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Early diagnosis of spinal tumors is a prerequisite for achieving satisfactory neurological recovery. However, rare diseases tend to have a long diagnostic course.1 In addition, the clinical presentation of spinal tumors in most children is not apparent, moreover, spinal tumors may not show clinical symptoms if they are located in the lumbar spine and sized no more than one vertebra.2,3 Clinical presentations caused by tumors in the lumbar spine may include weakness of both limbs, impaired urination, and constipation.

In surgical correction of frontoethmoidal encephalocele with transcranial approach, advanced facilities are required. While with extracranial approach, though deemed as a safe option in area with limited facilities, procedure was associated with cerebrospinal fluid (CSF) leakage. In this case series, we evaluate the results of transcele reconstruction of frontoethmoidal encephalocele, our approach to reduce the incidence of CSF leaks by focusing on the closure of layers by its embryological derivatives, by its bone fusion.A case series of 14 patients with various types of frontoethmoidal encephalocele who underwent surgery for defect closure using transcele approach between June 2015 and December 2018 was carried out. Surgery was done by a single surgeon in the Department of Neurosurgery of Cipto Mangunkusumo Hospital in Jakarta, Indonesia. We collected the data of intraoperative blood loss and any signs of infection and CSF leak during the patients' one-year follow up. Bone fusion in the defect was evaluated from 3D rendering of head CT scan that was performed before and in 1 year after surgery.The median percentage of intraoperative blood loss was 5.9% (0.5-18.7%). All 3D rendering of head CT post-surgery during 1 year follow up showed bone fusion and no patient experienced CSF leaks or CNS infections.This study showed that using transcele approach in frontoethmoidal reconstruction could give good bone fusion with minimal blood loss and no CSF leaks. We assumed that closure of the layers by its embryological derivative played an important part in bone fusion and in reducing the incidence of CSF leaks, although this finding has to be validated with large-scale studies.

Background: O6-methylguanine-DNA methyltransferase (MGMT) is a DNA-repair enzyme that correlates with tumor resistance mechanism to chemotherapy. Methylation of the MGMT promoter inhibits the cells from producing MGMT and is useful to predict chemotherapy's effectiveness with alkylating agents. This study aims to evaluate the MGMT promoter methylation of low-grade and high-grade glioma in the Neurosurgery Department of Cipto Mangunkusumo National General HospitalMethods: We evaluated MGMT promoter methylation status using methylation-specific polymerase chain reaction in low and high-grade glioma patients who underwent surgical resection in the Neurosurgery Department of Cipto Mangunkusomo Hospital Jakarta. The result then correlated with age, sex, Karnofsky Performance Scale (KPS), and glioma grading. Data were analyzed using SPSS version 20 for Windows.Results: MGMT promoter methylation was observed more often in patients diagnosed with age more than 40 years old than in patients less than 40 years old (85.7% vs. 50.0%), also more in men than women (77.7% vs. 50.0%). In patients with KPS more than 70 and KPS 70 or less, methylation of MGMT promoter was observed in 70.0% and 57.1%, respectively. Based on tumor grading, MGMT promoter methylation was observed more often in low-grade gliomas (WHO grade II) than high-grade gliomas (WHO grade II and IV) (85.7% vs. 50.0%). There was no significant relationship between gender, age, KPS, malignancy degree, and Overall Survival (OS) to the MGMT promoter methylation (p>0.05).Conclusion: MGMT promoter methylation was observed less in the higher grade of tumors (grade IV), lower KPS, younger age at the time of diagnosis, and female patients, although the differences were not statistically significant. MGMT promoter methylation was observed more often in gliomas with oligodendroglioma components.

Bicycle mishap, a common and ordinary event occurring in children, can have devastating consequences associated with cervical spine injury. Furthermore, either diagnosis or surgical management of cervical spine injury in children is a challenging issue. This research report a challenging case of an anterior cervical corpectomy and fusion with plating in a 7-year-old boy due to cervical spine instability with spinal cord compression after a bicycle mishap. After 20 months of the primary surgery, the titanium-based cervical plate was removed by a second surgery to allow the growth of the cervical spine.

