Vertex extradural hematomas: when to operate?: A case report
Yunus Kuntawi Aji, Matteo Rasi, Tedy Apriawan, Abdul Hafid Bajamal
Background: Vertex Extradural Hematomas (VEDHs) are rare consequence of head injury which represent another distinct group of EDHs. They may present with unusual clinical signs that can delay diagnosis and present a dilemma as to indication for and timing of surgery.
Case: A man with VEDHs was reffered to our institution due to neurological deterioration and worsening symptoms after conservative treatment. Emergency craniotomy was done to the patient. Postoperatively, the patient made good clinical improvement.
Conclusion: Prompt decision to surgery is vital for good outcome of patient with VEDHs.
Extended endonasal endoscopic approach for the resection of craniopharyngioma - an analysis of 40 cases
Shamsul Alam, Abu Naim Wakil Uddin, Mashiur Rahman Majumder, Abu Saleh Mohammad Abu Obaida, Saif Ul Haque, Narendra Shalike, Kamrunnessa Hossain
Extended endonasal endoscopic approach for the non-pituitary lesions of the sellar and suprasellar regions are not new in the field of neurosurgery. Traditional transsphenoidal approach gives exposure to the pituitary fossa, whereas extended approach provides exposure to the optic nerve, chiasm, A-com complex, basal frontal lobe, mammillary body, midbrain, 3rd cranial nerve, basilar artery, Circle of Willis and laterally to the cavernous sinuses.
Methods and Materials:
From November 2007 to February 2016,there were 40 cases of craniopharyngiomaoperated by the extended endonasalendoscopic approach. Patientâ€™s history, clinical findings, pre-operative &post-operative visual acuity, visual field analysis and radiological data were collected and analyzed.
Age group of the patients varied from 10 to 60 yrs. Male were 19 (47.5%), female were 21 (52.5%).Gross total removal was achieved in 22 cases (55.0%) and subtotal in 10 (25.0%) cases. Visual acuity and visual field improved in all cases. One case (2.5%) had prolonged period of unconsciousness, probably from hypothalamic disturbance. Cerebrospinal fluid leak developed in 10 (25.0%) cases. All patients required thyroxin and cortisol for replacement. Permanent diabetes insipidusdeveloped in 10 cases (25.0%). No cases required traditional, open approaches following endoscopic resection. Three patients required permanent CSF diversion via a ventriculo-peritoneal shunt after documentation of post-operative hydrocephalus.
Conclusion:Extendedtransspehnoidal approach is an excellent alternative of skull base approach for the removal of most of the craniopharyngiomas.It gives better visualization, improved postoperative visual outcome for less manipulation and lower complicationrate than craniotomy. However,CSF leak and DI are known common complications which shouldbe managed promptly and appropriately.
Bone Autograftafter Total Corpectomy in Cervical Tuberculosis Spondylitis : A Case Report
Ria Amelia, Amiril Muâ€™minin
Tuberculosis (TB) of the cervical spine is reported about 2 to 3% of all the TB cases in Indonesia. In this case report, we demonstrated the use of bone auto-graft to obtain a good clinical result. This case reported a 38 years-old woman complained weaknesses in all the extremities, preceded by the neck pain radiating in both of the shoulders and the arms since past few months. There isthe restriction of the neck movement, also stiffness and numbness in both of the hands. The laboratory study showedincreasing of the Erythrocyte Sedimentation Rate (ESR). The imaging studies showeddestructionsin the spine body of theCervical 4 and the Thoracal 2, narrowing in the Cervical 3-4-5 and the Thoracal 1-2-3 intervertebral disc with paravertebral abscess.The Histopathologicalexamination showed a spondylitis Tuberculosis. The anterior corpectomy was performed using the microscope surgery with bone graft from the right iliac and the insertion of an anterior plate. This patient was also treated with anti-tuberculosis agent for 9 months.
Hyperdense Appearance in Active Epidural and Subdural Hematoma: Serial Case Report
Krisna Tsaniadi Prihastomo, Tedy Apriawan, Agus Turchan
Many of traumatic brain injured patients come to the emergency department with active intracranial bleeding, either Epidural Hematoma (EDH) or Subdural Hematoma (SDH). The most common source of bleeding in EDH cases might be either from the oozed bleeding from fracture of adjacent bone or tear of medial meningeal vessel branches. The classic appearance usually found in non-contrast head CT, which formed a biconvex lesion. The active bleeding, usually from blood vessels tearing origin, could also be found in CT imaging. There is hypodense mixed within the hyperdense lesion, sometimes formed a whirlpool-like appearance, which later known as â€œSwirl Signâ€3. The acute subdural hematoma, by its process, is different with EDH. It is usually caused by clot accumulation of adjacent cortical laceration or tearing of bridging veins. The crescent-like appearance is the classical CT image shown in acute SDH. However, up to now, the active bleeding in subdural hematoma is not widely explained. We report 12 cases of epidural and subdural hematoma which indicate active bleeding from imaging study.All of the cases revealed the active bleeding during the surgery.We suggest that hypodense lesion in acute TBI imaging should be considered as active bleeding not only for EDH but also for SDH cases. Thus, more attention must be taken carefully during the surgery.
Keyword: Swirl sign, Subdural Hematoma, SDH, active bleeding
Dural tear in primary versus reoperative spinal decompression surgery: A Meta-Analysis
Khrisna Rangga Permana, Yeni Purnamasari, Tommy Alfandy Nazwar
Dural tear is one of the most frequent but anticipated potential complications of spinal decompression surgery. Spinal decompression surgery is one of the most common procedure in neurosurgery which undergoes vast development in the technology and technique in last decades. The objective of this meta-analysis was to evaluate the dural tear incidence following primary spinal decompression surgery compared to reoperative spinal decompression surgery worldwide. Authors were using meta-analysis. Studies were searched throughout JNS, Cochrane, PubMed, and Google Scholar from 2000-2017. Keywords were "dural tear" and "surgery" and "spine" and "primary" or "reoperative". Inclusion criteria were full-text observational study or randomized control trial articles stating dural tear or incidental durotomy rate in both primary and reoperative spinal decompression surgery. Articles which not written in Bahasa or English were excluded. From 320 studies, total 9 studies were eligible for this study. Statistical analysis was done by using Review Manager 5 in December 2017. Based on statistical analysis, there was difference between dural tear incidence between primary compared to reoperative spinal decompression surgery. Dural tear appeared less frequent in primary surgery and this result was significant. It still needs more multicenter and long term period researches in the future to get better understanding dural tear incidence in spinal decompression surgery.
Keywords: Dural tear, Primary, Reoperative, Spinal decompression surgery