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Introduction: Traumatic brain injury (TBI) is the disease that causes the most common disability globally. The cisternostomy as adjuvant management of TBI lacks documentation. We aim to prove the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury. Methods: The search for published scientific articles using the Preferred Reporting, Items for Systematic Reviews, and Meta-Analysis (PRISMA) method. The search was conducted using the PubMed, Cochrane library, and Medline databases published in English for the last ten years until June 2022, evaluating the effectiveness and safety of cisternostomy and decompressive craniectomy in managing traumatic brain injury. The Oxford Center for Evidence-based medicine assessed the evidence levels of each study. Data analysis with RevMan version 5.3. Results: Four studies were included in this meta-analysis, two RCTs, and two observational studies. We find a total of 1000 patients with; 596 cisternostomies and 404 decompressive craniectomies. These primary points show that mean GOS at six weeks is 0.93 (I2:52%; 95%CI: 0.70 to 1.17; p

Background: Even though pericardiocentesis is a routine life-saving procedure for massive pericardial effusion, there is scarce data regarding risk factors predicting the outcome in patients undergoing pericardiocentesis. This study aimed to investigate the role of various clinical, demographic, and laboratory risk factors as a predictor of in-hospital mortality and Major Adverse Cardiac Events (MACE) in patients undergoing pericardiocentesis at Sanglah General Hospital, Bali, Indonesia. Methods: Prospective cohort study with consecutive sampling was conducted in patients undergoing pericardiocentesis in Sanglah General Hospital, Bali, Indonesia, from May 2017 until September 2021. Risk factors and blood samples were observed and measured at the first admission. MACE and in-hospital mortality were observed during hospitalization. Data were analyzed using SPSS version 23 for Windows. Results: Twenty-seven patients were involved in this study. Malignant etiology was associated with increased risk of in-hospital mortality with HR 13.459 (95%CI: 1.378-131.49). Respiratory Failure during admission was associated with increased risk of mortality with HR 5.99 (95% CI: 1.355-26.55) and increased risk of persistent pericardial effusion HR 5.72 (95% CI: 1.570-20.800). Conclusion: Malignant etiology and respiratory Failure are independent predictors of in-hospital mortality in patients undergoing pericardiocentesis in Sanglah General Hospital. Respiratory Failure was associated with an increased risk of persistent pericardial effusion.

Traumatic brain injury is a common trauma. Traumatic brain injury is commonly followed by sleep disorder such as insomnia, hypersomnia and circadian rhythm disturbance. Sleep disorder can cause many complications, including the worsening of the brain injury prognosis. Insomnia occurs in 29% traumatic brain injury patient. Insomnia suspected due injury in inferior frontal, anterior temporal including basal forebrain, also sympathetic nerve hyperactivity. Insomnia increase the risk of stroke, disability and mood disturbance. Hypersomnia occurs in 28% traumatic brain injury patients. Hypersomnia suspected due orexin decrease and injury in sleep promoting area. Hypersomnia suspected related to recovery, less activity time and accident due sleepiness. There are no prevalence data of circadian rhythm disturbance after traumatic brain injury. This disturbance is caused by injury in supra-chiasmatic nucleus and related to global worsening on the patient. Insomnia and circadian rhythm disturbance are highly linked with injury area, but hypersomnia is not particularly linked to any area and only related to orexin decrease. Insomnia and circadian rhythm disturbance are highly related to the worsening condition on the patient, but hypersomnia is associated with recovery and not particularly related to any disturbances. It is hoped that understanding the sleep disorder after traumatic brain injury can rise the alertness of this matter and encourage clinicians to increase the quality of sleep disorder due to traumatic brain injury management. Cedera kepala merupakan salah satu cedera yang umum terjadi. Cedera ini sering diikuti dengan gangguan tidur seperti insomnia, hipersomnia dan gangguan ritme sirkadian. Gangguan ini sering dapat menyebabkan berbagai komplikasi termasuk memperparah penyembuhan cedera kepala. Insomnia setelah cedera kepala terjadi sebanyak 29%. Insomnia diduga disebabkan oleh cedera pada daerah inferior frontal, anterior temporal termasuk basal otak depan, juga peningkatan kerja saraf simpatis. Insomnia meningkatkan resiko stroke, disabilitas dan gangguan suasana hati. Hipersomnia setelah cedera kepala terjadi sebanyak 28%. Hipersomnia diduga akibat penurunan orexin dan akibat kerusakan pada area yang mempertahankan bangun. Hipersomnia diduga berhubungan dengan penyembuhan, waktu tersita akibat tidur dan kecelakaan akibat mengantuk. Belum ada data prevalensi gangguan ritme sirkadian setelah cedera kepala. Gangguan ini disebabkan oleh cedera pada nukleus suprakiasmatik dan sering dikaitkan dengan perburukan kondisi pasien. Insomnia dan gangguan ritme sirkadian sering dihubungkan dengan lokasi tertentu dari cedera, namun hipersomnia berhubungan dengan kadar orexin dan tidak terlalu dikaitkan terhadap area tertentu. Insomnia dan gangguan ritme sirkadian berhubungan dengan perburukan, namun hipersomnia bisa menandakan perbaikan dan tidak berhubungan signifikan dengan gangguan lainnya. Diharapkan dengan memahami gangguan tidur ini dapat meningkatkan kewaspadaan bagi para klinisi dan mendorong untuk penelitian berikutnya sehingga penanganan pasien gangguan tidur akibat cedera kepala dapat menjadi lebih baik.

