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Burst fracture Th 9-10 treat with Transthoracal Corpectomy and stabilization: A Cases Report Manurung, Halim Rahman; Ibrahim, Sabri; Dharmajaya, Ridha
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 1 No. 2 (2019): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhs-j.v1i2.1032

Abstract. Spinal fracture and dislocation are among the most feared injuries by patients and physicians alike, as the consequences can be devastating, ranging from mild pain and discomfort to severe paralysis and even death. Spinal trauma is commonly found in patients admitted to level-one trauma centers after serious accidents like traffic, falling, and sports accidents.Injuries of the cervical spine account for one third of spinal fractures and half to two thirds of all spinal cord injuries.In the thoracolumbar spine, the most common unstable fracture is the burst fracture. Altogether, burst fractures have been reported to account for about 15% of spinal injuries.Incidence of burst fractures peaked at the thoracolumbar junction and between levels T5 and T8. In 10% of cases,more than one burst fracture was seen, thereof 53% on noncontiguous levels. Main accident mechanisms were falls, traffic, and sports. Neurological deficit was highest in patients with burst fractures of the cervical spine, independent of accident mechanism, and lowest in thoracolumbar junction fractures. Burst fractures occur frequently in high energy traumas and are most commonly associated with falling and traffic accidents.Multiple burst fractures occur in 10% of cases, half thereof on noncontiguous levels.Access to the anterior thoracic spine via the transthoracic approach (via thoracotomy) can be used for decompression and fusion. To perform adequate decompression and stabilization of the thoracic spine, obtaining good exposure is a must. Preservation and protection of the vascular structures in the thoracic cavity is the key to such an exposure. Preoperative workup should include imaging modalities (plain rontgens, MRI/CT scan) to specifically define the area of decompression. If a tumor is being evaluated, CT angiography and embolization are helpful in preoperative planning. Assistance by a thoracic surgeon for exposure is highly recommended.

Epidemiology of Pediatric Brain Tumor in the Center of Referral Hospital in North Sumatera from 2013 -2017 Putra, Prawira; Tala, Ihsan Z; Dharmajaya, Ridha; Mouza, Abdurrahman; Tandean, Steven
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 1 No. 1 (2019): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhs-j.v1i1.1033

Brain tumors are the most common disease group of solid tumors in childhood, and children with brain tumors have a relatively poor survival rate. Epidemiologic data from a hospital-based registry provide the necessary information to obtain a full picture of the frequency of this disease, which is a great challenge in pediatric oncology. One hundred thirty four tumors in children between 0 and 17 years of age diagnosed between 2013 to 2017 were classified according the sex, and topography. Incidence of brain tumor in boys were higher than girls. From the registry data, the prevalence for boys was higher (67%). In the whole series, 54% were supratentorial, 46% infratentorial. The most common histopathologic pattern seen in the registry were pilocytic astrocytoma which accounts for 42 cases (31%) followed by medulloblastoma and craniopharygioma with the percentage of 25% and 18% respectively. The least histopathologic pattern of pediatric tumor seen in our center are diffuse astrocytoma and choroid plexus papiloma which was only seen in 1 patient for the last 5 years of our experience.

Abdominal Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunting Faisal; Dharmajaya, Ridha; Tala, Muhammad Ihsan Zulkarnain; Mousa, Abdurrahman; Tandean, Steven
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 1 No. 2 (2019): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhs-j.v1i2.1061

Abstract: Ventriculoperitoneal (VP) shunt placement is one of the most commonly performed procedures in neurosurgery. One rare complication is the formation of an abdominal pseudocyst, which can cause shunt malfunction.

Medulloblastoma: Intraventricular Recurrences Setiawan, Hendy; Wijaya, Celia; Dharmajaya, Ridha
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 1 No. 1 (2019): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhs-j.v1i1.1126

Abstract :Medulloblastoma is the most common malignant pediatric brain tumor. Incidence in adult population is less than 1 %. Medulloblastoma in adult usually between 20 and 40 years old, which is lateral hemispheric and not midline vermian. Survival rate in adult is 67% lower than adolescents is 69% and children is 72%. Location of recurrences most commonly presents at posterior fossa, spinal, supratentorial, and bone metastases. Recurrences of medulloblastoma in supratentorial ventricular is uncommon. The outcome for patients with recurrent medulloblastoma has historically been poor. 37 years old male who presented with severe headache gradually. Patient has history of headache 2 months ago and gait ataxia 1,5 months ago. Patient had surgery 2 years ago with result of hystopathology medulloblastoma. He had irradiation completely 22 months ago. Physical examination showed GCS 15 with gait ataxia. Head CT scan show multiple isodense lesion intraventricular. Before patient had surgery, Head CT scan showed hiperdense lesion at cerebellopontine angle. Seeding medulloblastoma to intraventricular is recurrences which have poor prognosis. Patient had poor condition in few days. Patient died before got reriradiation

Tuberculosis of Sacrum: A Rare Location of Spinal Tuberculosis Sinaga, Patrice LWY; Ibrahim, Sabri; Dharmajaya, Ridha
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 1 No. 1 (2019): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhs-j.v1i1.1127

Abstract :Tuberculosis is one of the most common infectious diseases in the world. The thoracolumbar spine is the commonest form of vertebral tuberculosis, whereas isolated tuberculosis of the sacrum is rarely reported in the literature. A male patient of 22-year old had complained low back pain since 2 years before admission to hospital without history of trauma on back. He also got low-grade fever and weight loss. There was no tuberculosis contagion found, no cough or night sweat. Clinical examination revealed neurological deficit with strength of both lower extremities were 4 and hipestesia in the level of lumbal 5 and downward. Radiographs of lumbosacral showed deformity of lumbal 5. CT scans of spine showed deformity of sacrum. MRI revealed spondylolisthesis L5-S1, S1-S2, S2-S3 and mass in the anterior posterior and lateral of paralumbal 5 and parasacral. There is no involvement of gluteus muscle and the around muscle. The patient underwent surgical of sequestrectomy with drainage abscess and lumbo-sacral-illiac fusion. The culture of sacral tissue showed Mycobacterium tuberculosis. The patient was treated with combination of four antituberculosis agents.