Pendahuluan: Meningioma sphenoorbita (MSO) adalah massa tumor eksofitik yang menginfiltrasi tulang pada sphenoid ridge, dinding lateral orbita, atap orbita, dan meluas ke fisura orbita superior. Trias klasik dari klinis pasien adalah penonjolan bola mata (proptosis), penurunan ketajaman penglihatan (visus) dan oftalmoplegia. Hasil dari operasi pasien MSO belum pernah dievaluasi sebelumnya, terutama terhadap visus dan proptosis. Tujuan: Mengevaluasi karakteristik klinis pasien meningioma sphenoorbita sebelum dan sesudah operasi. Metode: Penelitian deskriptif dengan desain potong lintang. Subjek adalah pasien MSO yang datang ke Unit Rawat Jalan Bedah Saraf RSUPN Dr. Cipto Mangunkusumo (RSCM) dari Januari 2014 hingga Desember 2015. Semua pasien menjalani operasi kraniektomi, orbitotomi lateral dan reseksi tumor. Ketajaman visus dievaluasi dengan Snell chart dan indeks proptosis pasien dievaluasi sebelum dan sesudah operasi dengan mengukur mata yang proptosis pada CT scan aksial. Hasil: Terdapat 66 pasien yang dievaluasi dalam penelitian ini dan 65 pasien adalah perempuan. Rentang usia 31-64 tahun. Indeks proptosis rata-rata preoperasi adalah 18,27 dan pascaoperasi adalah 16,43. Pengurangan indeks proptosis rata-rata adalah 1,84. Visus pasien pascaoperasi mengalami perbaikan hanya pada 9,7% pasien. Diskusi: Pasien MSO yang dioperasi terdapat pengurangan indeks proptosis tetapi hanya sedikit perbaikan visus. Kata kunci: Indeks proptosis, meningioma sphenoorbita, visus

Pendahuluan: Adenoma hipofisis dapat menyebabkan penurunan visus dan penyempitan lapangan pandang. Beberapa penelitian telah menunjukkan bahwa lama keluhan berhubungan secara signifikan dengan hasil klinis. Sebagai rumah sakit pusat rujukan nasional, semua pasien adenoma hipofisis yang datang ke RSUPN Dr. Cipto Mangunkusumo (RSCM) dirujuk dari dokter spesialis mata, ahli saraf, dan ahli bedah saraf dari institusi lain. Tujuan: Dalam penelitian ini, kami meneliti hubungan antara durasi, yang dihitung dari saat gejala pertama kali muncul ke waktu operasi, dan hasil visus dan lapang pandang pada pasien adenoma hipofisis yang menjalani operasi transfenoidal. Metode: Penelitian ini merupakan penelitian restrospektif pada pasien adenoma hipofisis yang menjalani operasi transsfenoidal antara 2015-2017 di RSCM. Durasi antara awitan gejala dan operasi dihitung dalam bulan. Pemeriksaan visus dan lapang pandang dilakukan 1 hari sebelum operasi dan dalam 1 hingga 2 bulan pascaoperasi. Hasil: Terdapat 71 pasien (36 pria, 35 wanita) dengan penurunan visus dan lapang pandang menyempit, dengan usia rata-rata 42 tahun (20-77 tahun). Durasi rata-rata awitan untuk kedua gejala adalah 12 bulan (1-108 bulan). Sebanyak 40,5% pasien mengalami peningkatan visus pascaoperasi, dengan durasi rata-rata awitan 11 bulan. Peningkatan lapang pandang dialami pada 67,6% pasien, dengan durasi rata-rata awitan 12 bulan. Diskusi: Kesimpulan penelitian terdapat hubungan bermakna secara statistik antara durasi awitan sampai dilakukan tindakan operasi dengan luaran klinis lapang pandang. Perbaikan lapang pandang didapatkan pada pasien yang memiliki durasi awitan sampai dilakukan tindakan operasi sampai dengan 12 bulan. Kata kunci: Adenoma hipofisis, lapang pandang, operasi transfenoidal, visus

