PERAN ERYTHROPOIETIN DALAM MEMPERLAMBAT PENIPISAN LAPISAN SEL PUNCA ENDOGEN ZONA SUBVENTRIKULAR MELALUI HAMBATAN AKTIVASI MIKROGLIA DAN ASTROSIT REAKTIF PADA HIDROSEFALUS

Purpose: To elucidate the potential role of Erythropoietin (EPO) as a neuroprotective agent against reactive strogliosis and reducing the thinning rate of subventricular zone (SVZ) in kaolin-induced hydrocephalic rats. Method: Thirty-six ten-week-old Sprague-Dawley rats were used in this study. Hydrocephalus was induced with 20% kaolin suspension injected into the cistern of thirty rats and leaving the six rats as normal group. The hydrocephalic rats were randomly divided into hydrocephalic and treatment group. The treatment group received daily dose of recombinant human erythropoietin (rhEPO) from day-7 to day-21 after induction. The animals were sacrificed at 7 (only for hydrocephalic group) and 14 or 21 (for both groups) days after induction. Brain was removed and was prepared for histological analysis by hematoxylin and Eosin staining as well as immunohistochemistry for 4-HNE, β-catenin, GFAP, Iba-1 and Ki-67. Results: Immunohistochemical analysis showed that animals treated with rhEPO had a reduced astrocyte reactivity displayed by lower GFAP expression. Hydrocephalic rats received rhEPO also displayed reduced microglial activation shown by lower Iba-1 protein expression. Exogenous rhEPO exerted its protective action in reducing astrogliosis by inhibiting lipid peroxidation that was documented in this study as lower expression of 4-HNE than non-treated group. Expression of β-catenin was also reduced following the pattern of 4-HNE. The SVZ thickness was progressively declining in hydrocephalus group, while the progression rate could be reduced by rhEPO. Conclusion: Erythropoietin inhibited lipid peroxidation, and reactive astrogliosis in hydrocephalic animal model. The reduced thinning rate of SVZ demonstrated that EPO also had effect in reducing the hydrocephalus progressivity. Further research is warranted to explore its efficacy and safety to use in clinical setting

Combination of encephalo-myo-pial-synangiosis and encephalo-arterio-pial-synangiosis procedure in pediatric moya-moya disease

Background: Moya-moya disease in children is a cerebrovascular disorder that may cause cerebral ischemic or hemorrhage.Case Details: We report an 8-year-old boy that was admitted with the chief complaint of repeated sudden half left body paralyze. MRA showed acute thrombotic infarction in the right hemisphere and internal carotid artery stenosis in the form of puffs of smokes. Indirect revascularization surgical procedure with combination of Encephalo-myo-pial-synangiosis (EMS) and Encephalo-arterio-pial-synangiosis (EAS) was performed. It resulted in a good response.Conclusion: Moya-moya disease can lead to permanent neurological disability if untreated. Satisfactory outcome was noted following combination surgery management with EMS and EAS.Keywords: Moya-moya disease, Encephalo-myo-pial-synangiosis, Encephalo-arterio-pial-synangiosis, childre

Profil Pasien Ensefalokel Anak Usia 0-18 Tahun Di Departemen Bedah Saraf, RSUD Dr. Soetomo, Surabaya

Background: Data of encephalocele patient is rarely found in Indonesia, especially in East Java. Researcher conducted an observation aboutprofile of encephalocele patient age 0–18 years old at Department of Neurosurgery, Dr. Soetomo Hospital, Surabaya, Indonesia.Objective: To observe profile of encephalocele patient age 0–18 years at Department of Neurosurgery, Dr. Soetomo Hospital, Surabaya, Indonesia. Material and method: This is cross sectional observation research observing medical record of encephalocele patient age 0–18 years at Department of Neurosurgery, Dr. Soetomo Hospital, Surabaya, Indonesia from 2010 to 2012.This study also observeage groups, gender, address, and types of encephalocele. Results: 27 male and 23 female patients were included. From 5 types based on the defect location, 30 patients are diagnosed as nasofrontal encephalocele, nasoorbita is found at 17 patients, while nasofrontoorbita, maxilonasoorbita and nasoethmoorbita is found at 1 patient each. The most dominant age group is 0 – 3.5 years old (n=15). From 50 patients, 43 patients were from outside Surabaya.Conclusions: The number of male patients diagnosed with encephalocele were slightly higher compared to female patients. Nasofrontal type was the predominant type amongst other types. The majority of encephalocele patients were 0 – 3.5 years old. These patients mostly were from outside of Surabaya city

