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Nasofrontal Mucocele Following after Craniotomy Procedure Hutagalung, Tommy Rizky; Mouza, Abdurrahman
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.v2i3.4623

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.

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.

Giant Medial Sphenoid Wing Meningioma with Hyperostosis Sphenoid Bone : A Case Report Faisal; Hutagalung, Tommy Rizky; 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.v2i3.4730

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.

Prevalence and Demographic of Spontaneous Intracerebral Hemorrhage Cases In Haji Adam Malik Hospital From 2018-2019 Irsyad, Muhammad Ari; Hutagalung, Tommy Rizky; Farhan, luthfi; Tala, Muhammad Ihsan Zulkarnain
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.v2i3.5003

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.

Improving Motoric Outcome after Early Craniectomy in Patient with Open Depressed Fracture Involving Motoric Cortex Area : A Case Report Husain, Syekh Ahmad Arafat; Hutagalung, Tommy Rizky; Lizen, Nindi; Mahyudanil
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 3 No. 1 (2021): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v3i1.5946

Introduction : Traumatic brain injury (TBI) remains a major public health problem worldwide. It is a leading cause of mortality and disability across the globe. Brain swelling and intracranial hypertension are well-recognized secondary insults associated with increased mortality and poorer outcomes. In majority of head injury cases, the incidence of depressed skull fracture is also increasing. When this situation involving in motoric cortex area, it can cause limb weakness and devastating effect. Case Report : We reported a 21 year old male patient came with complaints of decreased consciousness due to a motorcycle accident. On motoric examination, hemiplegia was found in the left limb. There was a open wound in the right fronto-parietal region, Head CT Scan revealed a depressed fracture in the right fronto-parietal region and multiple contusions on the right frontal. Craniectomy procedures was performed. Post operatively there is an improvement in patient consciousness and motoric outcome. Discussion : Open depressed fracture is one of the most common traumatic brain injury (TBI). Prevent infection and saving traumatic penumbra is the main target of surgery in this case. The pathophysiological changes in the traumatic penumbra are dynamic processes, the development and outcome of TBI depends greatly on the progression of tissue damage in the traumatic penumbras. Early clinical treatment can effectively rescue the tissue which has the potential to recover and hinder the progression of secondary injury Conclusion : Traumatic brain injury (TBI) has high morbidity and mortality in worldwide. Time dependent progression has provided a window of opportunity to take interventional action and reduce secondary injury after TBI. Motoric outcome can improve with early management.

Prevalence, Risk Factors and Demographic of Pediatric Hydrocephalus in RSUP H. Adam Malik Medan 2019-2020 Delrizal, Sulaiman; Mouza, Abdurrahman; Hutagalung, Tommy Rizky
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 3 No. 2 (2021): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v3i2.6501

Introduction: Hydrocephalus is a disorder of the central nervous system which manifests as excess cerebrospinal fluid found in the head either inside the ventricular system or the subarachnoid space. The prevalence and demographics of congenital hydrocephalus remain poorly defined, in part because the definition of “congenital hydrocephalus” varies between studies; depending on the clinical criteria used to define congenital hydrocephalus, the prevalence has been reported between 1 and 32 per 10,000 live births. Previously known several risk factors include infection during pregnancy (toxoplasmosis, CMV, meningitis), family history hydrocephalus (less than 2%), premature pregnancy and low birth weight (which may increase the incidence of intraventricular hemorrhage). Method and Result : This Study was a descriptive study, we collected data from 2018-2019 at Haji Adam Malik General Hospital. From the data we found 58 cases of pediatric Hydrocephalus, with hydrocephalus obstructive 24 cases (41%) and communicans hydrocephalus 34 case ( 59%). Based on age, most samples were <6 months of age in both types of hydrocephalus. Most of the gender is male. Most of the GCS conditions at admission were GCS 13-15. The most common etiology in obstructive hydrocephalus cases was aquaduct stenosis in 13 cases (54%), while the most common etiology in cases of hydrocephalus communicans was infection in 22 cases (65%). Infection during pregnancy, low birth weight and premature pregnancy are thought to be the most risk factors found Discussion : Hydrocephalus is described as non communicating when it is caused by lesions that obstruct CSF flow through the ventricular system, such as fourth ventricular tumors. Communicating hydrocephalus is present when the lesion is at the level of the subarachnoid spaces, arachnoid granulations, or the venous system. Previously known several risk factors include infection during pregnancy, family history hydrocephalus, premature pregnancy and low birth weight.

Microsurgical Resection of Cerebral Arteriovenous Malformation: Our Precious Experience Irsyad, Muhammad Ari; Hutagalung, Tommy Rizky; Putra, Prawira Buntara; Tala, Muhammad Ihsan Zulkarnain
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 3 No. 2 (2021): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v3i2.6569

Introduction : Intracranial ateriovenous malformation (AVM) is a non-neoplastic congenital vascular abnormality which appears as a mass lesion composed of tangled blood vessels connecting arteries and veins in the brain. Case Report : Twenty seven years old male was present in our emergency department (ED) with decreased of conciousness and reccurent generalized seizure. The physical examination reveal the patient Glasgow coma scale (GCS) of 12 points (E4M5V3). Head CT scan with contrast shows contrast enhancing lesion on the frontoparietal region with extension to right lateral ventricle which suggest vascular lesion. We performed surgical resection of the AVM using the temporary clip on M2 branch which supply the nidus to reduce the risk of bleeding on operation. Discussion : Patients with grade I or II AVM tolerate resection with acceptable morbidity, whereas those with a grade IV or V AVM may be considered for conservative management because of the high anticipated risk of surgical morbidity Conclusion : AVMs are abnormalities of the intracranial vessels that constitute a connection between the arterial and venous systems and lack an intervening capillary bed. Microsurgical excision of the AVM involves a craniotomy, careful dural opening with circumferential nidus dissection until complete AVM resection is achieved.

