Neurologico Spinale Medico Chirurgico Journal
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Delayed Treatment of Spinal Cord Injury In Young: A Case Report
No full textBackground: Spinal cord injury (SCI), one of the problems caused by traffic accidents, has a high morbidity in developing country like Indonesia. In Indonesia, the use of motorcycles is increasing every year. The epidemiological data from Fatmawati Hospital of spinal cord injury in 2014 was 104 cases both traumatic and non-traumatic SCI. In this case, a young boy with worsening of SCI, delayed the treatment for about 3 months.Case: A 19 years-old male complained of limbs paralysis for the past two weeks. He felt numbness and tingling in hamstring and calf areas. From past medical history, he had a motorcycle accident 3 months prior. After the accident, he suffered from extreme low back pain, but he could still move his legs. Due to economic restrictions, the patient refused to go to the hospital, and they chose a traditional treatment. For about three months, the pain was decreasing, but he was never pain-free. As the symptoms continued to worsen, the neurosurgeon decided to decompress the spinal cord and performed discectomy. After a week of treatment, the pain disappeared, motor muscle got better, and he could feel again the sensation on the dermatome of S1. Conclusion: Early treatment is recommended to get a better outcome. The surgery is not the only treatment, rehabilitation and orthotics using are important too. Delayed treatment increases morbidity rate
Acute Traumatic Cervical Facet Fractures
No full textAcute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization
SKULL-BASE MENINGOENCEPHALOCELE PRESENTING AS A LABIOGNATOPALATOSCHIZIS AND BILATERAL MACROSTOMIA ON IMPENDING PARTIAL AIRWAY OBSTRUCTION IN A NEONATE
No full textA unique skull-base meningoencephalocele presenting as a labiognatopalatoschizis and bilateral macrostomia in a neonate is reported, with impending partial airway obstruction. Surgical management requires neurosurgical intervention and plastic reconstruction. This case report presented a term neonate was noted to have a soft, fxed, 5-cm mass fulled of his mouth with the impending partial airway obstruction. The patient had several episodes of apnea related to partial airway obstruction by the mass. Computed tomography (CT) scan showed a large complex cystic and solid mass on lamina cribrosa of ethmoidal bone. Focal calcifcation was seen within the mass. The mass extended resulting in the complete cleft of lip and palate, and bilaterally macrostomia. The brain on CT scan was normal with no dysmorphic structures. A transcranial approach by the neurosurgeon was performed to excise the cephalocele and close the dura mater. The bone defect on lamina cribrosa of ethmoidal bone was closed using periosteum tissue. The procedure was followed by total excision of the prolapsed brain tissue and osteotomy on the left palate and then nasal airway reconstruction continued with gradual reconstruction with external compression for close loopholes of the palate. Three months after the initial surgery, a defect of the palate was narrowing and without cranial nerve defcits. Skull-base transethmoidal meningoencephalocele with labiognatopalatoschizis and bilateral macrostomia is a rare congenital abnormality. Neurosurgical procedures through transcranial approach are safe and provide excellent results. Moreover, gradual reconstruction will improve a patient’s quality of life and activity of daily livin
Anterior Approach to Thoracic and Thoraco-Lumbar Spine
No full textAnterior surgery approaches have been used for thoracic and upper lumbar spine. These approaches provided a very good exposure to the anterior part of vertebrae and allows for decompression of the spinal canal that help to improves neurological status in patients with neurological deficitsThe primary indications for the anterior approach in vertebral surgery are the conditions with the destruction of corpus vertebrae and disk diseases caused by several diseases. The aim of surgery is to decompress the neural element, reduction and stabilize the anterior part of the vertebra with and without posterior stabilization. Specifically, it could know the underlying disease and eradication of the disease. Access route is determined by the spinal and the length of the procedure, the location of the more prominent lesion, with special attention for the anatomy of the vessel, visceral, nerve, diaphragm for thoracic-lumbar approach and avoid injuring artery between T4-L4 that critical for spinal cord injury. A multidisciplinary team effort with thoracic and urologic surgeon increases the likelihood of the outcome.
Decision Making in Peripheral Nerve Injury
No full textThe decision making process during diagnosis and treatment of a peripheral nerve injury can be complex at times. The nature and cause of nerve injury, its location, and its severity require very distinct decisions with regards to timing and intervention chosen. For good decision-making, a good knowledge of the pathophysiological conditions of peripheral nerve and its response to injury is paramount.In this article, the decision-making process related to pre-operative, intra-operative, and post-operative periods are discussed.
