Prevalence and Demographic of Spontaneous Intracerebral Hemorrhage Cases In Haji Adam Malik Hospital From 2018-2019

Introduction: Spontaneous intracerebral hemorrhage (ICH) represents as cerebral parenchymal bleeding that may also extend into ventricular (IVH). ICH, as a stroke subtype, is associated with poor neurological outcome as well as high mortality in 40% cases. Hypertension is the main and the most common risk factor in the development of ICH, particularly in the basal ganglia, thalamus, pons and deep cerebellar white matter. Hypertensive ICH in these localizations are particularly common in patients with chronic hypertension and they are not in compliance with blood pressure management. Other risk factor such as smoking and diabetes meilitus. Case Report: This retrospective study reviewed patient who were diagnosed with spontaneous intracerebral hemorrhage from January 2018 until December 2019 at the Haji Adam Malik General Hospital Medan,Indonesia. The patient’s demographic data and number of cases are collected. There were 163 cases of pure spontaneous ICH and 159 cases of Spontaneous ICH with IVH were among the total cases of ICH from 2018 to 2019. Discussion: Based on data at the Haji Adam Malik General Hospital Medan from 2018 to 2019,there are differences in the number of men and women proportion in the incident of pure ICH , for men who are 110 people around 67% while in women it is 53 people or about 32%. The incidence also higher in diabetes meilitus and smoking patient. Conclusion: We reported 163 cases of pure ICH and 159 cases of ICH with IVH. Based on demographic examination, male are dominant about 67% of total cases. Based on the biggest risk factors in patients with spontaneous ICH are hypertension, in the case of spontaneous ICH with IVH the biggest risk factor was smoking.

Nasofrontal Mucocele Following after Craniotomy Procedure

Introduction : Mucocele is a chronic, expanding, mucosa-lined lesion of the paranasal sinus characterized by mucous retention that can be infected becoming a mucopyocele. They originate from obstruction of the sinus ostium by congenital anomalies, infection, inflammation, allergy, trauma (including surgery) or a benign or malignant tumor. The frontal sinuses are most commonly affected, and subsequently ethmoidal sinuses. Case Report : A 56 years old man, presented with a lump on the left and right forehead accompanied by a protruding left eye since 6 months and is getting wors. Patient with a history of craniectomy debridement surgery indicated for open depressed fracture due to an accident 12 years ago, then underwent a titanium mesh cranioplasty 11 years ago. From examination of the head CT scan revealed a solid mass lesion filling the left and right frontal sinuses expands into the left orbital cavity. Bifrontal craniotomy was performed on the patient. Discussion : Mucoceles are mucous-secreting expansive pseudocystic formations, and capable of expansion by virtue of a dynamic process of bone resorption and new bone formation. They result from obstruction of a sinus ostium and frequently are related to a previous condition as chronic sinusitis, trauma, surgery or expansible lesion. With continued secretion and accumulation mucus, the increasing pressure causes atrophy or erosion of the bone of the sinus, allowing the mucocele to expand in the path of less resistance. This may be into the orbit, adjacent sinuses, nasal cavity, intracranial or through the skin; intracranial and orbital extension were demonstrated in this patient. Conclusion : Frontal mucoceles are benign and curable, but early diagnosis and treatment of them is important. Open surgery remains a valid procedure in frontal mucoceles with orbital and/or intracranial extension and in cases where the district anatomy is unfavourable for a purely endonasal approach.

Comparative between Syndromic and Nonsyndromic Craniosynostosis: A Literature Review

Craniosynostosis (CS) refers to the premature fusion in the perinatal stage of one or multiple skull sutures, also denominated synostoses (sagittal, metopic, uni and bilateral coronal, and lamboidal), which are commonly accompanied by facial, trunk, and limb deformities. During normal human body and head development, cranial growth achieves approximately 80% of the adult size at birth and its definitive size between 2.5 and 3 years of age. In the fetal or newborn skull, the flat bones are separated by four fontanelles and six major cranial sutures that participate in this process. Hereby presented the literature review of syndromic and non-syndromic craniosynostosis.