Objectives COVID-19, a global pandemic, affects neurosurgical care in Indonesia. This study has objective to propose guideline and algorithm recommendation for the management of TBI patients during this pandemic, which can be used flexibly at neurosurgery centers, both in Indonesia and throughout the world. Methods We performed retrospective Cohort analysis from TBI database at tertiary public general hospitals. All neurotrauma cases from mid-February until mid-August 2020 was included in this study. The chronology of COVID-19 pandemics impact in Indonesia was defined by early period from mid-February until end of May 2020, and late period are latter. All subjects undergone the screening and perioperative measures that based on our proposes scoring system and algorithm as follows. Results There are many guidelines that explain screening methods in neurosurgery patients in general, as well as neurotrauma in particular. But here, we proposed our own scoring and screening algorithm that has been developed based on conditions in Indonesia. In total of 757 neurotrauma cases data were collected from the pandemic starts in Indonesia. Discussion Screening is a crucial initial step in this pandemic period, not only for COVID patients, but also all patients who enter the emergency room. The use of PPE is a necessity in several neurosurgery centers, especially with high COVID-19 case rates. Conclusion The management of neurotrauma patients with suspected and confirmed COVID-19 requires special attention, starting from admission of the patient in ER. Rapid scoring and screening are important and the highest level of PPE is mandatory during patient care., Highlights • Retrospective analysis from TBI database at tertiary public general hospitals in Indonesia • This study has objective to propose guideline and algorithm recommendation for the management of TBI patients during this pandemic • Total of 757 neurotrauma cases data were collected from the pandemic starts in Indonesia • Screening is a crucial initial step in this pandemic period, not only for COVID patients, but also all patients who enter the emergency room • The management of neurotrauma patients with suspected and confirmed COVID-19 requires special attention, starting from admission of the patient in ER

Introduction Neuropathic pain may arise from conditions that affecting the central or peripheral nervous system. This study was held to determine the difference P2X3 receptor expression in the dorsal horn of the spinal cord and pain threshold after estrogen therapy in neuropathic pain. Methods This study design was an experimental research laboratory. The 24 mice samples divided into negative control group, positive control, and treatment groups. The treatment groups were given subcutaneous injections of estrogen 0.4 ml and also examined for the onset of thermal hyperalgesia in every rat. On day 15, an autopsy was performed on rats, and the spine was taken. The spinal cord was stained by hematoxylin-eosin, and the expression of P2X3 receptors was investigated. P2X3 receptor expression was examined in the dorsal horn on each sample. Results From 24 subjects of the study revealed an increase in the onset of thermal hyperalgesia on the estrogen group compared with the placebo group, a higher start. This study also obtained a decrease in the expression of P2X3 on the therapy group compared to the positive control group with significant differences. Statistical test results revealed the appearance of the P2X3 estrogen group had a substantial difference with the placebo group (p = 0.000) and the mean of the negative control group (p = 0.030). The placebo group had a significant difference from the negative control group (p = 0.035). Conclusion Estrogen could decrease the expression of P2X3 receptors and prolonged the onset of thermal hyperalgesia. So, both of these explained that estrogen has a role in preventing the occurrence of neuropathic pain after peripheral nerve lesions., Highlights • Experimental study on mice subjects to determine the difference P2X3 receptor expression in the dorsal horn of spinal cord. • Pain threshold after estrogen therapy in neuropathic pain. • Estrogen could decrease the expression of P2X3 receptors. • Estrogen prolonged the onset of thermal hyperalgesia.

