A New Method in Walking Analysis Using the Angles around the Midpoint between Print Length and Toe Spread by Four Different Color Footprints

Sciatic function index (SFI) has long been used as one of the evaluation methods of walking analysis. SFI is a method in assessing nerve function through footprints in walking analysis. Methods that previously have been developed use one color ink, but this method is difficult to interpret. The interpretation is difficult because of mingled footprints among the mice four legs. If rats do not walk straight, their footprints will be overlapped to one another and complicate the measurement. SFI is a method using a special mathematic formula. Many researchers questioning this method because this method is affected by the muscle contracture, auto mutilation and the way and speed of the rat walk. In this study we use four different colors, which allow us to more easily interpret the results of the footprint. In this study, we modify a tool from the existing tools in other literatures. The measurement result of this tool is print length (PL), inter toe spread (ITS) and toe spread (TS), which belong to the SFI component. This tool must be valid and reliable when it is used to measure the components of measurements in the function analysis of the nerves. Validity and reliability are needed to ensure that research data can be trusted. We confirm the SFI result with the toe out of angle (TOA) and a new method to describe the normal footprint. TOA is believed to be the important measurement in walking analysis especially it affects the change of abduction-adduction and internal-external rotation of hind limb. The purpose of this study was to develop a new method to assess the nerve functional analysis, not only using measurement of the SFI and TOA, but also the angles around the meeting point of PL and TS. This study was a laboratory-based research. The subjects of the research are 6 Sprague Dawley rats

The Role of Irradiation in Hypophyseal Adenoma

Pituitary adenomas are histopathologically benign, however the clinical presentations are often quite severe. These clinical signs are due to the tumor mass effect, hormonal disturbances or both. Besides that, these tumors often recurred after treatment. The treatment of pituitary tumors have developed greatly with the improvement of techniques of several modalities such as surgery, radiation and medication. Multimodality treatment is often used for optimal results in treating these tumors. Radiotherapy is a cytotoxic agent using ion radiation for the treatment of pituitary tumors in combination with other methods. Post-surgical radiotherapy has shown to decrease the recurrence rate significantly (22-71% vs 8-23%). At present there has been rapid improvements in radiation techniques for pituitary tumors. These developments are not only based upon the increase of know-how in computer technology and radiation instruments, but are also based upon the development of cellular and molecular biology in connection with normal and tumor tissues. The objective in developing radiation methods and techniques is to create a high radiation dose, homogeneous in the target area with low radiation dose in normal tissue. The development in science and technology, in particular concerning computer science, have created the development of radiation techniques and methods. This paper elaborates on several aspects of radiation in the treatment of pituitary

Penentuan Tingkat Kedaruratan Bedah Adenoma Hipofisis Melalui Stratifikasi Prabedah di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo

Adenoma hipofisis menyebabkan defisit neurologis yang memerlukan tata laksana tepat. Belum ada standar baku penetapan tingkat kedaruratan bedah untuk adenoma hipofisis. Penelitian ini bertujuan mengetahui distribusi tingkat kedaruratan bedah pengangkatan tumor melalui operasi trans-sfenoid pada pasien adenoma hipofisis. Penelitian retrospektif berbasis rekam medik dilakukan pada 50 pasien adenoma hipofisis yang menjalani operasi pengangkatan tumor dengan teknik trans-sfenoid di Departemen Bedah Saraf FKUI-RSUPNCM pada tahun 2018-2019. Proporsi pasien yang menjalani operasi elektif dan dipercepat dibandingkan dengan stratifikasi risiko prabedah menurut tingkat kedaruratan bedah A/B/C/D. Proporsi pasien yang menjalani operasi elektif dan dipercepat adalah 86% dan 14%, sedangkan proporsi tingkat kedaruratan bedah adalah 54% (A), 36% (B), 8% (C), dan 2% (D). Median hari waktu tunggu menuju operasi [min-max] adalah 77,6 (4-549) hari (A); 45,4 (7-258) hari (B); 71 (8-140) hari (C); dan 99 hari (D); tidak terdapat perbedaan bermakna. Terdapat ketidaksesuaian proporsi antara pasien kategori dipercepat/elektif dan tingkat kedaruratan bedah A/B/C/D serta tidak ada perbedaan waktu tunggu menuju operasi pada keempat kelompok risiko operasi A/B/C/D. Diperlukan penelitian lebih lanjut untuk menetapkan manfaat stratifikasi risiko prabedah tumor hipofisis terhadap luaran pasien pasca operasi pengangkatan tumor melalui operasi trans-sfenoid.   Determination of Surgical Emergency Levels of Pituitary Adenoma Patients Through Pre-Surgical Stratification at the dr. Cipto Mangunkusumo National Hospital   Pituitary adenomas may cause neurological deficits that require prompt management. There is no standard for determining the level of surgical emergencies for pituitary adenomas. The author aims to know the distribution of pituitary adenomas surgically removed through trans-sphenoid surgery. This medical record-based retrospective study was conducted on 50 pituitary adenoma patients who underwent trans-sphenoidal surgery at the Department of Neurosurgery, dr. Cipto Mangunkusumo National Hospital in 2018-2019. The proportion of patients undergoing elective and urgent surgery is compared with pre-surgical risk stratification according to the level of A/B/C/D surgical emergencies. The proportions of patients who underwent elective and urgent surgery were 86% and 14% respectively, while the proportion of surgical emergencies for each group was 54% (A), 36% (B), 8% (C), and 2% (D). The median waiting time to surgery [min-max] for each group is 77.6 (4-549) days (A); 45.4 (7-258) days (B); 71 (8-140) days (C); and 99 days (D); no significant difference were found. There was a large discrepancy in the proportion between patients included in the urgent/elective category and the level of emergency A/B/C/D surgery. Furthermore, there is no difference in waiting time for surgery between the four risk groups for A/B/C/D. Further research is needed to establish the benefits of preoperative risk stratification of pituitary adenoma in terms of patient outcomes after trans-sphenoid surgery. &nbsp