Tumor spinal primer memiliki morbiditas dan disabilitas yang tinggi. Profil demografi dan luaran nilai fungsional penderita tumor primer spinal intradural ekstramedular 60% dari seluruh tumor spinal primer sehingga penting dinilai karena dapat dijadikan parameter keberhasilan operasi dan dapat digunakan dalam memberikan informasi kepada pasien dan keluarga sebelum operasi. Studi retrospektif deskriptif analitik ini menggunakan data rekam medis penderita tumor spinal intradural ekstramedular yang baru menjalani operasi pertama kali di RSUPN dr. Cipto Mangunkusumo tahun 2014 – 2016. Skor luaran fungsional Medical Outcome Study 36-item Short-form Health Survey (SF-36) pra dan pasca-operasi dievaluasi dan dibandingkan menggunakan uji korelasi Friedman. Rerata usia subjek adalah 46,3 tahun (min-maks 15-71 tahun), dengan 31% penderita berusia 50-60 tahun, 69% penderita perempuan, dan rerata lama awitan keluhan hingga operasi adalah 7,79 bulan. Sebanyak 65% menderita Schwannoma dan 34,5% meningioma. Dibandingkan dengan skor pra-operasi, skor pasca-operasi kuesioner SF-36 memperlihatkan peningkatan bermakna pada kedelapan aspek kuesioner. Nilai fungsional SF-36 penderita tumor primer spinal intradural ekstramedular menunjukkan perbaikan bermakna pada masa 1 tahun pasca-operasi. Kata kunci: Tumor primer spinal, intradura ekstramedula, SF -36. Evaluation of Functional Outcome of Primary Extramedullar Intradura Spine Tumor Operated in Dr. Cipto Mangunkusumo General Hospital, 2014–2016 Abstract Spinal tumor is one of the neural disorders that contributes to high number of morbidities disabilities. Demographic profile and functional outcome of primary intradural extramedullary spinal tumor patient is important to be evaluated for the purpose of providing holistic information for patients and their family prior to surgery, as well as measuring surgical results. This analytical descriptive retrospective study utilized medical record of primary intradural extramedullary spinal tumor patient who underwent first surgery in dr. Cipto Mangunkusumo General Hospital from 2014-2016. Pre- and postsurgical Medical Outcome Study 36-item Short-form Health Survey (SF-36) functional score were evaluated and compared using Friedman correlation test. The mean age of study participants is 46,3 years old (min-max: 15-71 years old), with 31% participants included in the age group of 50-60 years old, 69% participants were female, and the mean of onset-to-surgery time is 7,79 months. The dominant histopathological finding was Schwannoma (65%). Compared to the pre-surgical score, post-surgical SF-36 showed significant improvements in all eight aspects of the questionnaire. SF-36 functional score of primary intradural extramedullary spinal tumor patient presented significant improvement in 1 year after surgery. Keywords: Primary spinal tumor, intradural extramedullar, SF-36.

DIFFERENCES BETWEEN PRE- AND POST-SURGERY LEUKOCYTE COUNTS AS FUNCTIONAL OUTCOME PREDICTOR IN SPONTANEOUS INTRACEREBRAL HEMORRHAGEABSTRACTIntroduction: Hematoma in spontaneous intra-cerebral hemorrhage (SICH) results inflammation due to secondary brain injury. Leukocyte, an inflammation indicator which is routinely examined, known as an outcome predictor in non- operated SICH. The role of inflammation in operated SICH is still unknown, however, pre- and post-surgery leukocyte counts can be a marker of brain tissue damage (brain injury).Aim: This study investigated the characteristics of leucocyte parameters in operated SICH patients and its correlation to functional outcome based on Glasgow Outcome Scale (GOS).Methods: This was a retrospective cohort study for SICH patients who underwent surgery at Department of Neurosurgery in Dr. Cipto Mangunkusumo National General Hospital from January 2012–March 2017. This study analyzed the association between pre-operative leucocyte level with age, pre-operative GCS, hemorrhage volume, length of hospitalization, and six-month post-operative GOS. The correlation of differences of pre-operative and one-day post- operative leucocyte counts with six-month post-operative GOS and hematoma evacuation percentage were analyzed. The analysis was done using Pearson correlation test, Spearman, Chi-square χ2 test, Fisher exact test, and Anova test.Results: There was a significant correlation between differences of leukocyte counts in pre- and post-surgery with GOS. A higher post-surgery leukocyte difference would lower GOS; there was a significant correlation between the leukocytes counts in pre-operative leucocyte and GCS. A higher pre-operative leukocytes counts would lower the GCS.Discussion: The differences of pre-operative and post-operative leucocyte counts is a functional outcome predictors within 6 months in operated SICH patients.Keywords: Leukocyte, outcome, spontaneous intracerebral hemorrage, surgeryABSTRAKPendahuluan: Hematoma pada perdarahan intraserebral spontan (PISS) menyebabkan inflamasi akibat cedera otak sekunder. Leukosit sebagai indikator inflamasi yang rutin diperiksa, diketahui memiliki peranan sebagai prediktor luaran pada PISS yang tidak dioperasi. Sejauh ini belum diketahui peranan inflamasi pada PISS yang dioperasi, namun kadar leukosit pra- dan pascaoperasi dapat menjadi penanda adanya kerusakan jaringan otak (brain injury).Tujuan: Untuk mengetahui karakteristik parameter leukosit pasien PISS yang dioperasi dan kaitannya dengan luaran fungsional berdasarkan skor Glasgow Outcome Scale (GOS).Metode: Studi kohort retrospektif pada pasien PISS yang dioperasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo periode Januari 2012-Maret 2017. Dilakukan analisis antara nilai leukosit praoperasi dengan usia, GCS praoperasi, volume perdarahan, lama rawat inap, dan skor GOS 6 bulan pascaoperasi. Dilakukan analisis perbedaan nilai leukosit praoperasi dibandingkan hari pertama pascaoperasi dengan skor GOS 6 bulan pascaoperasi dan persentase evakuasi hematoma. Analisis dilakukan menggunakan korelasi Pearson, Spearman, uji Chi-square χ2 test, Uji Fisher exact test, dan Anova.Hasil: Pada uji statistik didapatkan korelasi bermakna antara perbedaan nilai leukosit pascaoperasi dibandingkan praoperasi dengan skor GOS. Semakin tinggi nilai perbedaan leukosit pascaoperasi akan menurunkan skor GOS; didapatkan korelasi bermakna antara leukosit praoperasi dengan GCS praoperasi. Semakin tinggi leukosit praoperasi, semakin rendah GCS.Diskusi: Perbedaan nilai leukosit pascaoperasi dibandingkan praoperasi merupakan prediktor luaran fungsional dalam 6 bulan pada pasien perdarahan intraserebral spontan yang dioperasi.Kata kunci: Leukosit, luaran, operasi, perdarahan intraserebral spontan