Latar Belakang: Pandemi Corona Virus Disease 2019 (COVID-19) dengan penularannya yang sangat cepat di seluruh dunia berdampak terhadap perubahan pelayanan kesehatan di bidang neurologi sebagai upaya mendukung program pengendalian penyakit ini. Tujuan: Merumuskan rekomendasi panduan pemeriksaan neurologis untuk pelayanan teleneurologi. Diskusi: Penyesuaian dalam pelaksanaan pelayanan neurologi perlu segera dilakukan dengan mengadopsi metode pelayanan dengan telemedicine terutama dalam tata cara pemeriksaan pasien dengan pembatasan fisik dan sosial sebagai salah satu langkah pencegahan infeksi SARS-CoV-2. Simpulan: Layanan teleneurologi perlu dikembangkan dalam pelayanan neurologi termasuk pengembangan prosedur pemeriksaan neurologis secara virtual.

Coronavirus Disease-19 (COVID-19) is a highly transmittable disease. While the most common symptoms of COVID-19 include fever, cough, and fatigue, severe symptoms could feature acute respiratory distress syndrome and severe pneumonia. Reverse-transcription polymerase chain reaction (RT-PCR) remains the gold standard for diagnosing COVID-19. Unfortunately, it has high cost, extensive waiting time, and low availability in remote areas. Therefore, we developed the Udayana COVID-19 Scoring System (UCSS) for quick detection of COVID-19. This study aims to determine the cutoff score and measure the sensitivity and specificity of the UCSS. We conducted an observational cross-sectional study from June 2020 to July 2020. A questionnaire consisting of 3 objective and subjective scores assesses COVID-19 symptoms and risk factors. Participants were patients suspected of COVID-19 awaiting RT-PCR test results. The UCSS total score then compared with the RT-PCR test result and analyzed to determine the cutoff score, sensitivity, and specificity. 150 participants were included in this study (74 male, 49.3%; mean age 42 ± 15.7). The UCSS total score was significantly correlated with RT-PCR test result (p-value = 0.000). The receiving operator characteristic analysis showed an optimal cutoff score of 7, with a sensitivity of 72% and specificity of 71%. Therefore, the UCSS’ accuracy is at a moderate level. The UCSS showed acceptable sensitivity and specificity, and has the potential to be used as a diagnostic aid for COVID-19 early detection. Further study in diverse areas and larger sample size are needed.

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 which attacks the respiratory tract and has been declared a global pandemic by the World Health Organization. The disease has a very wide clinical spectrum which can be manifested as asymptomatic to critical conditions. SARS-CoV-2 shows a neurotropism proven by its identification in the cerebrospinal fluid and brain vascular endothelial. The complete mechanism of how the virus invades the human nervous system is yet to be identified. Thus, every neurologist needs to follow the progressivity of COVID-19 symptoms involving the nervous system.

Which conditions treated by neurosurgeons cause the worst economic hardship among patients in low- and middle-income countries? Might a responsive health financing be the solution to the inequities in the delivery of neurosurgical care? In this review article, we attempt to answer these questions that are relevant to global neurosurgery. Based on the results of a survey of neurosurgeons from Indonesia and the Philippines, socioeconomically disadvantaged patients with malignant intracranial tumors were found to incur the highest out-of-pocket expenses. The surveyed neurosurgeons also observed that treatment of traumatic brain injury may have to require greater financial subsidies. It is therefore imperative to frame health financing alongside the goals of equity, efficiency, and quality of neurosurgical care for the impoverished. Using principles and perspectives from managerial economics and public health, we conceptualize an implementation framework that addresses both the supply and demand sides of healthcare provision as applied to neurosurgery. For the supply side, strategic purchasing enables a systematic and contractual management of payment arrangements that provide performance-based economic incentives for providers. For the demand side, the scheme of conditional cash transfers similarly leverages on financial incentives to reward certain health-seeking behaviors of patients that significantly influence their clinical outcomes. We formulate these health financing strategies in order to ultimately build neurosurgical capacity in LMICs, improve access to care for patients, and ensure financial risk protection.

