Farid Yudoyono

Multiple meningiomas consisting of fibrous meningioma, transitional meningioma, and meningotheliomatous meningioma in one adult patient

Multiple histopathology of meningioma is a condition in which the patient has more than one histopathology feature of meningioma in different intracranial locations, with or without sign of neurofibromatosis. Meningiomas are the most common, non-glial, primitive intracranial tumors; their prevalence among operated tumors is around 13-19%. They may occur at any age, but have a peak incidence around 45 years of age. The incidence of multiple intracranial meningiomas varies from 1% to 10% in different series, and the frequency of multiple meningiomas without neurofibromatosis was reported to be <3%.

Comprehensive management of frontal and cerebellar tumor patients with personality changes and suicidal tendencies.

Background: Brain tumor patients have a tendency to suffer from psychiatric disturbances. One of the most frequent disturbance experienced by frontal area tumor patients are personality changes. Case Description: In this paper, the authors report a 28-year-old male patient who presented with headache and personality changes, with no other neurological disturbance. The patient became increasingly pensive and apathetic with frontal and cerebellopontine angle tumor. The diagnosis is based on computed tomography scanning images, and histopathological examination of the excised tumor results in meningioma. Conclusion: Before the operation was performed, the patient suffered from personality changes and suicidal tendencies. After the operation, the patients suicidal tendency was gone, but the personality changes still persist. For this reason, a comprehensive management of the patient is required, including postoperative pharmacological and psychological treatment.

Predictive Factors of Cervical Traction based on Cervical Spine Realignment shown by Series Lateral Cervical X-ray in Subaxial Cervical Spine Injury Patients

Introduction: Cervical spine injury is the most feared spinal injury for physicians, patients, and their families. All patients with unstable subaxial cervical spine injury must be managed by cervical traction and stabilization. Lateral cervical X-ray remains standard diagnostic tools to evaluate the stability of cervical spine structure and has a high diagnosis value in evaluating the success of the cervical traction. The success of the cervical traction could be predicted by observing the alignment of the cervical based on series lateral cervical spine X-ray. Materials and methods: This retrospective study involves 30 patients with subaxial cervical spine injury admitted to the Emergency Unit of Dr. Hasan Sadikin Hospital, Bandung, Indonesia, from 2012 to 2016. This study uses the logistic regression analysis with p < 0.05 considered to be significant and the confidence interval (CI) of 95%. Results: The results of this study showed that the failure of cervical traction (closed reduction) was mainly determined by interval admission time and facet lock (FL). The interval admission time (p = 0.015; two-sided tail, Pearson’s chi-square) and distribution of FL showed significant results (p = 0.001; two-sided tail Fisher’s exact test). Odds ratio (OR) whether FL is present or absent is 3.8; 95% CI 0.5 to 27.1, with p = 0.001. Conclusion: It is concluded that informed consent regarding cervical traction failure is needed in subaxial cervical injury >24 hours, where in patients with FL cervical traction trail is not needed, instead immediate definitive management (opened reduction) with stabilization is recommended.

Transforaminal Epiduroscopic Basivertebral Nerve Laser Ablation for Chronic Low Back Pain Associated with Modic Changes: A Preliminary Open-Label Study

Background Chronic low back pain (CLBP) arising from degenerative disc disease continues to be a challenging clinical and diagnostic problem whether treated with nonsurgical, pain intervention, or motion-preserving stabilization and arthrodesis. Methods Fourteen patients with CLBP, greater than 6 months, unresponsive to at least 4 months of conservative care were enrolled. All patients were treated successfully following screening using MRI findings of Modic type I or II changes and positive confirmatory provocative discography to determine the affected levels. All patients underwent ablation of the basivertebral nerve (BVN) using 1414 nm Nd:YAG laser-assisted energy guided in a transforaminal epiduroscopic approach. Macnabs criteria and visual analog scale (VAS) score were collected retrospectively at each follow-up interval. Results The mean age was 46 ± 9.95 years. The mean symptoms duration was 21.21 ± 21.87 months. The mean follow-up was 15.3 ± 2.67 months. The preoperative VAS score of 7.79 ± 0.97 changed to 1.92 ± 1.38, postoperatively (P < 0.01). As per Macnabs criteria, seven patients (50%) had excellent, six patients (42.85%) had good, and one patient (7.14%) had fair outcomes. Conclusion The transforaminal epiduroscopic basivertebral nerve laser ablation (TEBLA) appears to be a promising option in carefully selected patients with CLBP associated with the Modic changes.