Penetrating Brain Injury in Children Ula, Mutammamin; Dharmajaya, Ridha
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 1 No. 2 (2019): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhs-j.v1i2.3242

Background: Accidental penetrating brain injury through supraorbital route is an unusual occurrence in emergency practice of civilian cases. At time, it could be potentially life threatening. We report an interesting case of supraorbital penetrating brain injury with an iron stick in a 12-year-old female patient. The stick was removed successfully through supraorbital exploration, without any neurovascular complications. Case Report: A 12-year-old female presented to our emergency department with injury to his right eye. History revealed that she was practicing marching band in her school as the leader. As she thrown the iron stick, she lost balance and that iron stick entered into her right supraorbital. Her Glasgow Coma Scale (GCS) score, on admission, was 15. There was circumferential laceration on the right supraorbital, flat margins, visible iron stick penetration with diameter 3 cm but no active bleeding was found. Rest of the physical and neurological examination findings were within normal limits. He was resuscitated promptly according to the advanced trauma life support system. Discussion: Intravenous fluids are given and efforts are taken to maintain high blood oxygen levels.Management of patients with transorbital brain injuries and foreign bodies in situ should follow basic surgical principles, including removal of the object under direct vision in order to reduce further brain tissue damage by the foreign bodies catching on bone fragments. Following removal of the foreign body, thorough debridement with removal of all involved skull bone and foreign materials, hematoma evacuation followed by careful hemostasis along the trajectory, and meticulous dural closure to reduce the possibility of CSF fistula are mandatory. A transorbital or transcranial approach can be chosen depending on the location of the fragment. Conclusion: In conclusion, supraorbital penetrating brain injury caused by an iron stick is a rare but fatal event. High index of suspicion toward the presence of foreign bodies and emergent surgical intervention is to be considered in spite of consistent lack of evidence on CT scan. Retrieval should be performed on the operating table under direct vision only after preoperative imaging of neurovascular structures. Keyword: Penetrating brain injury, Iron Stick

Penetrating Wooden Injury : Wooden Stick Siregar, Rais; Dharmajaya, Ridha; Mahyudanil
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 1 No. 2 (2019): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhs-j.v1i2.3244

Background : Accidental penetrating brain injury is relatively uncommon representing about 0.4% of all head injuries. Penetrating brain injury (PBI) were divided into Missile and Non missile penetrating head injuries (NPHIs). Non missile penetrating head injuries (NPHIs) are relatively rare compared with missile injuries. Wooden Penetrating Brain Injury is one of Non missile penetrating head injuries (NPHIs) Case Report : 20-year-old male presented with Decreased of Conciousness. History revealed that he was riding motorcycle and had an crash injury with other motorcycle rider from a head. He fell down and a broken wooden stick entered into his skull. Airway was clear, Breathing was spontan and respiratory rate 26 per minutes, Circulatory finding were warm skin, pulse rate of 118 per minute and blood pressure of 140/80 mm Hg, Glasgow Coma Scale (GCS) score on admission was E3M5V4. Radiology Imaging finding a foreign body in Left Frontal Lobe. Discussion : Wooden Penetrating Brain Injury was Nonmissile penetrating head injuries (NPHIs). The pathophysiology is similar to closed head injuries causing cerebral contusion or intracranial hemorrhage, but there is more chance of infection. Primary survey and stabilization of the patient with regard to the airway, breathing, cervical spine, and circulation including external hemorrhage. Computed tomography (CT) scanning of the head is primary modality . MRI can be a useful neuroradiologic modality if a penetrating object is a wood. Patient was performed Craniectomy Debridement and was treated with triple antibiotic regiment. Conclusion : The management of PBI differs considerably from nonpenetrating brain injury because of the unique mechanism of injury and pathophysiology involved in this type of trauma In this patient surgical treatment was undergoing after 12 h. Patient was treated with triple antibiotic regiment and was discharged on 7th day post operation. The recovery of the patient went uneventfull. Patient gained back his conciousness without any neurological deficit. Key words : Penetrating Brain Injury, Nonmissile, Wooden stick

Long Term Post Traumatic High Flow Carotid Cavernous Fistula with Patent Collateral Vessel : A Case Report Farhan, Luthfy; Dharmajaya, Ridha
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 2 No. 2 (2020): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v2i2.4338

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

Giant Olfactory Groove Meningioma in Pregnancy Hutagalung, Tommy Rizky; Faisal; Dharmajaya, Ridha
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 2 No. 2 (2020): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v2i2.4359

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.

Planum Sphenoidale Meningioma: A Rare Location of Skull Base Meningioma Sinaga, Patrice LWY; Faisal; Dharmajaya, Ridha
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 2 No. 3 (2020): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v2i3.4558

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.

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