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
Background: Hydrocephalus is a brain disease that requires prompt treatment. The outcome of hydrocephalus is dependent on early detection and treatment. This study was conducted to analyze the medico-socio-economic perspective on the delayed treatment of hydrocephalus patients, which aimed to advance the practice of neurosurgery in the socio-neurosurgery field, including both preventive and therapeutic aspects. Method: This was an observational analysis study. The study subjects were all patients with congenital hydrocephalus treated in dr. Soetomo Academic General Hospital between January 2017 and December 2019. The study was carried out on January 2017 to December 2019 at the Inpatient Surgery ward, dr Soetomo Academic General Hospital, neurosurgery outpatient unit, and home visits. Research data consists of both primary and medical record data. Data on patient characteristics were obtained through direct interviews with the sample using prepared questionnaires, medical record data, and radiological data of both patients examined at dr. Soetomo Academic General Hospital and other health services. Bivariate correlation analysis was performed to assess the effect of each risk factor on the incidence of delay in treatment, and multivariate logistic regression analysis was performed to assess the magnitude of the effect of risk factors. Result: The number of cases was 101 subjects. A total of 101 patients included as research samples were congenital hydrocephalus patients who received the first treatment at dr. Soetomo Academic General Hospital from January 2017 to December 2019. Up to 50 individuals (49.5%) were delayed in treatment. The data analysis with Chi-square did not reveal a statistically significant correlation between delay in treatment and level of parent's education (p=0.0951), delay in treatment and economic status ((p=0.4955). Delays in the treatment of congenital hydrocephalus were statistically significant and correlated with Posyandu's role (p=0.0012), health insurance ownership (p=0.0001), family support (p=0.0130), and professional medical decisions (p=0.0001). Health insurance ownership has the smallest p-value (0.000) and largest wald (16.545) in the multivariate logistic regression analysis calculation using the enter method. The insurance ownership variable has the most significant and largest partial influence on the delay in treating congenital hydrocephalus. Conclusion: There were 101 patients included, and up to 50 individuals (49.5%) were delayed in treatment. Parents' education level and socioeconomic status were not associated with delayed treatment of congenital hydrocephalus. Delays in managing congenital hydrocephalus were influenced by Posyandu's role, health insurance ownership, family support, and professional medical decisions.
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