Presurgical Aspects of Nutrition in Tuberculous Spondylitis Patients

Tuberculous spondylitis is a chronic infectious disease caused by Mycobacteriumtuberculosis on the vertebral bone. Involved less than 3% of all cases of TB, but the incidencevaries around the world, and is associated with the quality of public health and socioeconomicconditions.The purpose of this study is to investigate the presurgical aspects of nutrition inpatients with tuberculous spondylitis. A total of 39 consecutive patients between January 2011-December 2012 were evaluated retrospectively. All patients diagnosed with spondylitistuberculousis and treated with decompression, stabilization and fusion. All patients had beendiagnosed with Spondylitis tuberculousis based on history taking, physical examination,laboratory finding and MRI. Our study showed that of all subjects, ten male patients and eightfemale patients had cervical (n=1), thoracic (n=15), and lumbar (n=2) tuberculousspondylitis.The average age of the patients was 32.83 ± 12.25 (17-56) years old. The averagepreoperative body mass index (BMI) was 16.67 ± 1.2 kg / m2, albumin levels 3.23 ± 0.21 g / dl,total protein level 6.2 ± 0.34 g/dL. These were lower than normal value. We conclude thattuberculous spondylitis patients experience nutritional deficiencies presurgically andnutritional support should be considered pre-operatively.Keywords: Mycobacterium tuberculosis, nutritional state, presurgical aspect,tuberculousspondylitis

Symptomatic Ruptured Seed-Type Partial Ossification of the Ligamentum Flavum: A Case Report

Abstract Background Seed‐type partial ossification of the ligamentum flavum (OLF) causing severe radiculopathy after rupture has not yet been described in the literature. Case Description A 51‐year‐old man presented with sudden onset severe back pain and right anterior thigh pain without any neurologic deficit after lifting a heavy weight. On preoperative computed tomography, we identified a ruptured seed‐type partial OLF at the L1‐L2 level. T2‐weighted magnetic resonance sagittal and axial images showed thecal sac compression by the ruptured OLF. There was no improvement in his symptoms after 2 weeks of conservative management. The patient had percutaneous full endoscopic interlaminar removal of OLF. Postoperatively he experienced prompt improvement of his symptoms. Conclusion Rupture of seed‐type partial OLF causing severe radiculopathy is extremely rare, and percutaneous endoscopy is a safe and effective alternative to open surgery in selected cases.

Suprapedicular Circumferential Opening Technique of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for High Grade Inferiorly Migrated Lumbar Disc Herniation

Purpose To evaluate the efficacy of suprapedicular circumferential opening technique (SCOT) of percutaneous endoscopic transforaminal lumbar discectomy (PETLD) for high grade inferiorly migrated lumbar disc herniation. Material and Methods Eighteen consecutive patients who presented with back and leg pain with a single-level high grade inferiorly migrated lumbar disc herniation were included. High grade inferiorly migrated disc was removed by the SCOT through PETLD approach. Outcome evaluation was done with visual analog scale (VAS) and Mac Nabs criteria. Result There were 14 males and 4 females. The mean age of patients was 53.3 ± 14.12 years. One, 4, and 13 patients had disc herniation at L1-2, L3-4, and L4-5 levels, respectively, on MRI, which correlated with clinical findings. The mean follow-up duration was 8.4 ± 4.31 months. According to Mac Nabs criteria, 9 patients (50%) reported excellent and the remaining 9 patients (50%) reported good outcomes. The mean preoperative and postoperative VAS for leg pain were 7.36 ± 0.73 and 1.45 ± 0.60, respectively (p < 0.001). Improvement in outcomes was maintained even at final follow-up. There was no complication. Conclusion In this preliminary study we achieved good to excellent clinical results using the SCOT of PETLD for high grade inferiorly migrated lumbar disc herniation.

Intervertebral Disc Characteristic on Progressive Neurological Deficit

Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI) in lumbar herniated disc (LHD) patients with progressive neurological deficit. Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination. Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females) suffered from progressive neurological deficit with an average age of (52.07±10.9) years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01). Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients. Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients. Keywords: Lumbar herniated disc, magnetic resonance imaging, progressive neurological deficit DOI: 10.15850/ijihs.v5n2.1042

Surgical management of giant skull osteomas

Objective: Surgical management of giant skull osteomas Osteomas are benign, generally slow growing, bone forming tumors limited to the craniofacial and jaw bones. Materials and Methods: A retrospective review of all cases of osteoma diagnosed from 2009 to 2013 treated in our hospital. The data collected included age at diagnosis, gender, lesion location, size, presenting and duration of symptoms, treatment, complication and outcome. Results: During our study period there were 15 cases that were treated surgically. Their mean age was 42 years (range: 15–65 years) and all of our patients were female. The average duration of symptoms was 3 years and size varying from 4 cm to 12 cm. Eight patients complained of headache, whereas 6 patients complained about esthetics, and 1 patient presented with proptosis. The tumor was excised by cutting the base of the tumor and then residual tumor was grinded using a round head cutting bar. Osteoma was removed with esthetically acceptable appearance. Conclusion: There were no major complications during operative and postoperative period. Although osteomas are usually slow growing but surgery is usually performed due to esthetic reasons. It is important to plan an appropriate surgical approach that minimizes any damage to the adjacent structures.

High-Voltage Electrically Head Injury Presenting underlying Calvarial Osteomyelitis: Single Indonesian Tertiary Hospital Experience

Objective: To demonstrate the characteristic of high-voltage electrically head injury patients presenting underlying calvarial osteomyelitis.