Muhammad Zafrullah Arifin

Penetrating skull fracture by a wooden object: Management dilemmas and literature review

Most penetrating skull injuries are caused by gun shot wounds or missiles. The compound depressed skull fracture represents an acute neurosurgical emergency. Management and diagnosis of such cases have been described, but its occurence following a fall onto a piece of wood is quite unusual. A 75-year-old female fell onto a piece of wood that penetrated her skull on the left frontal region and was treated in our department. The patient had no neurological deficits during presentation. She was managed surgically and removal of the wooden object was performed to prevent early or late infection complications. Wooden foreign bodies often pose a different set of challenges as far as penetrating injuries to the brain are concerned. Radiological difficulties and increased rates of infection due to its porous nature make these types of injuries particularly interesting. Their early diagnosis and appropriate treatment can minimize the risk of complications.

Pterional approach versus unilateral frontal approach on tuberculum sellae meningioma: Single centre experiences.

Introduction: Tuberculum Sellae Meningioma is one of the most challenging surgeries among neurosurgeons. Many approaches have been established in the effort of removing the tumor and some of them are supported by an advanced neurosurgical technology. In this study, we aim to compare the efficacy of the two most common approaches, the pterional and the unilateral frontal. Materials and Methods: This was a restrospective study that aimed to observe the efficacy of the two most common approaches used in our center, the pterional and the unilateral frontal, in resecting the tuberculum sellae meningioma, which was held in Dr. Hasan Sadikin General Hospital, Bandung, from July 2007-July 2010. Twenty patients were enrolled with half of them operated by the pterional approach and the rest by unilateral frontal approach. We evaluated six parameters: tumor size, degree of tumor removal, surgery duration, post-operative cerebral edema, patients outcome, and length of stay, which were evaluated to take measure of the efficacy of each procedure. Results: We found that the pterional approach gave more advantages than the unilateral frontal. Total tumor removal, especially in tumor size ≥ 3 cm was achieved in a greater number of subjects in the pterional (P<0.023). Other advantages of the pterional compared to the unilateral frontal were a shorter surgical duration (P=0.024), shorter length of stay (P=0.009) and less frequency of post-operative cerebral edema incidence (P=0.023). Conclusion: According to our facilities and conditions, it seems that the pterional approach have more advantages than the unilateral frontal approach in tuberculum sellae meningioma surgery.

Trumpet Laminectomy Microdecompression for Lumbal Canal Stenosis

Microsurgery techniques are useful innovations towards minimizing the insult of canal stenosis. Here, we describe the trumpet laminectomy microdecompression (TLM) technique, advantages and disadvantages. Sixty-two TLM patients with lumbar disc herniation, facet hypertrophy or yellow ligament or intracanal granulation tissue. The symptoms are low back pain, dysesthesia and severe pain on both legs. Spine levels operated Th11-S1; the patients who had trumpet-type fenestration, 62.9% had hypertrophy of the facet joint, 11.3% had intracanal granulation tissue, 79.1% had hypertrophy of the yellow ligament and 64.5% had disc herniation. The average of procedure duration was 68.9 min and intraoperative blood loss was 47.4 mL. Intraoperative complications were found in 3.2% of patients, with dural damage but without cerebrospinal fluid leakage. The TLM can be performed for all ages and all levels of spinal canal stenosis, without the complication of spondilolistesis. The TLM has a shorter duration, with minimal intraoperative blood loss.

Inhibition of activated NR2B gene- and caspase-3 protein-expression by glutathione following traumatic brain injury in a rat model

Background. Traumatic brain injury (TBI) remains a major cause of death and disability. Oxidative stress is an important element of the injury cascade following TBI. Progressive compromise of antioxidant defenses and free radical-mediated lipid peroxidation are one of the major mechanisms of secondary TBI. NR2B is a glutamate receptor and its activation is caused by TBI increasing a brain cell death, along with caspase-3 as a hall mark of apoptosis. Glutathione is a potent free radical scavenger that might prevent secondary TBI damage and inhibited apoptosis. Materials and Methods. In the present study, it aims to demonstrate the effect of glutathione on inhibition of brain oxidative damage in a TBI rat model. Results. In this study, the expressions of mRNA NR2B in placebo group and groups with glutathione administration at 0, 3, and 6 hours after TBI were 328.14, 229.90, 178.50, and 136.14, respectively (P<0.001). The highest caspase-3 expression was shown in placebo group with 66.7% showing strong positive results (>80%); as expected, glutathione administered in 0, 3, and 6 hours groups had lower strong positive results of 50%, 16.7%, and 16.7%, respectively, (P=0.025). Conclusion. In conclusion, this study showed that glutathione administration in a TBI rat model decreased NR2B gene- and caspase-3 protein-expression that lead to the inhibition of brain cell death. Our results suggest that glutathione, as a potent free radical scavenger, has a brain cell protective effect against oxidative damage and cell death induced by TBI in rat model.

