In the field of neurosurgery, often the dura mater cannot be sutured, and consequently, it requires a duraplasty procedure using a dural fascial graft. Since 1890, various materials have been researched as dura mater substitutes. Amniotic membrane, for example, is suitable as a dural graft material and has been used in neurosurgery since 2012. However, there has been little research on human patient's dural healing after the use of amniotic membrane in their duraplasty procedure. To address this gap, a clinical experimental study was undertaken to evaluate the human dural healing of 16 patients who had undergone duraplasty in decompressive craniectomy surgery at Dr. Soetomo General Hospital, Surabaya. The amniotic membrane allograft, was sutured to cover the dural defect for eight randomly chosen patients (Group I). The fascial autograft from the temporal muscle had been applied for eight other patients (Group II). Between 10 and 20 weeks after surgery, the patients underwent cranioplasty and dural healing evaluation by cerebrospinal fluid (CSF) leakage testing through the edge of the dural defect. The fibrocyte infiltration around the edge of the dural defect was examined histologically. Statistical analysis, using an independent t-test, was performed with a confidence interval of 95%. The results of the clinical and histological analysis suggest that an amniotic membrane graft was able to provide watertight dural closure and adequate fibrocyte infiltration comparable with that provided by temporalis muscle fascia. This study shows that using an amniotic membrane in neurosurgery has a potential advantage over an alternative dural healing.

OBJECTIVEGlobal outbreak of the novel coronavirus disease 2019 (COVID-19) has forced healthcare systems worldwide to reshape their facilities and protocols. Although not considered the frontline specialty in managing COVID-19 patients, neurosurgical service and training were also significantly affected. This article focuses on the impact of the COVID-19 outbreak at a low- and/or middle-income country (LMIC) academic tertiary referral hospital, the university and hospital policies and actions for the neurosurgical service and training program during the outbreak, and the contingency plan for future reference on preparedness for service and education.METHODSThe authors collected data from several official databases, including the Indonesian Ministry of Health database, East Java provincial government database, hospital database, and neurosurgery operative case log. Policies and regulations information was obtained from stakeholders, including the Indonesian Society of Neurological Surgeons, the hospital board of directors, and the dean’s office.RESULTSThe curve of confirmed COVID-19 cases in Indonesia had not flattened by the 2nd week of June 2020. Surabaya, the second-largest city in Indonesia, became the epicenter of the COVID-19 outbreak in Indonesia. The neurosurgical service experienced a significant drop in cases (50% of cases from normal days) along all lines (outpatient clinic, emergency room, and surgical ward). Despite a strict preadmission screening, postoperative COVID-19 infection cases were detected during the treatment course of neurosurgical patients, and those with a positive COVID-19 infection had a high mortality rate. The reduction in the overall number of cases treated in the neurosurgical service had an impact on the educational and training program. The digital environment found popularity in the educational term; however, digital resources could not replace direct exposure to real patients. The education stakeholders adjusted the undergraduate students’ clinical postings and residents’ working schemes for safety reasons.CONCLUSIONSThe neurosurgery service at an academic tertiary referral hospital in an LMIC experienced a significant reduction in cases. The university and program directors had to adapt to an off-campus and off-hospital policy for neurosurgical residents and undergraduate students. The hospital instituted a reorganization of residents for service. The digital environment found popularity during the outbreak to support the educational process.

Stroke is one of the most important causes of morbidity and mortality worldwide, with survivors subjected to long-term disability. Stroke is classified as ischemic and hemorrhagic. 87 % of strokes are classified as ischemic. Except for thrombolytic therapy, there is no established treatment to reduce the neurological deficits caused by an ischemic stroke. Therefore, it is necessary to develop new therapeutic strategies designed to improve neurological functions after ischemic stroke. Stem cell-based therapies aim to promote neurogenesis and replacement of lost neurons or protect surviving neurons to improve neurological recovery. Further understanding of the mechanisms by which the stem cells exert their beneficial effect could potentially revolutionize the field. The next decade of stem cell research in stroke needs to focus on. Although still in need of exploration, stem cell treatments for stroke may offer ways to protect and replace neurons to improve outcomes for stroke patients.