MYELUM INTENSITY ON MRI CERVICAL AS PROGNOSTIC FACTORS IN CERVICAL SPONDYLOSIS MYELOPATHY PATIENTSABSTRACTIntroduction: Cervical spondylosis myelopathy (CSM) is a stenosis condition in cervical canal due to the cervical structural changes that compress the myelum, thus causing spinal medulla ischemia. Other than clinical factors, myelum intensity changes on MRI T1-weighted images (T1W1) and T2W1 might be useful to predict the pos-operative outcome.Aims: Identify prognostic factors in post-operative patients with CSM based on clinical symptoms and myelum intensity on cervical MRI.Methods: Retrospective study on CSM patients who underwent surgery in Neurosurgery Department, Cipto Mangunkusumo hospital, Jakarta, from January 2013 to December 2016. Magnetic resonance imaging data was obtained before the surgery, while clinical symptoms were assessed by Nurick scale before and 1 year after the surgery to evaluate outcome.Results: There were 50 subjects included in this study with mean age 51.98±9.64 years, majority male (76%), have moderate myelopathy (Nurick scale pre-operative ≤2), and time between onset and surgery mostly ≤1 year (80%). Most subject (88%) had improvement clinically, but mostly without hypointensity on cervical T1W1 MRI.Discussion: Myelum hypointensity in cervical MRI is associated with poor outcome in CSM post-surgery patients.Keywords: Cervical spondylosis myelopathy, MRI, myelum hypointensity, Nurick scaleABSTRAKPendahuluan: Cervical spondylosis myelopathy (CSM) merupakan suatu kondisi stenosis kanal servikal akibat adanya perubahan struktur servikal yang menyebabkan kompresi mielum, sehingga timbul iskemia medula spinalis. Selain faktor-faktor klinis, perubahan intensitas mielum pada MRI T1-weighted images (T1W1) dan T2W1 dapat dijadikan modalitas untuk memprediksi luaran pascaoperasi.Tujuan: Mengidentifikasi faktor prognosis luaran pasien CSM pascaoperasi berdasarkan gejala klinis dan intensitas mielum pada gambaran MRI servikal.Metode: Penelitian retrospektif terhadap penderita CSM yang dilakukan operasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada bulan Januari 2013 hingga Desember 2016. Dilakukan penilaian klinis dan gambaran MRI awal, serta luaran 1 tahun pascaoperasi menggunakan skor Nurick.Hasil: Terdapat 50 subjek dengan rerata usia 51,98±9,64 tahun, terutama laki-laki (76%), memiliki derajat mielopati ringan (skor Nurick preoperasi ≤2), dan jarak antara onset dengan waktu operasi ≤1 tahun (80%). Sebagian besar subjek (88%) mengalami perbaikan skor pascaoperasi yang mayoritas (95,4%) tidak didapatkan gambaran hipointesintas pada T1W1 MRI servikal.Diskusi: Hipointensitas mielum pada MRI servikal merupakan faktor prognosis luaran buruk pascaoperasi pada pasien CSM.Kata kunci: Cervical spondylosis myelopathy, hipointens, mielum, MRI, skala Nurick

