Frontoethmoidal encephalocele: clinical presentation, diagnosis, treatment, and complications in 400 cases

Purpse The purpose of this study is to review a large series of frontoethmoidal encephalocele (FEE) regarding their clinical presentation, the progressiveness of the mass volume, the skin stigmata as well as its surgical approach and post-surgical complications. Method Records of all FEE patients treated in Soetomo General Hospital, Surabaya, and Charity Foundation Program from 2008 to 2015 were reviewed. Detailed patient’s demography, clinical findings, radiology results, operative procedures, and complications were documented. Follow-up was organized in weekly basis for the first 1 month after surgery or more often when situation or complication occurred. Wound healing, neurological assessment for new or progressive deficit, pseudomeningocele, skin breakdown, cerebrospinal fluid (CSF) leakage, exposed implant, recurrent mass, and cosmetic results were documented. Since most of the patients had no direct phone line at their hometown, we relied on social worker to contact them. Results One-stage surgery was performed for 400 patients with FEE (212 were male and 188 were female). Of 400 patients, 388 (97%) were younger than 18 years old. Most FEEs were nasoethmoidal, either isolated or combined with nasoorbital type (347 cases [86.75%]); nasofrontal subtypes were seen in 34 cases (8.5%) and nasoorbital in 14 cases (1.5%). The mean operative time was 2 h (range 30 min–3 h). There were only two patients (0.5%) needed postoperative blood transfusions. Mean hospitalization time was 5 days (range 4–7 days). Overall, complication rate in our series was 12.5%, mostly was CSF leakage and wound dehiscence. Conclusion The current socioeconomic conditions and local facility should be considered to treat these specific disease processes. The refined and meticulous technique, especially in choosing the approach and handling the dural closure, is essential in lowering the complication rate

Nasoethmoid-nasoorbital encephalocele presenting with orbital pulsation

Encephalocele, a herniation of cranial contents beyond the normal confines of the skull, is usually classified according to the location of the skull defect [1]. Suwanwela and Suwanwela classified encephaloceles into four types, which are divided further into subtypes. Frontoethmoidal encephaloceles (FEE) type has subtypes of nasofrontal (NF), nasoethmoidal (NE), and nasoorbital (NO) [2]. Mahatumarat added “combined” subtype, defined as combination of nasoethmoidal and nasoorbital subtype [3]. Nasoorbital type is of the most infrequent type among others. The content may comprised of meninges and cerebrospinal fluid (CSF), meninges and brain parenchyma, combination of both, or involving part of the ventricle. The clinical presentation of NO FEE includes mass in the orbit, displacement of the eye, and interorbital hypertelorism. Anophthalmia or microphthalmia may occur. The authors describe cases of NE-NO, presenting with clinical sign of pulsating orbits

Eyebrow Keyhole Approach in Aneurysm Surgery

The concept of keyhole neurosurgery is not only to perform small incision and reduce the craniotomy size for the sake of a small opening as we called “keyhole,” but it is rather to make “minimum craniotomy” required to access deep intracranial lesions at the end of the route. Standard craniotomy forms a “funnel-shaped surgical corridor" to reach deeper area of the brain. In contrast, keyhole mini craniotomy forms a “reverse funnel-shaped surgical corridor” that provides adequate working space through small incision and bone window to reach the target. This concept of this approach is that the deep area of the brain can be accessed through smaller craniotomy since the superficial optical field is widened if the size of craniotomy is bigger

Development of pediatric neurosurgical service at Dr. Soetomo Hospital, Surabaya, Indonesia

Purpose This review traces the history of pediatric neurosurgery at Dr. Soetomo General Hospital (DSGH) and its role in advancing the field of pediatric neurosurgery. Methods The history, the founding fathers, and the next generations of the pediatric neurosurgery in DSGH were traced back from original sources and authors’ life stories. Result Pediatric neurosurgical service at DSGH has its own unique perspective being a pediatric service in general hospital setting. It serves second largest city of Indonesia - the fifth most populated country in the world. Historical vignette and future perspectives are narratively presented. Conclusion As a pediatric neurosurgical service at general hospital in developing country, its development deserves a special mention

