Program Studi Ilmu Bedah Fakultas Kedokteran UGM, Yogyakarta
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Epidural Hematoma Case Profiles Compatible for Exploratory Burr Hole in dr. Sardjito General Hospital and Affiliated Hospitals

 

Adiguno Suryo W1, Rahmat Andi Hartanto2

1. Resident of Neurosurgery, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

2. Consultant Neurosurgeon, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

 

Background

 

Epidural hematoma (EDH) is considered an emergency because the correlation between response time and patient prognosis is highly significant. A more immediate response results in better prognosis, as the intracranial pressure is rapidly decreased. Burr Hole Exploration is one of the neurosurgical procedures that may be performed by surgeons in areas with minimum supporting facilities or resources.

 

Method

 

This is a cross-sectional study with a descriptive study design that was carried out in RSUP dr. Sardjito, Yogyakarta and affiliated hospitals within the period of February 1st 2012 — March 30th 2012. The patients included in this study are those specifically suffering epidural hemorrhage only, with no other intracerebral bleeding sites.

 

Results

 

The researchers performing this study obtained 20 EDH cases, 6 (30 %) with presenting GCS of 14-15; 11 (55 %) with presenting GCS of 9-13, and 3 (15 %) with presenting GCS of GCS 6-8. Pupil sizes present consisted of 7 anisochoric cases; 3 among patients with the GCS of 6-8, 3 among those with the GCS of 9-13, and 1 with the GCS of 14-15. Ten (50%) patients suffered from linear head fractures, 1 (5%) suffered a depression head fracture, and 1 (5%) suffered diasthatic fracture.

Distribution of the number of cases corresponding to the region of the hematoma are as follows: 5 frontal, 5 parietal, 1 fronto-parietal, 2 parieto-occipital, 1 temporal, 3 temporoparietal , 1 temporo-frontal and 2 occipital. External lesions were found corresponding to the location of hemorrhage (coup) in 18 patients and not corresponding (countre-coup) in 1 patient. 7 (35%) patients are found to be compatible to undergo Burr Hole Exploratory.

 

Conclusion

 

The diagnosis and management of EDH must be done rapidly and thoroughly. 35% of patients in Yogyakarta presenting with signs of herniation are indicated to undergo Burr Hole Exploratory by surgeons with minimum supporting facilities or resources.

 

Keywords: EDH, Burr Hole Exploratory, Herniation

 

Meningioma In Pregnancy

 

I Gusti Putu Victor Widnyana1, Rahmat Andi Hartanto2

1. Resident of General Surgery, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

2. Consultant Neurosurgeon, GMU Faculty of Medicine/RSUP Dr Sardjito Yogyakarta

 

 Abstract

Introduction

Meningioma is one of the most frequent types of brain tumors in adults. It remains an issue that can’t be resolved by the neurologists, neurosurgeons, and oncologists. Meningioma is 15-20% of brain tumors and 10-15% of all meningiomas considered as malignant tumors. The incidence of meningiomas in women is higher than men. Tumor growth is stimulated by female sex hormones that lead to rapid growth in pregnancy or breast cancer.

Clinical symptoms such as nausea, vomiting, and convulsions sometimes are misdiagnosed as hyperemesis gravidarum in early pregnancy or preeclampsia in late pregnancy age. Abnormal funduscopy examination, vision disturbances, focal seizures, lateralization of neurological deficits are supporting the diagnosis of intracranial masses and then further tests should be performed using a CT scan or MRI for diagnosis.


Case Description

Female, 34 years old, G5P4A0, 30 weeks of pregnancy with impairment of consciousness (GCS E3V5M4). Since seven years prior admission, patients have often felt an intermittent headache. Headache felt worse in the past year. Ten months before admission, the patient perform a CT scan of the head and was diagnosed as meningioma. But the patient refused to do the surgical removal of the tumor at the time and chose to do alternative medicine. Perceived symptoms of patients continued to deteriorate up to 15 days before admission the patient had weakness in both lower extremities. The patient was not able to walk alone and should be assisted by others. Three days before admission the patient fell because it had total weakness on both lower extremity. The patient was then taken to one hospital in Purworejo but the situation continued to deteriorate until the occurrence of impairment of consciousness then eventually refer the patient to the dr. Sardjito hospital, Yogyakarta. Then the patients underwent surgical removal of the tumor as well as termination of pregnancy. Anatomical pathology results showed a transitional meningioma grade I.

 

Key Words : meningioma, pregnancy

 


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