of distant hematogenous spread should remain until proven otherwise.

Keywords: management, multiple brain abscesses, otogenic

Background: Hydrocephalus is a multifactorial abnormal condition characterized by the accumulation of cerebrospinal fluid (CSF) and an enlarged head and classified into numerous types based on its etiology, examination results, and management. This study aimed to obtain the profile of pediatric hydrocephalus patients with the ventriculoatrial shunt.

Methods: This study was a retrospective descriptive study using secondary data from the medical records of pediatric hydrocephalus patients during 2019 – 2020.

Results: The research results obtained from 15 patients were dominated by patients with an age range of 12 months – 2 years (46.7%) and male (66.7%). The majority of patients had undergone shunt or drainage surgery (53.3%). Most of the patients had a total GCS of 14 – 15 (66.7%), the majority of patients experienced two clinical symptoms (40%) and experienced shunt malfunction (53.3%) while only a few patients experienced shunt malposition (13.3%). Vomiting was the most common symptom (53.3%), while abdominal enlargement and nausea were experienced by a small proportion of patients (20%). The majority of result in the CSF examination was colorless CSF (46.7%), clear (86.7%), no clots (100%), and positive Nonne Pandy examination (80%). The average total cells in the CSF were 56,303, the average polymorphonuclear cell was 25,593; the average mononuclear cell was 73.37; the average glucose concentration was 41.86; and the average protein concentration was 846.32.

Conclusion: The decision to insert a ventriculoatrial shunt in a pediatric hydrocephalus patient varies considerably. Some patients report complaints of abdominal pain, nausea, and bloating, while others report mechanical shunt failure and shunt malposition. Furthermore, there are discrepancies in the CSF examination results.

Keywords: child well-being, hydrocephalus, pediatric, ventriculoatrial shunt