Planum Sphenoidale Meningioma: A Rare Location of Skull Base Meningioma

Background: Meningioma is common primary central nervous system tumors. Twenty-five percent of all meningioma consist of skull base meningioma. Planum sphenoidale meningiomas are rare. Planum sphenoidale meningiomas can extend into adjacent areas. Approximately two thirds of patients complain of failing vision in one eye as the first symptom. Case Report: A 32-year-old woman presented with 6-month history of progressively worsening blurred of both of vision. She also complained her smell ability was reduced for 3 months. She had headache for 6 months. The pain was worsening in the morning. She is conscious. A neurologic examination revealed bilateral hyposmia and visual deficits but no weakness. Visus of oculo dextra was 1/300 and visus of oculo sinistra was no light perception. Magnetic resonance imaging (MRI) intravena contrast of brain revealed a large extra-axial mass measured ±6,2x5,9x6 cm centred on planum sphenoidale displacing both frontal lobes. She had an operation of tumor removal with cranio-orbito-zygotomy approach. The tumor, which measured ±7cmx7cmx6 cm, was succesfully removed completely. She gets improvement of smell ability and both visual postoperatively. The histopathology of the tumor revealed meningioma WHO grade I. Discussion: Planum sphenoidale meningiomas present a frequently encountered pathology of the anterior skull base. These meningiomas give rise to an early visual disturbance with relatively slow progression. Displacement of the olfactory tracts and optic chiasm occur when the meningioma extends into the paranasal sinuses and nasal cavity. Clinical presentation and diagnosis often occur in the late stage. Anosmia is one of common finding on physical examination. Postoperative improvement of visual symptoms depends on the preoperative duration of those symptoms.

Giant Medial Sphenoid Wing Meningioma with Hyperostosis Sphenoid Bone : A Case Report

Introduction: Meningiomas of the sphenoid wing make up approximately 15–20% of total cranial meningiomas.Giant medial sphenoid involve the dura of the greater and lesser wings of the sphenoid, the anterior clinoid process,the spheno-orbital bone and the middle cranial fossa, hyperostosis bone was common to found. Surgicalmanagement of giant medial sphenoid is extremely challenging due to their intimate relationship with vital neuralstructures.Case Report : A 40-year-old woman came to the emergency room with complaints of decreased consciousness thathad been experienced since 1 week , recurrent headaches, weakness of the right limb and history of blurred vision. Anon-contrast head ct scan and MRI brain contrast revealed an extra-axial giant mass meningioma in left medialsphenoid wing with hyperostosis bone Craniectomy tumor removal was performed with a subtemporal approachcombined with cranio-orbytozygotomy.Discussion : Hyperostosis is a common phenomenon occuring in different meningiomas with incidence rangingfrom 25 to 49% of meningiomas.it is most commonly seen in sphenoid wing and convexity meningioma . The bonyhyperostosis is of neoplastic nature and is responsible for many of the clinical manifestation of such tumors andhence should be totally drilled to achieve cure and avoid recurrence.Conclusion : Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are characterized by theassociated bony hyperostosis that gives them a distinct radiological appearance. Extensive tumor removal is crucialfor correction of proptosis and adequate visual decompression to achieve satisfactory cosmetic and functionaloutcome.

The Role of Minimally Invasive Spine Surgery

Introduction :In the past half of century, the spinal surgery techniques has advanced significantly. Along with the improvement and various of techniques and technologies in general, there has been a big movement to reduce the morbidity of surgery. Case review : As opposed to open spine surgery, minimally invasive surgical approaches can be faster, safer and require less recovery time. The minimally invasive spine surgery also need to make an efficient target of surgery. The roots in minimally invasive spine surgery (MISS) are based primarily on technique modifications. Discussion: The Williams microdiscectomy, described in 1978, revolutionized MISS by starting the evolution of lumbar discectomy from an open surgery through a 6-inch incision to a microsurgical approach through as small an opening as possible. Conclusion :We don’t use the MISS technique when the extension of tumor is more than 2 levels; extension of the tumor is 20% longer than diameter of largest retractor; the tumor > 3cm for interlaminary approach, the wide durotomy is needed; and also the case with intramedullary tumor with 80% extention, from left to the right side; en bloc as the the goal of surgery for extradural tumor

Giant Olfactory Groove Meningioma in Pregnancy

Introduction: Meningioma is slow growing neoplasm cells that comes from arachnoid cap most common benign intracranial tumours. Olfactory groove meningiomas (OGM) account for 8–13% of all intracranial meningiomas. Intracranial tumors on pregnancy is a rare event, with few reports. Case Presentation: A 36-year-old- female (G11P9A1) 34 gestational week presented to the Adam Malik General Hospital with smelling disturbances for 6 months and lossing smelling sense in the past 1 month. Slowly progression of vision disturbances for 3 months without improvement in using glasses, progressive loss of vision in both eyes for the past 1 month. CT scan and MRI revealead a solid mass lesion, with 6.3 x 4.2 x 3.1 cm. It was a supratentorial in frontal region, olfactory groove mass. The Craniotomy tumor removal was performed in this patient. Discussion: Meningiomas are mostly silent brain tumors with slow growth, however may get detected and mostly become symptomatic during pregnancy and luteal phase of menstrual cycle due to increase in size secondary to either water retention, enhanced vascularity or progesterones are possible etiologies. The majority of meningiomas express progesterone reseptor, which can be detected also by immunohistochemistry. In fact, tumour growth when progesterone concentrations are higher, shows the role of sex hormones in the mechanism. Regardless of the status of pregnancy, symptomatic and large meningiomas require surgical resection. Conclusion: Changes of plasma concentration hormones during pregnancy and their effect on meningioma growth in the second and third trimester are crucial and critical. The management of brain lesions during pregnancy required professional collaboration between neurosurgeons, obstetricians and anesthesiologists.