PEDIATRIC CRANIOFACIAL DISFIGUREMENT WITH AUTOLOGOUS RIBS BONE GRAFT RECONSTRUCTION
No full textPediatric reconstruction of the cranial defect is a challenging task, the standard reconstruction method has been bone grafting. The reconstruction of complex facial defects should satisfy both aesthetic and functional requirements. In the case of large defects, the use of craniofacial prostheses using autogenous bone is the material of choice because of its potential for revascularization and its osteoconductive properties. A 3-year-old patient has facial disfgurement as result from bone defciency following anterior skull base tumour resection. To minimize the associated functional and cosmetic problems, a number of reconstructive options are available to the surgeon including the use of autogenous and alloplastic implants. A computed tomography (CT) 3-dimensional reconstruction scan showed a large craniofacial defect as residual radical skull base tumour resection. A transcranial approach by a neurosurgeon and plastic surgery was performed to reconstruct the defect using autologous rib bone graft. Six months after the reconstruction surgery, a defect of the craniofacial was narrowing without cranial nerve defcits.Complex reconstructions of extensive defects in craniofacial area can be achieved using autologous bone grafts. They yield reasonable functional and aesthetic outcomes and noticeably improves the qualityof life
MINIMALLY INVASIVE SURGERY: A CONCEPTUAL REVIEW
No full textWe are living in an era that performs minimally invasive approaches to many surgical aspects, and spine surgery is not an exception. Nowadays, minimally invasive spine surgery is a routine procedure in many countries around the world. It began in the mid-twentieth century and has now developed into a large field of progressive spinal surgery. This paper will review the philosophy, indications, patient selections, advantages, and disadvantages of minimally invasive spinal surgery
Lateral Mass Screws, Pitfalls, and Practise
No full textLateral mass screws represent a unique challenge to practising spine surgeons because this technique is still the most appropriate technique for fixation at the subaxial spine from C3 to C7.There is a wide range of indications for lateral mass screws fixation including acute and chronic instability resulting from tumours, infections, posterior element fractures, posterior ligamentous injuries, post-laminectomy instability, and following multilevel corpectomy and pseudarthrosis after anterior cervical fusion.Lateral mass screws may be inadequate in cases with poor bone quality secondary to fracture, neoplasm, or revision surgery. Pitfalls and practice of this technique will be discussed
PRE-OPERATIVE DIAGNOSTIC CHALLENGE OF TORSION OF THE GALLBLADDER
No full textGallbladder torsion is a very rare clinical entity and a difficult condition to diagnose preoperatively. Since its first description in 1898 by Wendel there have been over 500 documented cases in the literature. The pathophysiology is that of mechanical organo-axial torsion along the gallbladder’s longitudinal axis involving the cystic duct and cystic artery, and with a pre-requisite of local mesenteric redundancy. Gallbladder torsion typically presents as an acute abdomen requiring emergency surgery but preoperative diagnosis of gallbladder torsion is difficult and most cases are found as a surprise at surgery. Consequently, a delay in diagnosis can have devastating patient outcomes. Herein we report a case of acute gallbladder torsion in an elderly Balinese woman and treated surgically. To our knowledge, this is the first reported case in Bali with a subsequent literature review on the management of this uncommon condition
THE TREND AND PROFILE OF THE THORACIC SPINE SURGERY IN NEUROSURGERY DEPARTMENT FACULTY OF MEDICINE UNIVERSITAS INDONESIA – RSUP NASIONAL DR. CIPTO MANGUNKUSUMO 2012 – 2016
No full textBackground: Spinal surgery, in general, is increasing in number. The most frequent pathology is degenerative disease, and the most common segment is cervical and lumbar. However, there is limited information concerning the thoracic spine surgeries.Objective: The aim of this study is to describe the trend and profle of the thoracic spine (T-spine) surgeries in the Department of Neurosurgery Faculty of Medicine Universitas Indonesia – RSUP Dr.Cipto Mangunkusumo from 2012 to 2016.Method: This is a retrospective study including all patients who were undergoing T-spine surgery during the period of study from January 2012 to December 2016. The number of T-spine procedureswas recorded and plotted in the trend graph. The data consisting age, gender, indication and procedure of T-spine surgery, and duration of hospital stay were recorded from medical records.Result: In the last fve years, there was an increasing trend of T-spine surgery. A total of 68 surgeries for T-spine performed with 35 female and 33 male subjects. Majority of subjects were aged 41 to 50 years old (28%), with an indication of surgery due to tumours (68%). As many as 76% T-spine surgery was carried out non-instrumented. Duration of hospital stay was 9-13 days.Conclusion: Productive age is the most common age undergoing T-spine surgeries. A spinal tumour is the most frequent indication of the T-spine surgerie