Background: Spinal surgery, in general, is increasing in number. The most frequent pathology is degenerative disease, and the most common segment is cervical and lumbar. However, there is limited information concerning the thoracic spine surgeries.Objective: The aim of this study is to describe the trend and profle of the thoracic spine (T-spine) surgeries in the Department of Neurosurgery Faculty of Medicine Universitas Indonesia – RSUP Dr.Cipto Mangunkusumo from 2012 to 2016.Method: This is a retrospective study including all patients who were undergoing T-spine surgery during the period of study from January 2012 to December 2016. The number of T-spine procedureswas recorded and plotted in the trend graph. The data consisting age, gender, indication and procedure of T-spine surgery, and duration of hospital stay were recorded from medical records.Result: In the last fve years, there was an increasing trend of T-spine surgery. A total of 68 surgeries for T-spine performed with 35 female and 33 male subjects. Majority of subjects were aged 41 to 50 years old (28%), with an indication of surgery due to tumours (68%). As many as 76% T-spine surgery was carried out non-instrumented. Duration of hospital stay was 9-13 days.Conclusion: Productive age is the most common age undergoing T-spine surgeries. A spinal tumour is the most frequent indication of the T-spine surgeries

FIBRINOGEN VALUE AS PROGNOSTIC FACTOR IN SPONTANEOUS INTRACEREBRAL HEMORRHAGEABSTRACTIntroduction: Spontaneous intracerebral haemorrhage (SIH) refers as spontaneous bleeding in the brain paren- chyma due to injury of blood vessels. Thus causing tissue inflammatory and coagulation reaction, activating the release of fibrinogen. Fibrinogen, an active substrate of coagulation cascade, also considered as the most powerful indicator of acute inflammatory response in SIH. Elevated levels of fibrinogen may be the marker for the increasing degree of brain tissue damage.Aims: Determine the correlation of fibrinogen levels with outcomes of patients with SIH who went on operative procedures.Methods: The study was conducted in Dr. Cipto Mangunkusumo hospital and its affiliation hospitals from January until August 2017. Total sampling was conducted. Preoperative Glasgow Coma Scale (GCS), blood volume, preoperative and postoperative serum fibrinogen values, and modified Rankin Scale (mRS) data were obtained and analyzed using the Spearman correlation test.Results: Significant correlation were found between the preoperative and postoperative fibrinogen with mRS score. Positive correlation coefficients were shown in both parameters, whereas the increase of preoperative and postoperative fibrinogen would increase the mRS score.Discussion: Pre and postoperative fibrinogen value showed significant association with mRS score, thereby they could be considered as prognostic predictive factors. However, because of the limited number of subject of this study to fulfill the criteria of validity study, a future study with a larger scale should be carried out.Keyword: Fibrinogen, mRS, outcome, spontaneous intracerebral haemorrhageABSTRAKPendahuluan: Perdarahan intraserebral spontan (PISS) adalah perdarahan spontan pada parenkim otak akibat kerusakan pembuluh darah pada jaringan otak. Kerusakan tersebut menimbulkan reaksi inflamasi jaringan dan koagulasi yang mengaktivasi pelepasan fibrinogen. Fibrinogen merupakan substrat aktif kaskade koagulasi yang juga merupakan penanda paling kuat respons akut inflamasi pada PISS. Adanya peningkatan kadar fibrinogen dapat menggambarkan peningkatan derajat kerusakan jaringan otak.Tujuan: Mengetahui korelasi kadar fibrinogen dengan luaran pasien dengan PISS yang dilakukan tindakan operatif.Metode: Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dan rumah sakit jejaring pendidikan dalam periode Januari–Agustus 2017. Sampel diambil dengan total sampling, data yang diambil adalah, Glasgow Coma Scale (GCS) preoperasi, volume perdarahan, kadar fibrinogen serum preoperasi dan pascaoperasi, dan modified Rankin Scale(mRS), kemudian dianalisis dengan tes Spearman correlation.Hasil: Dari uji statistik didapatkan hasil bermakna antara fibrinogen preoperasi mau pun pascaoperasi dengan skor mRS. Koefisien korelasi, menunjukkan korelasi positif pada keduanya, dimana peningkatan fibrinogen preoperasi dan pascaoperasi akan meningkatkan skor mRS.Diskusi: Fibrinogen pre dan pascaoperasi sebagai faktor prediksi prognostik memiliki hubungan bermakna dengan skor mRS. Namun dengan jumlah sampel penelitian yang masih belum mencukupi untuk memenuhi kriteria validitas untuk dapat diajukan sebagai faktor yang bersifat pasti, diperlukan penelitian lebih lanjut dengan sampel yang lebih besar.Kata kunci: Fibrinogen, luaran, mRS, perdarahan intraserebral spontan