Long Term Post Traumatic High Flow Carotid Cavernous Fistula with Patent Collateral Vessel : A Case Report

Introduction : A carotid-cavernous sinus fistula (CCF) is an abnormal communication between arteries and veins within the cavernous sinus. Carotid cavernous fistula (CCF) is a very rare case it's difficult to diagnose. because most CCF patients rarely come for treatment. Case Report : A 33-year-old male presented with history of protrusion of Left eye ball, and double vision for the last 2 years. visual disturbances were found in the right eye for 2 years, blurry vision is increasingly. Bruit was audible in orbital region on the left side. DSA showed that there was a fistula in the left sinus cavernous region, the arteries in the left area showed inadequate to direct the left hemisphere, but in the right arety showed that the right artery was adversely affected right and left brain. Discussion : Traumatic CCFs are the most common type, accounting for up to 75% of all CCFs.87 They have been reported to occur in 0.2% of patients with craniocerebral trauma and in up to 4% of patients who sustain a basilar skull fractur.2 The symptoms and signs of CCF always include eyelid swelling, proptosis, chemosis, and hyperaemia, dilated of vessel and the condition is commonly misdiagnosed as Graves’ophthal-mopathy or inflammatory conjunctivitis.3Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of endovascular intervention in CCFs. Angiographic results in this patient showed a fistula in the left cavernous sinus and inadequate supply of the left artery to the left hemisphere. Conclusion : This case is very unique because the left brain gets blood supply from the right carotid system, with the left carotid artery system inadequate to direct the left hemisphere because of the carotid cavernous fistula on the left side

Anatomy Variation of Ruptured Anterior Communicating Artery (AcoA) Aneurysm : Serial Cases

Introduction : Intracranial aneurysms (IA) is an acquired disease characterized by dilatation of intracranial arteries, and is usually found at the location of arterial branches in the cranii base region. The selection of management and anatomic variations is quite interesting to be discussed in the case of aneurysms. Cases Report : Four cases of AcoA aneurysm were reported with variations in clinical manifestations, A1 segment anatomy, fundal projections and management considerations (Coiling vs. Clipping). This case series illustrates the compatibility with previous case studies that have existed. Discussion : The author concludes that the actions taken in cases I, II and III are in the form of coiling due to age, dome and neck ratio and access to perform such difficult surgical procedures. In case IV , it was considered to be performed surgical clipping action due to the presence of intracerebal hemoraghic, and the approach can be done from a non dominant hemisphere, proximal control only through the right carotid and the location of the posterior dome which was favorable for surgical clipping Conclusion : Aneurysms from the ACA-anterior communicating artery (ACoA) complex are some of the most complex lesions in the field of vascular neurosurgery. This location is where most rupture aneurysms occured with high mortalities due to complications of vasospasm and SAH. The choice of management in aneurysm cases which involved many factors such as age and anatomic variations.

A Case Report : Massive Subdural Empyema Following Ventriculo-Peritoneal Shunt Placement in Child Patient

Background: Subdural empyema is a critical neurosurgical condition that arise from neurosurgical procedures, trauma, meningitis, sinusitis, or otogenic infection. Reported mortality rates vary from 4.4% to 24%. Ventriculoperitoneal (VP) shunt placement is one of the most common procedures and reported rates for shunt infections are relatively high. However, their association with subdural empyema is rare. Case Report: One years old boy who presented with fever, lethargy, and inability to walk was admitted to the hospital. He was undergone Vp-shunt 1 month ago because of hydrocephalus. At the time of admission, the child was alert, had a moderate right hemiparesis, and a macrocephalic appearance. An emergency CT scan showed well-circumscribed subdural empyema. Discussion: A craniotomy was performed, then thick fibrous capsule underlying the dura mater was encountered, finally the pus was totally removed. Postoperatively, he was fully alert with a marked motoric improvement. Diplococus gram positive was found. The patient was given appropriate antibiotic treatment for 3 weeks periode. Conclusion: Subdural empyema is an unusual complication of a VP-shunt. Although rare in children, it is still a neurosurgical problem. The combination of medication and surgery treatment in Subdural empyema resulted in a good response.