Introduction: Penetrating brain injury is a medical emergency which, although rare, often results in high mortality and morbidity. Management of penetrating brain injury itself is still a challenge for neurosurgeons around the world. Optimal management of the penetrating brain injury requires a comprehensive understanding of the mechanism and pathophysiology of the occurrence of these injuries. Until now the standard management of cases of penetrating brain trauma is still a debate. Methods: This article was case series, we reported 3 cases of penetrating trauma at this institution. This article was compiled from various references and experiences of cases that have been managed at the Dr. Soetomo Academic General Hospital. We got that penetrating brain injury patients who performed debridement craniotomy less than 12 hours post trauma followed by the administration of empirical prophylactic antibiotics with ceftriaxone and metronidazole for 7 days and anti seizure of phenytoin for 7 days. Results: A satisfactory outcome was obtained. Conclusion: Management of penetrating brain injury needs early diagnostic methods such as CT scan of the head anf CT angiography for cases of suspected vascular lesions, followed by early operation procedure dan administration of the right antibiotics.
Pendahuluan. Trauma tembus otak merupakan kegawatan medis yang meskipun jarang terjadi namun sering mengakibatkan mortalitas dan morbiditas yang tinggi. Penanganan trauma tembus otak sendiri masih menjadi tantangan bagi para ahli bedah saraf di seluruh dunia. Menajemen yang optimal pada penaganan trauma tembus otak memerlukan pemahaman yang komprehensif terhadap mekanisme dan patofisiologi terjadinya cedera tersebut. Sampai saat ini penanganan standar pada kasus trauma tembus otak masih menjadi perdebatan. Metode. Artikel ini berbentuk serial kasus, kami melaporkan 3 kasus trauma tembus pada institusi kami. Artikel ini disusun dari berbagai referensi dan pengalaman kasus yang pernah ditangani di Rumah Sakit Umum AkademikDr. Soetomo. Hasil. Pada pasien trauma tembus yang dilakukan kraniotomi debridement kurang dari 12 jam post trauma diikuti pemberikan antibiotik profilaksis empirik dengan ceftriaxone dan metronidazole selama 7 hari dan antikejang phenytoin selama 7 hari didapatkan keluaran yang memuaskan. Kesimpulan Manajemen trauma tembus otak memerlukan metode diagnostic yang cepat dan tepat. Pemeriksaan CT scan kepala menjadi wajib untuk penegakan diagnosis trauma tembus kepala. CT angiografi diperlukan pada kasus kasus yang dicurigai menyebabkan lesi vaskular. Yang kemudian iikuti dengan penangan operasi segera dan pemberian antibiotic yang tepat. Kata Kunci: Trauma tembus otak, kraniotomi debridement, antibiotik profilaksis empiri, CT angiografi
This study aims to determine the relationship between disc height as objective data and the degree of disc degenerative Pfirrmann score assessed on MRI imaging, the imaging modality with the best current degenerative lumbal disease’s diagnosis. The measurements of disc height and Pfirrmann degenerative degree of the intervertebral disc were performed on a T2WI MRI sequence, sagittal sections of the 1-2 lumbar intervertebral discs to 5-sacral 1 (5 disc levels) using dicom MRI data using the Horos dicom viewer software. Analysis of the correlation between disc height and the degree of degeneration on MRI was performed using the Pearson correlation test. Statistical tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). The results were evaluated with a significance value of p<0.005. The results of the Pearson test in the three groups of patients, namely in the HNP L4-L5, HNP L5-S1 and HNP patient groups at both disc levels showed an inverse relationship between disc height and Pfirrmann's degenerative degree which was statistically significant, with values in the L4 HNP group.
The incidence of a metastatic tumor of the calvaria is uncommon, but it has a considerable impact in the field of neurosurgery. The hematogenous metastatic spread was common in leiomyosarcoma. Calvaria is one of the most uncommon metastatic locations for this type of cancer. A 70-year-old man with a history of rhabdomyosarcoma and thyroid cancer came with a parietal mass that rapidly enlarged, followed by sudden hemiparesis and severe cognitive impairment. Head CT scan revealed a destructive soft tissue mass, indicating a metastatic development and mass effect of tumor pushing the brain parenchymal with slight compression of the right lateral ventricle and midline deviation of 8 mm to the left side. Perioperative embolization was done, and the tumor was effectively excised through extensive excision. Histopathology indicated a malignant spindle cell mesenchymal tumor, indicating leiomyosarcoma. After the operation, the patient's neurological status was stable, and there was no sign of tumor recurrence. Recommendation for managing metastatic calvaria tumor based on histopathological findings is insufficient. The information in this case report is essential for scholarly purposes and the participant gave written informed consent for publication. For the treatment of metastases in the skull, complete excision of osteolytic calvaria lesions is indicated.
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