INTRAVENTRICULAR HEMORRHAGE OUTCOME OPERATED ON NEUROSURGERY DEPARTMENT OF CIPTO MANGUNKUSUMO HOSPITALABSTRACTIntroduction: Intraventricular hemorrhage (IVH) is a spontaneous hemorrhage occurring within the ventricular system, 30-45% often associated with intracerebral hemorrhage (ICH). Evaluating accurate and precise daily activity in post-stroke patients is critical for the quality of care and measurement of post-stroke outcomes. Modified Rankin Scale (mRS) is a global disability measurement scale used for the evaluation of stroke recovery.Aims: Configuring outcome data of patient with intraventricular hemorrhage operated at neurosurgery department of Cipto Mangunkusumo Hospital based on mRS.Methods: A retrospective study with cross sectional design towards patient with intraventricular hemorrhage at neurosurgery department Cipto Mangunkusmo Hospital, Jakarta, between Januari 2019 and August 2016. Subject or family member was interviewed to assess the subject’s functional status 6 month after operation using mRS.Results: There were 23 subjects mostly under 60 years old (60.8%) with 6 months IVH overall outcomes independent (47.8%) based on mRS. Majority of the subjects were admitted in severe condition with IVH score mostly >15 (65.25), mean Glasgow Coma Scale (GCS) 7.6±2.14, and mean arterial pressure >100 (87%) with factor risk for hypertension (82.6%).Discussion: Operation procedure on patient with intraventricular hemorrhage gives a relatively good outcome although with poor baseline at the time of admission.Keywords: Intracerebral hemorrhage, intraventricular hemorrhage, Modified Rankin ScaleABSTRAKPendahuluan: Perdarahan intraventrikel (intraventricular hemorrhage/IVH) merupakan perdarahan spontan yang terjadi di dalam sistem ventrikel, 30-45% sering berhubungan dengan perdarahan intraserebral (PIS). Evaluasi aktifitas sehari-hari yang akurat dan tepat pada pasien pascastroke sangat penting untuk kualitas perawatan dan pengukuran luaran pascaperawatan stroke. Modified Rankin Scale (mRS) merupakan skala pengukuran disabilitas yang dipakai secara global untuk evaluasi pemulihan dari stroke.Tujuan: Menelaah data luaran penderita perdarahan intraventrikel yang dilakukan operasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo berdasarkan mRS.Metode: Penelitian retrospektif secara potong lintang terhadap pasien dengan perdarahan intraventrikel yang dikelola oleh Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada bulan Januari 2010 hingga Agustus 2016. Subjek atau keluarga diwawancara untuk menilai status fungsional 6 bulan pascaoperasi menggunakan mRS.Hasil: Didapatkan 23 subjek yang sebagian besar berusia di bawah 60 tahun (60,8%) dengan luaran 6 bulan yang dalam keadaan independen (47,8%) berdasarkan mRS. Mayoritas subjek masuk dalam keadaan yang buruk dengan skor IVH terbanyak adalah >15 (65,2%), rerata Skala Koma Glasgow (SKG) 7,6±2,14, dan mean arterial pressure >100 (87%), serta memiliki faktor risiko hipertensi (82,6%).Diskusi: Tata laksana operasi pada pasien dengan perdarahan intraventrikel memberikan luaran yang cukup baik, walaupun pasien masuk dalam keadaan yang buruk.Kata kunci: Modified Rankin Scale, perdarahan intraserebral, perdarahan intraventrikel

