and the World Spinal Column Society Executive Board-CONCLUSIONS: Based on the modifiable risk factors of depression in this study, it is recommended that the safety of neurosurgeons be ensured by providing appropriate safety measures for them to regain their confidence and hence reduce the incidence of depression.

Objective:Surgical management of giant skull osteomas Osteomas are benign, generally slow growing, bone forming tumors limited to the craniofacial and jaw bones.Materials and Methods:A retrospective review of all cases of osteoma diagnosed from 2009 to 2013 treated in our hospital. The data collected included age at diagnosis, gender, lesion location, size, presenting and duration of symptoms, treatment, complication and outcome.Results:During our study period there were 15 cases that were treated surgically. Their mean age was 42 years (range: 15–65 years) and all of our patients were female. The average duration of symptoms was 3 years and size varying from 4 cm to 12 cm. Eight patients complained of headache, whereas 6 patients complained about esthetics, and 1 patient presented with proptosis. The tumor was excised by cutting the base of the tumor and then residual tumor was grinded using a round head cutting bar. Osteoma was removed with esthetically acceptable appearance.Conclusion:There were no major complications during operative and postoperative period. Although osteomas are usually slow growing but surgery is usually performed due to esthetic reasons. It is important to plan an appropriate surgical approach that minimizes any damage to the adjacent structures.

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Background:Giant dermatofibrosarcoma protuberans (DFSP) of the scalp is a rare case, which is an intermediate grade soft tissue neoplasm originating from the dermal layer of the skin, which usually occurs in adults.Case Description:We describe such a case in a 26-year-old male. A wide local excision of the tumor with a generous tissue margin was performed; microscopic and immunohistochemical findings established the diagnosis of recurrent DFSP.Conclusion:Our case is unique in that it is presented as a dermatofibrosarcoma protuberans of the scalp, which is an extremely rare clinical entity, and the patient remains well after 14 months with no further treatment, without any tumor recurrence.

Background: Lumbar foramina stenosis is one of the causes due to lumbar disc herniation occurs in 40% of the population in the United States with peak incidence at the age of the third and fourth decades which are in the productive ages. This disorder is the cause of the most common non-traumatic disability and disruption of activity and often has significant socioeconomic impacts. Extensive foraminotomy is an invasive procedure by expanding the intervertebral foramen to remove the foramina stenosis thus reducing the compression of the neural roots. The purpose of this study was to identify the correlation of extensive foraminotomy techniques on lumbar foramina stenosis to its improvement using VAS (Visual Analogue Scale) and ODI (Oswestry Disabilty Index).Method: This study was a cross sectional study to identify correlation using retrospective data collection method with consecutive sampling in 30 cases of lumbar foramina stenosis treated and performed extensive foraminotomy at Department of Neurosurgery Dr. Hasan Sadikin General Hospital Bandung during January 2016 -December 2016 period. Surgical procedure was started in a safer extraforaminal area compared to a more risky intraforaminal area. Then the foraminal decompression is done by using burr and Kerrison punch. Follow up until 3 months and assessed using VAS and ODI.Results: Based on the Mann-Whitney correlation test, there is a statistically significant association between VAS for inferior limb pain that improved from baseline score of 6.57 to 1.73 in 3 months postoperatively (P = 0.000 <0.05). While for ODI also showing improvement from baseline index of 47 at first month post operation to 17,33 at 3 months post operation (P = 0,000 <0,05). Conclusion:Extensive foraminotomy could be an efficacious surgical procedure for the treatment of lumbar foramina stenosis. This result is expected to be a consideration for spine neurosurgeons in determining effective surgical procedures because it provides safe and promising results, especially in elderly patients or with other medical morbidities.

Background: Spinal tuberculosis (TB) is a common form of extrapulmonary TB. Although the first line of the treatment is anti-TB medications, patients with severe neurological deficits, spinal instability, and/or kyphotic deformity often warrant surgery. Here, we report five cases of spinal TB requiring operative intervention at Hasan Sadikin General Hospital, Bandung, Indonesia. Case Description: We operated on five patients with spinal TB cases from 2019 to October 2021. In addition to appropriate medical management, all five patients successfully underwent laminectomy with or without posterior stabilization. Conclusion: It is essential to establish the diagnosis and surgically manage patients with spinal TB early in the clinical course to minimize residual post-operative neurological deficits.

Objective: To determine the normal ranges of cervical spinal canal morphometry in Indonesian population and to compare the acquired data collected from other populations Methods:Computed tomography measurements on the diameter of midsagital spinal canal and corpus of cervical vertebrae and its Torg ratio from the lower cervical (C3-C7) canal from 24 normal Indonesian adults were performed at the Radiology Department of Dr. Hasan Sadikin General Hospital. Patients who had cervical spine disorders and those under 20 years old were exluded. We used computed tomography scan midsagittal view to measure the aforementioned parameters. Results:The average diameter for the cervical spinal canals for the Indonesian population is comparable with those of other Asian populations such as Hongkong and India, albeit with smaller Torg ratio. Conclusions:This study reports the normal radiological anatomy of the midsagital spinal canal and corpus of cervical vertebrae as well as Torg ratio from the lower cervical vertebrae among Indonesian population. The measurements result of this study shows that, although slightly smaller, the measurement results for those parameters are identical with other Asian populations.

Hypertrophy of the posterior spinal elements leading to compromise of the spinal canal and its neural elements is a well-recognized pathological entity affecting the lumbar or cervical spine. Such stenosis of the thoracic spine in the absence of a generalized rheumatological,metabolic, or orthopedic disorder, or a history of trauma is generally considered to be rare. Spinal ligaments, such as the ligamentum flavum (LF), are prone to degeneration and can lead to back pain and nerve dysfunction. Ossification of ligamentum flavum (OLF) is a pathological condition that cause neurological symptoms and usually occurs in the thoracic spine and less frequently in the cervical spine. However the disease is now being increasingly recognized as acause of thoracic myelopathy. We report a rare case of thoracic myelopathy caused by OLF. A 48-year-old male presented with a chief complaint of weakness of bilateral lower extremities. Neurological examination revealed sensory deficit at Th 11 level below. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9–11 level. Thoracicmyelopathy caused by OLF was consider and surgical intervention was performed. Posterior decompression and laminoplasty has been performed for this patient. Keywords: ossification of ligamentum flavum, thoracic myelopathy, laminoplasty