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

Multiple spinal extradural arachnoid cysts occurring in a child Case Report

Symptomatic multiple extradural arachnoid cysts of the spine are extremely uncommon in children and have only rarely been reported. The authors report a case of multiple extradural spinal arachnoid cysts in a 14-year-old child who presented with signs of spinal cord compression. The disease affected the thoracic spine and extended from T-5 to T-10 with an underlying defect in the dura of the spinal canal that was predisposed to the formation of cysts. The authors describe the imaging examination, surgical planning, and surgical technique, and they review the literature. They also discuss the possible mechanisms of cyst formation

Tuberculoma mimicking postoperative VP shunt seeding of craniopharyngioma: A rare case report

Abstract Background: Tuberculosis (TB) is still a big problem in developing and TB endemic countries such as Indonesia. The most common manifestations of TB in the central nervous system are tuberculous meningitis and tuberculoma. In developing and TB endemic countries, tuberculomas account for 33% of intracranial space-occupying lesions. Isolated tuberculoma without systemic TB is rarely seen. On physical and radiological examination, tuberculoma often gives an atypical appearance. From imaging, tuberculoma often mimics another intracranial tumor. Oftentimes the accurate diagnosis can only be made after postoperative histopathological and microbiology examination. Case description: An 11-year-old, Indonesian girl has been complaining persistent headache in the past 3 years. The patient had a history of surgical excision of craniopharyngioma 8 years ago, and placement of ventriculoperitoneal shunt due to postoperative hydrocephalus. Patient was immunocompetent with no sign of systemic TB nor tuberculous meningitis. Brain magnetic resonance imaging (MRI) revealed a 4 × 2.3 × 2.1 cm mass surrounding the ventricular drain which was attached in the anterior horn of the right lateral ventricle to the right frontal cortex. From dynamic susceptibility contrast MRI perfusion and MR Spectroscopy suggested a process of seeding metastases surrounding the ventricular drain. Postoperative histopathological examination results were consistent with tuberculoma. Conclusion: Tuberculoma should always be considered as one of the differential diagnoses along with primary and secondary intracranial neoplasm, particularly in developing and TB endemic countries, and inpatient with immunocompromised state

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

Spheno-orbital Encephalomeningocele associated with Multiple Intracranial Abnormalities

Spheno-orbital type of basal encephalocele is one of the rarest type of encephalocele. A rare case of protusion of cranial content through superior orbital fissure known as spheno-orbital encephalocele that co-existed with intracranial cystic changes and severe hydrocephalus in three-month-old infant is presented. Clinical presentation of this malformation are described in relation to its pathogenesis. Surgical treatment and prognosis are discussed

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

Drug utilization study of diuretics in children with hydrocephalus

Hydrocephalus is a condition characterized by a dynamic imbalance between formation and absorption of cerebrospinal fluid that increases the size of intracranial space of the brain and, in some situations, an extension of the outer space of the brain with or without increased ventricular size.This study aimed to examine the use of diuretics and identify drug therapy problems in hospitalized children with hydrocephalus through the medical record.The study design is observational retrospective with time-limited sampling based on data in medical records at 2010-2013 periods, found 17 of 70 patients using diuretics therapy.There are three categories of diuretic which are used were mannitol (70.6%), acetazolamide (23.5%), and a combination of mannitol and acetazolamide (5.9%).Diuretics can be used for pre-op, post-op, and pre & post-op on all types of hydrocephalus. Still, the specific use of diuretics may be caused by variations in comorbid diagnoses, clinical data, and laboratory data for each patient.Adverse drug reactions are potentially dominant in DTP analysis, and these are 7 of 17 patients.Monitoring of serum electrolytes such as sodium and potassium is needed because it decreases are potential adverse drug reactions of diuretics