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Introduction: Various surgical procedures have been found to effectively treat intractable temporal lobe epilepsy (TLE), including transcortical selective amygdalohippocampectomy (SAH), which is intended to protect the temporal lobe and to prevent interference with vascular structure. This research analyzed the outcome of post-operative seizure-free with transcortical selective amygdalohippocampectomy for intractable mesial temporal lobe epilepsy patients in a minimum two-year follow-up after surgery. Methods: Data of one hundred ninety-two patients who had undergone transcortical selective amygdalohippocampectomy for non-lesional, medically intractable, temporal lobe epilepsy were analyzed. Result: The statistical analysis indicated that Focal to Bilateral Tonic-Clonic Seizure had a more significant outcome (p=0.019) than other seizures. In all research subjects, after three, six, and twelve years of follow-up, the chance for a seizure-free after surgery was respectively 93.2 percent, 67.9 percent, and 36.7 percent with a median average survival period for all subjects of 11.00 years (95 % CI: 8.55 – 13.44) Conclusions: Transcortical selective amygdalohippocampectomy is an effective therapy for intractable mesial temporal lobe epilepsy and provides a satisfactory outcome. The transcortical approach allows an appropriate operative field by careful dissection with limited retraction to eliminate the epileptogenic target while preventing damage to the underlying vascular and cortical structures.

Behçet’s disease (BD) is a rare chronic inflammatory disease associated with systemic vasculitis. Involvement of the nervous system in BD is called neuro-BD (NBD). Epilepsy related to NBD is uncommon but responds well to anti-epileptic drugs. We present a case of NBD with drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS). The patient presented with headache, dizziness, disorientation, and generalized seizures. Magnetic resonance imaging (MRI) identified pontine lesions. Chronic inflammation was suspected, and steroid pulse therapy improved his symptoms. He relapsed 1 year after onset and was diagnosed with NBD. MRI revealed bilateral mesial temporal lesions, with the right being edematous and the left atrophic. NBD was controlled by steroid and immunosuppressive medication. Three years after the onset of NBD, the patient suffered MTLE, and MRI suggested left hippocampal atrophy. His seizures became drug-resistant and surgical therapy was considered 12 years after NBD onset. Pre-surgical MRI clearly showed left HS. After evaluations, the patient had left anterior temporal lobectomy (ATL) 13 years after NBD onset under stable NBD. The patient was seizure-free for > 2 years after surgery. Surgery will be an effective treatment for drug-resistant MTLE with HS even in patients with NBD, of course the effects of surgical intervention should be considered.

Background: Degenerative spinal disease increases in proportion to life expectancy. Surgical treatments that play an essential role in the management of degenerative spinal disease have evolved from open surgery to minimally invasive surgery as well as endoscopic spinal surgery. Advanced pathological understanding, diagnostic imaging, and instrument progress have support for endoscopic spinal surgery. The study aims to report the current situation of endoscopic spinal surgery to treat degenerative spinal diseases in the Department of Neurosurgery of Kariadi Hospital.Method: Review the Endoscopy Spine Surgery case in the Department of Neurosurgery of Kariadi Hospital with degenerative spinal diseases including canal stenosis and disc herniation at all levels.Results: A total of 123 degenerative spinal diseases have been treated with endoscopic spinal surgery. Most of patients comes with HNP (89 patients, 72.4%) and operated in lumbal segment (87 patients, 70,7%). Estimated blood loss parameter in 50 years group had mean 115.00 ± 95.25 ml with p=0.001. We got high correlation between operation time and estimated blood loss with r = 0.779 and statistically significant (p=0.000)Conclusion: Endoscopic surgery appears to be an option for treating degenerative spinal diseases especially for herniation and canal stenosis. The lumbar and thoracic regions are common areas for endoscopic spinal surgery.

Background:  The aim of epilepsy surgery is to improve the quality of life of people with epilepsy. Temporal lobe epilepsy (TLE) is the most common form of intractable epilepsy with a risk of low quality of life due to uncontrolled seizures. In this study, we evaluated the quality of life among TLE patients who underwent amygdalohippocampectomy between those who were free from seizure and those who were not.Methods: This was a cross-sectional observational study. The postoperative quality of life was measured by QOLIE-31 questionnaire followed-up at least 12 months since the surgery. Results: Among 31 patients, 21 patients (67.7%) were free from seizures after 12 months of follow-up. We observed significantly higher quality of life of those seizure-free patients either as overall quality of life (p=0.001) or among domains such as seizure anxiety (p=0.003), emotional well-being (p

