The administration of Indonesian public services has entered the era of Industrial Revolution 4.0, which is a collaborative phase, requiring that every public service implement a service system base on digitization and integrated. The public service that has always been an open discussion is the PATEN Sub-District service. PATEN is a public service system that facilitates community access to get assistance related to population and licensing issues through the Sub-District. Based on PANRB Ministerial Regulation No. 5 of 2018 concerning SPBE Guidelines. SPBE is the framework of the Indonesian Government's Maturity Model, which assesses the level of maturity index in Local Government services. SPBE implementation only stops at the District level and has not touched the Sub-District level, so the SPBE research conducted on public services in the Sub-District. SPBE maturity evaluation has been re-mapped in public services so that not all domains and indicators used. Based on the SPBE mapping results, it produces two domains and four indicators that will use as an assessment of maturity. The data collection method used was a questionnaire. The results showed the evaluation of the maturity of the SPBE in public services in the Sub-District obtained a “Poor” category with a total index value of 1.47. Accordingly, it was necessary to provide recommendations and improvement strategies to increase the value of the SPBE index.
Cerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannoma (acoustic neuromas). The preferred treatment for symptomatic vestibular schwannoma has been surgical excision. Craniotomy for vestibular schwannoma resections in lateral position gave better surgical field exposure, but also posed increased risk of ventilation-perfusion mismatch and atelectasis of the dependent lung in lengthy surgery. A 25 years old woman, with loss of hearing function, disturbed sense of balance, left hemiplegia, difficulties to swallow, on magnetic resonance imaging (MRI) examination had solid lesion in the cerebello-pontine angle size 5,6 cm x 5 cm x 4.5 cm which is diagnosed as Cerebello-pontine angle vestibular schwannoma sinistra. Patient underwent surgical resection in right lateral position under general anesthesia and the surgical resection performed in 6 hour 40 minutes. The goals of anesthetic management in vestibular schwannoma tumor resection are to facilitate ideal surgical condition and provide brain protection by maintaining cerebral perfusion pressure, avoid hemodynamic instability, enable intraoperative neuro-monitoring and ensure the early detection and prompt management of potential complications.
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