Traumatic Brain Injury Cases Through Emergency Department During Covid-19 Pandemic Era 2020 In Adam Malik General Hospital Medan Mahyudanil, Mahyudanil; Sinaga, Patrice LWY; Irsyad, M. Ari; Faisal, Faisal; Hutagalung, Tommy Rizky
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 3 No. 3 (2021): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v3i3.7567

Abstract Introduction: Coronavirus disease 2019 (COVID-19) has been infecting nearly 800.000 individuals of all ages in 31 March 2020. Based on Harvard Medical school experience, almost over 80% of patients have switched to telemedicine services. In Indonesia, there are almost 1,22 million cases with recovery of 1 million case and the death of 33.183 cases. In North Sumatera, the COVID-19 cases occurred in 22.999 cases and the recovery of 19.758 cases with death of 786 cases. Here, we report the trend of traumatic brain injury (TBI) cases in pandemic era 2020 in our institution in Adam Malik General Hospital, Medan, North Sumatera. Method: This retrospective observational study reported 343 TBI cases from January 2020 to December 2020. January 2020 to March 2020 regarded as pre pandemic and April 2020 to December 2020 as the pandemic era. Results: There is significant decrease of traumatic brain injury patients from March 2020 to April 2020. It was 61% decrease in patients admission to our Emergency Department (ED). Demographically, male patients in productive age group and mild TBI has the most common presentation to our ED. Discussion: There is significant decrease of patients with TBI in our institution. The number of cases was declining from 55 patients on January to 21 patients on April. This also occurred concurrently with the start of social distancing in Indonesia on April 2020 and the civilian suggested to stay at home during this period. This decline was also found in other countries, like Massachusetts, USA and India. Conclusion: We reported significant decrease in traumatic brain injury cases in Adam Malik General Hospital during COVID-19 pandemic era in 2020. Neurosurgeons and Residents of Neurosurgery have to be cautious in assessing the TBI patients to limit the spread of COVID-19 in ED.

Trend of Improvement in Visual Field Deficits after Transsphenoidal Endoscopic Surgery in Pituitary Tumour Patients: A Case Series Husain, Syekh Ahmad Arafat; Hutagalung, Tommy Rizky; Nasution, Muhammad Deni
Asian Australasian Neuro and Health Science Journal (AANHS-J) Vol. 3 No. 3 (2021): AANHS Journal
Publisher : Talenta Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/aanhsj.v3i3.7608

Abstract Introduction: Pituitary tumours account for approximately 15% of all brain tumours, and the growing tumours press against the optic chiasm, resulting in impairment of visual function manifested as visual field defects, decreased visual acuity, and decreased color vision . Compression of the optic chiasm by pituitary tumours generally results in selective loss of the temporal VFs, or bitemporal hemianopia, implying that the nasal retinal fibers are preferentially damaged. The reason for this preferential damage is not fully understood. Transsphenoidal surgery has been reported to safely reduce the pressure on the anterior visual pathway in most patients. Improvement in visual function may occur after transsphenoidal decompression of the chiasm. Because improvement in visual function may occur from a variety of proposed biologic processes. Case Series : The number of patients according to gender was 71% male (10 people) while 29% female (4 people). The age distribution was found mostly at the age of 40-50 years 36% (5 people). The most common clinical symptoms were field disturbances 85% (12 people). Patients complained of visual field disturbances for 1-2 years as many as 58% (7 people). Vision before surgery is /6 as much as 45% (4 people). Improvements in vision were found for 1 month postoperatively as much as 22% (2 people). Discussion : Compression of the optic chiasm by pituitary tumours generally results in selective loss of the temporal VFs, or bitemporal hemianopia, implying that the nasal retinal fibers are preferentially damaged. The minimally invasive transsphenoidal approach can be used effectively for 95% of pituitary tumours. Exceptions are those large tumours with significant temporal or anterior cranial fossa extension. In such circumstances, transcranial approaches are often more appropriate. Occasionally, combined transsphenoidal and transcranial approaches are used. Nevertheless, some surgeons extend the basic transsphenoidal exposure in order to remove some of these tumours and avoid a craniotomy . Potential mechanisms of axonal injury from a compressive lesion include direct disruption of conduction along the axon, impaired axoplasmic flow, demyelination with impaired signal conduction, and ischemia from compression or stretching of the blood supply of the chiasm by the tumour. An early fast phase of improvement is consistent with restoration of signal conduction along retinal ganglion cell axons after removal of a compressive lesion.In some individuals, we observed the rapid restoration of normal vision, which would be consistent with this hypothesis. In these individuals, a physiologic conduction block is presumably the main mechanism of injury. Conclusion: The pattern of improvement of visual function after decompression of the anterior visual pathways suggests three phases of improvement. Improvement in visual function may occur after transsphenoidal decompression of the chiasm. Because improvement in visual function may occur from a variety of proposed biologic processes, we sought to better define this potential for improvement.

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