Axonal Supercharging with Reverse End-to-Side Nerve Transfer in Delayed Peripheral Nerve Repair: Its Impact in SV2B mRNA Expression in Rat Sciatic Nerve Injury Model

To investigate the role of reverse end-to-side nerve transfer in delayed repair of peripheral nerve injury, a rat sciatic nerve injury model was used. The dynamic of SV2B mRNA expression was investigated. Sixteen Wistar rats were divided into four groups (four rats in each group). In Group I, the right tibial nerve was ligated 1 cm proximal to sciatic trifurcation, and the peroneal nerve was ligated distally at its entrance to peroneal tunnel. Two weeks later, the resulting neuroma was excised and the tibial nerve was repaired in end-to-end (ETE) fashion. The peroneal nerve was transferred to the distal stump of the tibial nerve in a reverse end-to-side fashion (RETS / axonal supercharging). In Group II, similar procedure to create the sciatic nerve injury was performed. Two weeks later, the tibial nerve was repaired in ETE fashion.No axonal supercharging procedure was added. In Group II, the sciatic nerve was exposed, and the wound was closed again (sham surgery / positive control). In Group IV, the sciatic nerve was injured in similar fashion, and never repaired (negative control). SV2B mRNA was measured from venous blood, taken at baseline, prior to nerve repair, and at the end of study (ten weeks after repair). Results from the test showed that the expression of SV2B mRNA, which represents the formation of neuromuscular junction, indicated that recovery of the denervated muscles was promoted by axonal supercharging (RETS transfer), and the result was better than conventional repair alone. In conclusion, axonal supercharging (RETS transfer) may be useful in delayed peripheral nerve repair for nerve injuries-in-continuity

Polylactic Acid Implant for Cranioplasty with 3-dimensional Printing Customization: A Case Report

BACKGROUND: Cranioplasty is aimed to restore the structure and function of the lost portion of the skull defect. Many materials can be used for cranioplasty, such as the bones of the patient (autograft), the bones of other patients (allograft), bones of animals (xenograft), or synthetic materials such as acrylic or titanium mesh. These materials are quite expensive and sometimes require complex processes. Manual shaping of material for cranioplasty is also quite time-consuming and prone to cause esthetic dissatisfaction. The author will discuss the case of using polylactic acid (PLA) implant with 3-dimensional (3D) printing customization as a cheap and accurate cosmetic solution for cranioplasty procedures. CASE REPORT: We report 2 cases of skull defect underwent cranioplasty. The first case, female, 20-year-old, had a history of severe traumatic brain injury (TBI) and epidural hematoma. She underwent decompression craniotomy on the left frontotemporoparietal region of her skull. The second case, male, 46-year-old, had a history of spontaneous intracerebral hemorrhage due to arteriovenous malformation (AVM). He underwent decompression craniotomy on the right frontotemporoparietal region of her skull. Both the data of computerized tomography (CT) scan were reconstructed to get 3D model of skull defect. Prosthesis was made by 3D printer accordingly using PLA as material. There was no complication reported postoperatively and cosmetic satisfaction was obtained on both cases. CONCLUSION: The use of PLA implant with 3D printing customization was proved to be cost-effective and good cosmetic satisfaction with no complication reported following cranioplasty procedure

Relationship Histopathology Grading of Meningioma with the Use of Medroxyprogesterone Acetate (MPA) as A Hormonal Contraceptive