OBJECTIVEThe authors, who are from Indonesia, Japan, Malaysia, the Philippines, and Taiwan, sought to illustrate the processes of training neurosurgeons in their respective settings by presenting data and analyses of the current state of neurosurgical education across the East Asian region.METHODSThe authors obtained quantitative data as key indicators of the neurosurgical workforce from each country. Qualitative data analysis was also done to provide a description of the current state of neurosurgical training and education in the region. A strengths, weaknesses, opportunities, and threats (SWOT) analysis was also done to identify strategies for improvement.RESULTSThe number of neurosurgeons in each country is as follows: 370 in Indonesia, 10,014 in Japan, 152 in Malaysia, 134 in the Philippines, and 639 in Taiwan. With a large neurosurgical workforce, the high-income countries Japan and Taiwan have relatively high neurosurgeon to population ratios of 1 per 13,000 and 1 per 37,000, respectively. In contrast, the low- to middle-income countries Indonesia, Malaysia, and the Philippines have low neurosurgeon to population ratios of 1 per 731,000, 1 per 210,000, and 1 per 807,000, respectively. In terms of the number of training centers, Japan has 857, Taiwan 30, Indonesia 7, Malaysia 5, and the Philippines 10. In terms of the number of neurosurgical residents, Japan has 1000, Taiwan 170, Indonesia 199, Malaysia 53, and the Philippines 51. The average number of yearly additions to the neurosurgical workforce is as follows: Japan 180, Taiwan 27, Indonesia 10, Malaysia 4, and the Philippines 3. The different countries included in this report have many similarities and differences in their models and systems of neurosurgical education. Certain important strategies have been formulated in order for the system to be responsive to the needs of the catchment population: 1) establishment of a robust network of international collaboration for reciprocal certification, skills sharing, and subspecialty training; 2) incorporation of in-service residency and fellowship training within the framework of improving access to neurosurgical care; and 3) strengthening health systems, increasing funding, and developing related policies for infrastructure development.CONCLUSIONSThe varied situations of neurosurgical education in the East Asian region require strategies that take into account the different contexts in which programs are structured. Improving the education of current and future neurosurgeons becomes an important consideration in addressing the health inequalities in terms of access and quality of care afflicting the growing population in this region of the world.

Background Patients with severe traumatic brain injury (TBI) usually required rapid evacuation and special care in the Intensive Care Unit for respiratory control, mechanical ventilation, neurosurgical evaluation, and intracranial pressure monitoring (ICP), but in areas with limited facilities not all of these are exist, so it is necessary to provide a novel protocol for it especially in the modest neurosurgical settings. Method The study sample was a severe TBI which classified from initial glasgow coma scale (GCS) score ≤8 in the West Nusa Tenggara General Hospital, who met the inclusion criteria in between 2016 and 2018 time periode. All samples underwent urgent subdural drainage management and also tracheostomy. Clinical outcome were assesed by the glasgow outcome scale (GOS). All analyses determined by the Medical Record data. Result 62 severe TBI patients who underwent subdural drainage and early tracheostomy procedures consisting of 53 (85.5%) men and 9 (14.5%) women. The average age of the study subjects was 30.47 years old with the youngest age of 3 years old and the oldest was 77 years old. The outcome of the study subjects consisted of 48 patients survived (77.4%) and 14 patients died (22.6%). Conclusion Subdural drainage and early tracheostomy are recommended novel to perform on severe TBI patient in the area with the modest neurosurgical settings, due to lower mortality rate and better end result.

Stroke is a world leading cause of death and disability in the field of neurology. Ischemic stroke occurs from the obstruction of blood flow to the brain and accounts for 85% of all strokes. Currently, the initial management of stroke to reduce the mortality rate is well known, resulted in increasing number of stroke survivor over the years. However, lack of appropriate treatment for post-stroke recovery lead to prolonged disability that will produce a negative impact, in particular for the productive-aged survivor. Researchers found that miRNA-124 has a lot of beneficial effect to the ischemic brain. miRNA-124 will upregulate the growth factor substances and down-regulate the TNF-α and other cytotoxic substances and increase the number of M2 microglia which is important to promote angiogenesis and matrix remodeling. Expression of miRNA-124 will also lead to differentiation and migration of neuro-progenitor cells to the lesion site while reducing the formation of the glial scar. Furthermore, chitosan derived from the extraction of shells, shrimp, and crabs, have been reported for its various advantages such as anti-infection, anti-tumor and also as carrier-mediated transported across blood–brain barrier. Administration of miRNA-124 loaded chitosan by intranasal route will improve the drug delivery into neuron by provides moiety for cell penetration and as affinity agent towards neuronal tissues. Based on those points, the combination of chitosan and miRNA-124 may be a potential therapy to improve revitalization and reduce disability after stroke ischemic.

The nature of cervical spine motions consists of multiple components of the cervical spine, intervertebral disc, ligaments, and adjacent facet joints. Cervical spinal stenosis is disabling and this chronic degenerative disorder commonly occurs in middle age-elderly persons. Surgical options for those spinal cord disorders generally are the anterior or posterior approach. Historically, a conventional multi-level laminectomy was performed to decompress the spinal cord but there is a high rate of late biomechanical complications such as segmental instability, and kyphosis. Laminoplasty was developed to relieve the spinal cord compression and maintain the posterior elements. Lately, there are various techniques of the cervical laminoplasty, the biomechanical impact of these techniques will be described.