BACKGROUND: Intracranial meningiomas are a common type of primary brain tumors. We would like to examine the profile of intracranial meningiomas at our institution. MATERIAL AND METHODS: We analysed the incidence and clinical, radiological, pathological features of meningiomas at Dr. Cipto Mangunkusumo General Hospital retrospectively between January 2012 and December 2017. The records of all surgically treated meningiomas were analysed from the medical record unit. RESULTS: We found 431 intracranial meningiomas were surgically resected at our institution. The patients had a median age of 45 years and were predominantly female (383 female and 48 male). WHO grade I meningiomas accounted for approximately 74 % of the intracranial meningiomas (316 of total 431 patients). WHO grade II and grade III meningiomas were found in 99 (22.9%) and 13 patients (3.1%) respectively. Of the histological subtypes, the most common are meningothelial in 71 patients (16.5%), mixed meningothelial and microcystic in 53 patients (12.3%) and mixed meningothelial and transitional in 41 patients (9.5%), whereas the uncommon subtypes such as atypical, angiomatous, anaplastic, clear cell, secretoric, chordoid, rhabdoid were found in 35 patients (8.1%). The most common site of meningioma is sphenoorbita region (223 patients; 51.9%.), followed by convexity (60 patients; 13.9%), and sphenoid wing (30 patients; 7.0%). Proptosis is the most common clinical presentation (176 patients; 40.8%), followed by decrease of visual acquity (75 patients; 17.4%) and headache (46 patients; 10.8%). CONCLUSION: This study showed intracranial meningiomas are a female preponderance among our patients. Proptosis is the most common clinical presentation, the sphenoorbita region as the most common site, whereas WHO grade I and meningothelial subtypes as the most common pathological finding.

Background. Cervical spine disease has the potential to reduce productivity in affected patients because of myelopathy and mood disorder (e.g. depression) which lead to decreasing of the patient’s quality of life. Objective. This study aims to elaborate the most frequent symptoms and pathology of C-spine disease in patients who underwent a surgical procedure over the period time from January 2012 to December 2016. Method. This study is a retrospective, conducted in Spine Division of Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia (FMUI). All patients who underwent surgery for the C-spine disease are included. The data was obtained from the records in our spine database. Result. The total number of surgical procedures for spine disease over the 5 years was 345 procedures, with 127 procedures in the C-spine which are the second most common procedures of spine surgery in Department of Neurosurgery FMUI. The C-spine diseases were more common in males, aged more than 50 years old. The most frequent disease or pathology is degenerative disease, and yet, tumour cases show an increasing number and became the most common pathology in the year of 2016. The most common procedure is anterior cervical discectomy and fusion (ACDF).Conclusion. Our study showed that the most common symptoms and pathology are myelopathies and degenerative disease respectively, which has similarity with another study in the term of the most frequent pathology and surgical procedure. The finding of the more advanced neurological condition by the time of surgery as the most common symptom is found to be contradictory with other studies in western countries.

Tethered cord syndrome (TCS) is a clinical condition of various origins, which comprises of progressive neurological, urological, and orthopaedic dysfunction, because of congenital fixation or tethering of the distal spinal cord by the terminal filum. It is believed that, if the filum elasticity is compromised by either fatty infiltration or abnormal thickening, the spine movement may cause stress upon the conus, resulting in TCS.Patients with symptomatic TCS can present with a wide variety of signs and symptoms in combination with cutaneous, orthopaedic, spinal, anorectal, and urological abnormalities. The common clinical presentations include the presence of cutaneous signs associated with open septal defects, neurogenic bladder with incontinence or urinary tract infection, leg or foot weakness, numbness and/or spasticity, differences in leg or foot length, deformities of the foot, spinal deformities, and back and leg pain.Neuroimaging is used to confirm when there is suspicion of TCS. Magnetic resonance imaging is the modality of choice in visualizing the level of the conus medullaris and for identifying a thickened and/or fatty filum.The fundamental goals of surgical intervention in TCS are to prevent future deficits in the asymptomatic patient and to improve or stabilize deficits in the symptomatic patient. These two goals are based on the fact that sectioning of the terminal filum can be done safely with minimal risk and a very low rate of morbidity. The reported complications of surgery are cerebrospinal fluid leakage (most common), wound infection, meningitis, bladder dysfunction, and neurological injury.