The Physician Tendency in Stereotactic Radiosurgery Dose Prescription in Benign Intracranial Tumor at dr. Cipto Mangunkusumo National Hospital, Jakarta

Stereotactic radiosurgery (SRS) is one of the treatment modalities for benign intra-cranial tumor, especiallyfor the tumor located next to the critical neural structure. The prescribed dose for radiosurgery depends onthe maximal tumor diameter and surrounding normal tissue tolerance dose. This cross sectional study wasconducted to evaluate the physician’s tendency in radiosurgery dose prescription. We observed treatmentplanning data of 32 patients with benign intra-cranial tumor, which had been treated with SRS at Dr. CiptoMangunkusumo National Hospital in 2009-2010. The peripheral dose, organ at risk (OAR) dose limitiationand maximum tumor diameter were recorded. We compared our SRS dose with dose limitation, whichallowed safer dosing based on maximal tumor diameter perspective and the nearest OAR dose constraint.From maximal tumor diameter perspective, we prescribed mean±SD radiosurgery doses, which were11.63±2.21Gy, 10.21±1.29Gy and 9.88±1.07Gy for the tumor size ≤2cm, 2.01-3cm and 3,01-4cm respectively.Our radiosurgery dose was the lowest than dose limitation based on the nearest OAR perspective, followedby maximal tumor diameter perspective. It was concluded that radiosurgery dose had the tendency to beinfluenced by surrounding healthy tissue tolerance rather than maximal tumor diameter

Clinical Profile of Tuberculum Sellae Meningiomas Based on Scoring System: An Institutional Experience in Indonesia

Tuberculum sellae meningioma (TSM) is a challenging tumor that grows close to several crucial structures, such as the optic nerve, arteries, and pituitary. Surgical treatment is currently evolving from a transcranial microsurgical resection to a transsphenoidal approach. This study examined the clinical profile of patients with tuberculum sellae meningioma and explored its relationship with scoring systems. This retrospective observational study included patients with TSM who underwent surgery at the Department of Neurosurgery at our hospital between 2017 and 2022. The patients were excluded if their data required completion. The clinical profiles of the patients were counted and transformed into a scoring system using several variables such as size, vascular, and canal invasion. We then analyzed the relationship between the clinical signs and symptoms to determine the efficacy of this scoring system. Thirty-six patients were included in the study. Most of our patients had a high score for tumor diameter, bilateral canal invasion, and vascular invasion (2-2-2). Moreover, when related to clinical signs, there was no relationship between the canal and vascular invasion and decreased visual acuity. Tuberculum sellae meningioma mostly causes visual impairment and several other symptoms, such as hemianopsia and parasellar extension. Several factors in the scoring system should also be considered to predict outcomes, such as the onset of visual symptoms, peritumoral edema, and grade of excision

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

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

CERVICAL MYELOPATHY AS THE MOST COMMON SYMPTOMS IN PATIENTS UNDERGOING C-SPINE SURGERY IN THE SPINE DIVISION, DEPARTMENT OF NEUROSURGERY, CIPTO MANGUNKUSUMO GENERAL HOSPITAL, FROM JANUARY 2012 TO DECEMBER 2016

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

A Dumbbell-shaped hypoglossal schwannoma managed by a combination of open surgery and endoscopic assistance

Background: Hypoglossal schwannoma is a rare benign tumor that comprises about 5% of all intracranial schwannoma. Surgical management for hypoglossal schwannoma is still evolving along with our understanding of neuroanatomy and surgical equipment improvement, especially endoscopy. The far lateral transcondylar approach is commonly used for hypoglossal schwannomas. This traditional approach requires great effort and is considered a lengthy procedure. The use of endoscopy gives an additional advantage to microscopic surgery in managing this tumor, making surgery less complicated and faster. Combining the microscope and endoscope is an effective way to operate in small corridors. Case: In a stepwise fashion, we present a case of a 53-year-old female with hypoglossal schwannoma, which was successfully resected using a retrosigmoid transcondylar approach with endoscopic assistance. Conclusion: A retrosigmoid transcondylar approach with endoscopic assistance is an excellent option in surgical management for hypoglossal schwannoma. Both microscopic and endoscopic approaches will be gaining more usefulness in managing skull base tumors and should be used collaboratively

Luaran Nilai Fungsional Kasus Tumor Primer Spinal Intradura Ekstramedula Pascaoperatif di RSUPN Dr. Cipto Mangunkusumo 2014-2016

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