Bladder migration and transurethral extrusion is an extremely rare complication of ventriculoperitoneal (VP) shunt. Only eight cases have been reported in the English literature since 1995. We report a case of a 4-year-old boy with cerebral palsy, hydrocephalus, and VP shunted on both sides who presented with a protruded distal VP shunt from his urethral orifice. The patient was reported for having previous shunt extrusion through the anus. The patient was treated on by a multidisciplinary approach, involving a neurosurgeon and urologist. Shunt removal with simple procedure was smoothly achieved without morbidities. He was discharged home in satisfactory condition.

Deep Vein Trombosis (DVT) is one of the extracranial complications after TBI. Prophylaxis DVT using on TBI reduce incidence and mortality. Climate variants of an area affect the risk of DVT. UV ray increasing synthesis of vitamin D and lowering risk of thrombus fomation. A systematic review and meta-analysis we performed according PRISMA guidelines. A through literature search was conducted on PubMed, Scopus, and Cochrane database. Total 3 publications match study criteria with 178 samples, without 144 samples and 34 samples with prophylaxis. The overall incidence is 5% (0-6.8%), without 6.25% (5.3-6.8%) and with prophylaxis 0%. No reported complications and 100% survival rate. The incidence of DVT in TBI in tropical climate is low on average 5% (0-6.8%). There was no difference in the outcome of DVT in TBI in tropical climate which given and without DVT prophylaxis. Asian races ethnic protective factor and UV ray exposure may contributed to the low of incidence rate.  Prevention of DVT is still recommended for the use of prophylaxis, mechanical compression and early mobilization in cases of TBI to prevent the occurrence of DVT.

The use of implants in pediatric cranioplasty is still debatable. Many surgeons prefer to use autologous bone grafts than implants due to previous concerns that implants have a higher risk of infection, allergic response, and are not biocompatible as an autologous bone graft. However, recent studies showed that several implant materials have a similar infection rate following cranioplasty or might be lower compared to autologous bone. Moreover, several studies also reported a high rate of bone flap resorption in autograft cranioplasty, particularly in patients below the age of 8 years, thus requiring revision surgery with an implant as a substitute in most cases. Implant materials also have advantages in several conditions that make them more suitable than autologous bone grafts. This literature review is expected to give information about the type of implant materials that can be used as an alternative to substitute autologous bone grafts in certain conditions.

Object:Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients.Method:This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed.Result:The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation.Conclusion: Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect.

Background: MLC601 is a natural product formulation from Chinese medicine that is extensively studied in ischemic stroke. Traumatic brain injury (TBI) shares pathophysiological mechanisms with ischemic stroke, yet there are few studies on the use of MLC601 in treating TBI. This Indonesian pilot study aimed to investigate clinical outcomes of MLC601 for TBI. Methods: This randomized controlled trial included subjects with nonsurgical moderate TBI allocated into two groups: with and without MLC601 over three months in addition to standard TBI treatment. Clinical outcomes were measured by the Glasgow Outcome Scale (GOS) and Barthel Index (BI) observed upon discharge and at months (M) 3 and 6. Results: Thirty-two subjects were included. The MLC601 group (n = 16) had higher GOS than the control group (n = 16) at all observation timepoints, though these differences were not statistically significant (p = 0.151). The BI values indicated a significant improvement for the MLC601 group compared to the control group at M3 (47.5 vs. 35.0; p = 0.014) and at M6 (67.5 vs. 57.5; p = 0.055). No adverse effects were associated with MLC601 treatment. Conclusion: In this cohort of nonsurgical moderate TBI subjects, MLC601 showed potential for a positive effect on clinical outcome with no adverse effects.