Introduction: Meningioma is a common brain tumor with an incidence of more than 30% of all primary brain tumors in adults. The incidence of meningiomas increases with increasing age, women suffer more from meningiomas with a ratio of 3:1. Meningiomas are known to have steroid receptors in the form of progesterone (88%), estrogen (40%), and androgen (40%). Therefore, the use of hormonal therapy is suspected to affect the incidence and histopathological degree of meningioma. One of the widely used hormonal therapy is medroxyprogesterone acetate (MPA). However, there is not enough literature to explain the relationship between MPA and the incidence of meningioma. Objective: To identify the relationship between the duration of the use of Medroxyprogesterone acetate (MPA) hormonal contraceptives and the histopathological degree of meningioma. Methods: This study is an analytic observational with a retrospective design of meningiomas patients based on the duration of use of MPAtype hormonal contraception who performed surgery at Dr. Soetomo General Academic Hospital during the period January 2015 to December 2019. We determined the inclusion criteria for meningioma patients: a history of using MPA hormonal contraceptives or 3-month injectable contraceptives; and the control group: meningioma patients without a history of hormonal contraception. Results: There were 452 cases of meningioma and 101 patients met the inclusion criteria. Based on the results of statistical analysis, it was found that there was no difference relationship between the grade of meningioma and meningioma patients either using MPA or without using MPA. There was no difference in duration of use between the group using MPA <10 years or more than 10 years with the non-hormonal control group on meningioma grading (p = 0.772). There was also no difference relationship between the group that did not use hormonal contraception and the MPA group on the age of the patient (p = 0.217), both using contraception for <10 years and more than 10 years. Conclusion: There was no relationship found between histopathological degree of meningioma with the patients who use MPA contraceptives, both duration of use <10 years and ≥10 years compared with meningioma patients who do not use MPA contraception

Thymoquinone modifies CD4+:CD8+ ratio without affecting tumor necrosis factor‑α and interleukin‑1β levels in Wallerian degeneration crush injury rat model

Wallerian degeneration following nerve injury not only suppresses CD4+ T-cell responses but also pro- motes pro-inflammatory immunological responses through TNF-α and IL-1β. Recent research suggests that thymoquinone might enhance nerve recovery by exerting anti-inflammatory effects on both the innate and adaptive immune systems. This study aims to evaluate the effect of thymoquinone on neuroinflammation in a sciatic nerve crush injury, as represented by TNF-α, IL-1β, and the CD4+:CD8+ ratio. In this study, 126 crush injury Wistar rats were divided into three main groups: placebo, thymoquinone 100 mg/kg, and thymoquinone 250 mg/kg administered daily. Rats were euthanized at six distinct time points: 12, 18, and 24 hours, as well as on day-5, day-6, and day-7. TNF-α and IL-1β levels were assessed using the Enzyme- Linked Immunosorbent Assay (ELISA). The CD4+:CD8+ ratio in peripheral blood was determined via flow cytometry. No significant TNF-α differences was found between treatment and placebo groups. However, on day 6, IL-1β was significantly lower in the TQ 250mg/kg group than in the placebo (p=0.008). A similar but non-significant trend existed on days 6 and 7. On day 5, both TQ groups showed a higher, statistically significant CD4+:CD8+ ratio compared to placebo (p=0.007), a trend that continued to day 7 but not sta- tistically significant. Daily TQ administration did not consistently reduce TNF-α and IL-1ß levels. However, both doses elevated the CD4+:CD8+ ratio during the early stages of Wallerian degeneration, suggesting a potential benefit of TQ on nerve regeneration

Development of pediatric neurosurgical service at Dr. Soetomo Hospital, Surabaya, Indonesia

Purpose This review traces the history of pediatric neurosurgery at Dr. Soetomo General Hospital (DSGH) and its role in advancing the field of pediatric neurosurgery. Methods The history, the founding fathers, and the next generations of the pediatric neurosurgery in DSGH were traced back from original sources and authors’ life stories. Result Pediatric neurosurgical service at DSGH has its own unique perspective being a pediatric service in general hospital setting. It serves second largest city of Indonesia - the fifth most populated country in the world. Historical vignette and future perspectives are narratively presented. Conclusion As a pediatric neurosurgical service at general hospital in developing country, its development deserves a special mention