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All Journal Majalah Kedokteran Bandung Paediatrica Indonesiana
Beny Atmadja Wirjomartani
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Health Professions Medicine & Pharmacology

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Anterior Transpetrosal Untuk Lesi pada Fosa Kranialis Media dan Posterior: Review Literatur dan Diseksi Kadaver Muhammad Zafrullah Arifin; Agung Budi Sutiono; Ahmad Faried; Takeshi Kawase; Beny Atmadja Wirjomartani; Kahdar Wiriadisastra
Majalah Kedokteran Bandung Vol 42, No 2
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2520.464 KB)

Abstract

Reseksi selektif pada bagian anterior piramid os petrosus (segitiga Kawase), dengan terlebih dahulu melakukan kraniotomi pada dinding lateral fosa kranialis media, dapat memberikan lapang pandang bedah yang cukup luas dari parasellar, clivus dan cerebellopontine angle (CPA), tanpa mengorbankan struktur organ pendengaran dalam (internal acoustics organ). Keuntungan utama teknik anterior transpetrosal ini adalah dapat langsung mengakses tumor yang melekat pada klivus melalui rongga kecil yang dibuat pada apeks os petrosus. Pengangkatan tumor dengan perdarahan yang minimal dapat dicapai dengan melakukan koagulasi pada arteri tentorium dan akses langsung ke arah anterior kanalis auditorius internus, juga dapat mengurangi cedera pada nervus fasialis dan vestibulokoklearis. Keuntungan lainnya, yaitu, rendahnya risiko komplikasi perdarahan vena, karena teknik ini tidak mengekspos sinus sigmoid ataupun vena Labbe. [MKB. 2010;42(2):86-91].Kata kunci: Anterior transpetrosal, fosa media dan posterior, diseksi kadaverAnterior Transpetrosal for Lession in Middle and Posterior Fossa: Literature Review and Cadaver DissectionResection of the anterior part of pyramid through the middle fossa craniotomy will give us a surgical field of the parasellar, clivus and cerebellopontine angle without sacrificing the auditory structure. The advantage of the anterior transpetrosal approach is the direct access to tumors that attached to the clivus via a keyhole created on the petrosus apex. Bloodless tumor removal can be achieved by detachment of the tentorial artery and direct access of the anterior internal auditory canal also can minimize the injury of the cranial nerve facialis and vestibulocochlearis. Another advantage is the low risk of venous damages since this approach is not exposing the sigmoid sinus and the vein of Labbe. [MKB. 2010;42(2):86-91].Key words: Anterior transpetrosal, middle and posterior fossa, cadaver dissection DOI: http://dx.doi.org/10.15395/mkb.v42n2.219
Diagnostic clues in spontaneous intracranial hemorrhage in babies Julius July; Eka Julianta Wahjoepramono; Beny Atmadja Wirjomartani
Paediatrica Indonesiana Vol 48 No 4 (2008): July 2008
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi48.4.2008.230-4

Abstract

Background There has been increasing number of babies detectedwith SIH. In regard to find diagnostic clues for the first-rate babieswho really needs CT scan and referral, simple observation to lookat certain clinical and laboratory findings is needed.Objective To identify diagnostic clues associated with spontaneousintracranial hemorrhage (SIH) in babies.Methods Retrospective observation was carried out among ba-bies with SIH within the last two and a half years. Patients wereexcluded if there was an obvious cause of SIH such as trauma orany underlying disease such as hemophilia. Variables that wereobserved were patient's age, seizure, decreased level of conscious-ness, tensed fontanel, neurological deficits, vomitting, fever(T > 3 7 .SOC), anemia, jaundice, PT and aPTT. All data weredescriptively evaluated.Results There were 53 babies with SIH (31 baby boys, 22 babygirls), forty eight of which (91%) were less than 3 months old.Of those, 50 patients (94%) had seizure as the leading clinicalpresentation, 44 patients (83%) had decreased level of conscious-ness, and 39 patients (74%) had tensed fontanel. PT and aPTTwere prolonged in 39 (74%) cases. The most common lesion wassubdural hematoma (38 cases/72%). Forty-three babies (81 o/o)required neurosurgical intervention. Overall mortality rate was22%.Conclusion Babies with seizure, decreased level of consciousness,tensed fontanel, and prolonged PT and aPTT should be consideredto harbor SIH. They need a CT scan and referral, particularlythose less than three months old. The prognosis is unfavorable,thus early recognition and treatment is needed
Co-Authors Agung Budi Sutiono Ahmad Faried Eka J. Wahjoepramono Julius July Kahdar Wiriadisastra Muhammad Zafrullah Arifin Takeshi Kawase