Characteristics of Moderate and Severe Traumatic Brain Injury of Motorcycle Crashes in Bandung, Indonesia

BACKGROUNDnTraumatic brain injury (TBI) constitutes a critical public health and socioeconomic problem. As one of the leading causes of mortality and disability from road traffic crashes, the incidence of TBIs is increasing with increasing motor vehicle usage. Understanding the prevalence and describing the characteristics of TBI are crucial for successful implementation of prevention and treatment efforts to reduce the mortality and morbidity caused by TBIs.nnnMETHODSnWe studied cases of moderate and severe TBI resulting from motorcycle crashes from January 1, 2013 to June 30, 2014. Variables studied included sex, age, time interval (from crash to arrival at the emergency department), alcohol consumption, helmet use, severity of TBI, choice of treatment, and the outcome.nnnRESULTSnA total of 2108 head injury cases were seen at the emergency department during this period, 1324 (62.8%) of which resulted from motorcycle crashes. Of those cases, 30.7% (407 cases) were categorized as moderate or severe TBI with 29.2% mortality. Most of the patients were male (80.8%), <60 years old (96.1%), and did not wear a helmet (71.2%). More than half of the cases (56.7%) arrived at the emergency department within 6 hours, 14.0% of the cases were under alcohol intoxication, and 37.8% of the cases were operated on.nnnCONCLUSIONSnThis preliminary analysis highlights the need to address road safety, especially with respect to helmet use and drink driving, to reduce the burden of TBIs in Bandung.

The Bandung neurosurgery patient outcomes project, Indonesia (Part I): Methods, participant characteristics, and pre‐discharge outcomes

INTRODUCTIONnLittle is known about neurosurgery patient outcomes in Indonesia. Our study sought to describe patient characteristics, health care pathways, health-related quality of life, and health/rehabilitation care needs of patients admitted to, and discharged from, a major neurosurgery department.nnnMETHODSnEligible patients were aged ≥18xa0years admitted to the Neurosurgery Department in a regional referral hospital in Bandung, Indonesia. Baseline data was collected on admission. An in-person interview (in the Indonesian language) was held 1 to 2xa0days pre-discharge. Sociodemographic along with clinical characteristics, Glasgow Coma Scale (GCS), and EQ-5D-5L data were collected.nnnRESULTSnA total of 217 patients were admitted, 37 died before discharge, and a pre-discharge interview was undertaken by 178 (82%). Almost half (48%) were admitted because of injury, 38% brain tumour, 10% acute illness, and 4% other conditions. The mean age was 41xa0years. On admission, 63% had a mild Glasgow Coma Scale, 31% moderate, and 3% severe. The average hospital stay was 8xa0days for injury and 24xa0days for illness patients. Prior to discharge, one-third, or less, of the 178 patients interviewed reported no problems in the EQ-5D dimensions of mobility (32%), self-care (27%), usual activities (16%), and pain/discomfort (32%), whereas 70% reported no problems with anxiety/depression.nnnCONCLUSIONnA large proportion of patients are being discharged with considerable levels of difficulty in four of the five EQ-5D dimensions. This stresses the importance of providing good follow-up and support of patients and their families.

Mother and children health reporting system: Innovative information system application in the rural West Bandung Area, Indonesia, by using multimodal communications systems

Objectives: Digitalization of maternal and post-natal care system (DigiMAPS) is a system consist of electronic medical record for mother and children health (KIA) also for tele-consultation facility called “Tele-Obgyn”. Our project focuses on the development of KIA Online and a cloud computing-based video conferencing as a basis of Tele-Obgyn platform. The web-based network allows online access not only among primary health care but also between government and private institution. DigiMAPS platform is designed to meet the needs of database management and its interphase with other services that are responsible for data acquisition and visualization. Methods: DigiMAPS combines the open-source flexible system design that benefits for implementation and development needs as well as support for mobile devices to enable high quality of patient care. The system has been developed gradually following lean-innovation management concept which focuses on customer-problem-solution matching with rapid prototyping and validation from idea to solution. There was significant effort to establish a close relationship and learning process with prospective users of DigiMAPS, hence in the broader perspective we used a participatory research approach. DigiMAPS act as central-portal and -data base in the communication information system (ICT), designed to compile patient report paperless and equipped with tele-consultation. Results: DigiMAPS developed for a variety of administrative processes. This system will simplify the work process and can be integrated with primary health care system, Health Department and the Ministry of Health. A good ICT will be useful in collecting clinical information than conventional paper-based reporting system and to minimize errors in the reporting chain. Conclusions: By using lean innovation management, several inputs are gathered from prospective users including health authority, head of local clinics, midwifes, obgyn doctors, and public health staffs. Our system may bridging gap between clinical needs and digital documentation, telemedicine-monitoring and improve the quality of patient care, facilitate communication within both the scope of the internal (primary health care) and external (stakeholders and follow-up), increasing productivity and reduce overall expenses.

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.

Enhanced expression of proapoptotic and autophagic proteins involved in the cell death of glioblastoma induced by synthetic glycans

OBJECTnGlioblastoma is the most aggressive malignant brain tumor, and overall patient survival has not been prolonged even by conventional therapies. Previously, the authors found that chemically synthesized glycans could be anticancer agents against growth of a series of cancer cells. In this study, the authors examined the effects of glycans on the growth of glioblastoma cells both in vitro and in vivo.nnnMETHODSnThe authors investigated not only the occurrence of changes in the cell signaling molecules and expression levels of various proteins related to cell death, but also a mouse model involving the injection of glioblastoma cells following the administration of synthetic glycans.nnnRESULTSnSynthetic glycans inhibited the growth of glioblastoma cells, induced the apoptosis of the cells with cleaved poly (adenosine diphosphate-ribose) polymerase (PARP) expression and DNA fragmentation, and also caused autophagy, as shown by the detection of autophagosome proteins and monodansylcadaverine staining. Furthermore, tumor growth in the in vivo mouse model was significantly inhibited. A dramatic induction of programmed cell death was found in glioblastoma cells after treatment with synthetic glycans.nnnCONCLUSIONSnThese results suggest that synthetic glycans could be a promising novel anticancer agent for performing chemotherapy against glioblastoma.