Introduction Intradural disc herniation (IDH) is a rare complication which comprises 0.27% of all herniated intervertebral discs. We are reporting a case of lumbar intradural disc herniation at the L4-L5 levels highlighting challenges in establishing clinical diagnosis and surgical approach involving a transdural microsurgery approach. Presentation of case A 38-year-old gentleman was presented with left radicular low back pain without motoric and autonomic involvement admitted to our neurosurgical service. Spine MRI showed an intradural, extra-axial spinal mass. Discussion Lumbar IDH is a rare pathology thus often initially diagnosed as other more common conditions. In our case, the IDH diagnosis was confirmed during surgery as the radiological examination results mimic intradural extra-axial tumor. During surgery, a hard irregular white mass was found shortly after dural incision. Histopathological results showed chondrocytes, fibrotic and necrotic appearances consistent with the diagnosis of disc herniation. Postoperatively, the patient showed improvement and pain alleviation. Conclusion We observed the beak sign which is one of the important features of IDH imaging. Surgery-wise, the challenge of dissecting the anterolateral part of the duramater from the annulus fibrosus of the intervertebral disc should be noted by the performing surgeon., Highlights • Intradural disc herniation (IDH) is a rare complication and comprises 0.27% of all herniated disc. • Radiological findings mimicking for intradural extra-axial spine tumors. • Challenge in dissecting the duramater of the anterolateral segments is a common problem. • A median or paramedian dural incision accompanied by a microsurgical technique. • Better visibility of hernia after a dural incision, avoiding damage to the nervous rootlets.

Background: Besides seizure control, quality of life (QoL) should be considered as an equally important outcome for epilepsy surgery service providers. The paucity of QoL reports from developing countries has enlarged the representation gap between wealthy countries and countries with fewer resources. In this study, we evaluated postoperative QoL in the Indonesian drug-resistant epilepsy cohort where the epilepsy surgery service faces limited resource availability.Methods: We evaluated the QoL in patients with temporal lobe epilepsy who underwent surgery in our epilepsy surgery center in Semarang, Indonesia, from 2001 until 2015. The follow–up period started in 2018 through 2019. Postoperative QoL, depression, and anxiety were evaluated with self-reporting questionnaires including the Quality of Life in Epilepsy Inventory-31, Beck Depression Inventory-II, and Zung Self-Rating Anxiety Scales.Results: Forty returned questionnaires were included in the analysis (male 25, 62.5%; mean age 27.6 ± 9.05 years). The seizure-free cohort (n = 22, 55.0%) reported higher scores in most QoL dimensions particularly adjustment, overall QoL, and seizure worry compared to those with persistent seizures. The overall QoL level was correlated with seizure freedom and surgery type. QoL dimensions were negatively correlated with anxiety and depression levels.Conclusions: Postoperative seizure freedom was a major factor of postoperative QoL level. Besides seizure freedom, anxiety and depression levels were also negatively correlated with QoL levels in the Indonesian population.

Background: Proliferation and progression of meningioma were influenced by the balance of estrogen and testosterone. Digit Ratio (DR) was a sign of prenatal exposure to estrogen and testosterone. This study intends to find the relationship between Digit Ratio and meningioma. Aim: To determine the relationship between DR and incidence of Meningioma and its Clinical Profiles (age at the onset, sex, Body Mass Indec (BMI) and histopathology grading) Methods: Analytical observational study was used with case-control design. Case group consisted of patients clinically and histopathologically diagnosed with meningioma (n=25). Patients who were not diagnosed with primary intracranial tumors were included in the control group (n=25). Matched group were conducted. Subjects of this study were patients of RSUP dr Kariadi in the period of January 2016-August 2017. This study was conducted by collecting data consisted of DR, age, sex, BMI, and grading histopathology. Tests used in this study are Chi-Square Test, Mann-Whitney Test and Fishers exact Test. Results: Digit Ratio Mean for right, left and right-left difference were 1.0041; 1.0104 and 0.0357 while for the right and left DR cutoff value 0.993; 0.989. There is a relationship between right and left Digit Ratio and incidence of meningioma (p = 0,000) with OR (Odds Ratio) Right DR = 11.17(CI95% 2,864 – 43,464) and OR left DR = 16,00 (CI95% 4,002 – 63,975). There is a relationship between Right Digit Ratio andBMI case group (p = 0,022). There is no relationship of Digit Ratio and age at onset, gender and histopathology grading (p

To share the experiences of organizing the epilepsy surgery program in Indonesia. This study was divided into two periods based on the presurgical evaluation method: the first period (1999–2004), when interictal electroencephalogram (EEG) and magnetic resonance imaging (MRI) were used mainly for confirmation, and the second period (2005–2017), when long-term non-invasive and invasive video-EEG was involved in the evaluation. Long-term outcomes were recorded up to December 2019 based on the Engel scale. All 65 surgical recruits in the first period possessed temporal lobe epilepsy (TLE), while 524 patients were treated in the second period. In the first period, 76.8%, 16.1%, and 7.1% of patients with TLE achieved Classes I, II, and III, respectively, and in the second period, 89.4%, 5.5%, and 4.9% achieved Classes I, II, and III, respectively, alongside Class IV, at 0.3%. The overall median survival times for patients with focal impaired awareness seizures (FIAS), focal to bilateral tonic–clonic seizures and generalized tonic–clonic seizures were 9, 11 and 11 years (95% CI: 8.170–9.830, 10.170–11.830, and 7.265–14.735), respectively, with p = 0.04. The utilization of stringent and selective criteria to reserve surgeries is important for a successful epilepsy program with limited resources.