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KADAR FIBRINOGEN SEBAGAI FAKTOR PROGNOSTIK PASIEN PERDARAHAN INTRASEREBRAL SPONTAN David Tandian; Muhammad Harisyah; Hanif Gordang Tobing; Samsul Ashari; Renindra Ananda Aman; Syaiful Ichwan; Mohamad Saekhu; Wismaji Sadewo; Affan Priyambodo; Setyo Widi Nugroho
NEURONA Vol 35 No 4 (2018)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i4.29

FIBRINOGEN VALUE AS PROGNOSTIC FACTOR IN SPONTANEOUS INTRACEREBRAL HEMORRHAGEABSTRACTIntroduction: Spontaneous intracerebral haemorrhage (SIH) refers as spontaneous bleeding in the brain paren- chyma due to injury of blood vessels. Thus causing tissue inflammatory and coagulation reaction, activating the release of fibrinogen. Fibrinogen, an active substrate of coagulation cascade, also considered as the most powerful indicator of acute inflammatory response in SIH. Elevated levels of fibrinogen may be the marker for the increasing degree of brain tissue damage.Aims: Determine the correlation of fibrinogen levels with outcomes of patients with SIH who went on operative procedures.Methods: The study was conducted in Dr. Cipto Mangunkusumo hospital and its affiliation hospitals from January until August 2017. Total sampling was conducted. Preoperative Glasgow Coma Scale (GCS), blood volume, preoperative and postoperative serum fibrinogen values, and modified Rankin Scale (mRS) data were obtained and analyzed using the Spearman correlation test.Results: Significant correlation were found between the preoperative and postoperative fibrinogen with mRS score. Positive correlation coefficients were shown in both parameters, whereas the increase of preoperative and postoperative fibrinogen would increase the mRS score.Discussion: Pre and postoperative fibrinogen value showed significant association with mRS score, thereby they could be considered as prognostic predictive factors. However, because of the limited number of subject of this study to fulfill the criteria of validity study, a future study with a larger scale should be carried out.Keyword: Fibrinogen, mRS, outcome, spontaneous intracerebral haemorrhageABSTRAKPendahuluan: Perdarahan intraserebral spontan (PISS) adalah perdarahan spontan pada parenkim otak akibat kerusakan pembuluh darah pada jaringan otak. Kerusakan tersebut menimbulkan reaksi inflamasi jaringan dan koagulasi yang mengaktivasi pelepasan fibrinogen. Fibrinogen merupakan substrat aktif kaskade koagulasi yang juga merupakan penanda paling kuat respons akut inflamasi pada PISS. Adanya peningkatan kadar fibrinogen dapat menggambarkan peningkatan derajat kerusakan jaringan otak.Tujuan: Mengetahui korelasi kadar fibrinogen dengan luaran pasien dengan PISS yang dilakukan tindakan operatif.Metode: Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dan rumah sakit jejaring pendidikan dalam periode Januari–Agustus 2017. Sampel diambil dengan total sampling, data yang diambil adalah, Glasgow Coma Scale (GCS) preoperasi, volume perdarahan, kadar fibrinogen serum preoperasi dan pascaoperasi, dan modified Rankin Scale(mRS), kemudian dianalisis dengan tes Spearman correlation.Hasil: Dari uji statistik didapatkan hasil bermakna antara fibrinogen preoperasi mau pun pascaoperasi dengan skor mRS. Koefisien korelasi, menunjukkan korelasi positif pada keduanya, dimana peningkatan fibrinogen preoperasi dan pascaoperasi akan meningkatkan skor mRS.Diskusi: Fibrinogen pre dan pascaoperasi sebagai faktor prediksi prognostik memiliki hubungan bermakna dengan skor mRS. Namun dengan jumlah sampel penelitian yang masih belum mencukupi untuk memenuhi kriteria validitas untuk dapat diajukan sebagai faktor yang bersifat pasti, diperlukan penelitian lebih lanjut dengan sampel yang lebih besar.Kata kunci: Fibrinogen, luaran, mRS, perdarahan intraserebral spontan

INTENSITAS MIELUM PADA GAMBARAN MRI SERVIKAL SEBAGAI FAKTOR PROGNOSTIK LUARAN CERVICAL SPONDYLOSIS MYELOPATHY PASCAOPERASI Mohamad Saekhu; Jeremia Prastya Pardede; Renindra Ananda Aman; Hanif Gordang Tobing; Samsul Ashari; David Tandian; Syaiful Ichwan; Wismaji Sadewo; Affan Priyambodo; Setyo Widi Nugroho
NEURONA Vol 35 No 4 (2018)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v35i4.30

MYELUM INTENSITY ON MRI CERVICAL AS PROGNOSTIC FACTORS IN CERVICAL SPONDYLOSIS MYELOPATHY PATIENTSABSTRACTIntroduction: Cervical spondylosis myelopathy (CSM) is a stenosis condition in cervical canal due to the cervical structural changes that compress the myelum, thus causing spinal medulla ischemia. Other than clinical factors, myelum intensity changes on MRI T1-weighted images (T1W1) and T2W1 might be useful to predict the pos-operative outcome.Aims: Identify prognostic factors in post-operative patients with CSM based on clinical symptoms and myelum intensity on cervical MRI.Methods: Retrospective study on CSM patients who underwent surgery in Neurosurgery Department, Cipto Mangunkusumo hospital, Jakarta, from January 2013 to December 2016. Magnetic resonance imaging data was obtained before the surgery, while clinical symptoms were assessed by Nurick scale before and 1 year after the surgery to evaluate outcome.Results: There were 50 subjects included in this study with mean age 51.98±9.64 years, majority male (76%), have moderate myelopathy (Nurick scale pre-operative ≤2), and time between onset and surgery mostly ≤1 year (80%). Most subject (88%) had improvement clinically, but mostly without hypointensity on cervical T1W1 MRI.Discussion: Myelum hypointensity in cervical MRI is associated with poor outcome in CSM post-surgery patients.Keywords: Cervical spondylosis myelopathy, MRI, myelum hypointensity, Nurick scaleABSTRAKPendahuluan: Cervical spondylosis myelopathy (CSM) merupakan suatu kondisi stenosis kanal servikal akibat adanya perubahan struktur servikal yang menyebabkan kompresi mielum, sehingga timbul iskemia medula spinalis. Selain faktor-faktor klinis, perubahan intensitas mielum pada MRI T1-weighted images (T1W1) dan T2W1 dapat dijadikan modalitas untuk memprediksi luaran pascaoperasi.Tujuan: Mengidentifikasi faktor prognosis luaran pasien CSM pascaoperasi berdasarkan gejala klinis dan intensitas mielum pada gambaran MRI servikal.Metode: Penelitian retrospektif terhadap penderita CSM yang dilakukan operasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada bulan Januari 2013 hingga Desember 2016. Dilakukan penilaian klinis dan gambaran MRI awal, serta luaran 1 tahun pascaoperasi menggunakan skor Nurick.Hasil: Terdapat 50 subjek dengan rerata usia 51,98±9,64 tahun, terutama laki-laki (76%), memiliki derajat mielopati ringan (skor Nurick preoperasi ≤2), dan jarak antara onset dengan waktu operasi ≤1 tahun (80%). Sebagian besar subjek (88%) mengalami perbaikan skor pascaoperasi yang mayoritas (95,4%) tidak didapatkan gambaran hipointesintas pada T1W1 MRI servikal.Diskusi: Hipointensitas mielum pada MRI servikal merupakan faktor prognosis luaran buruk pascaoperasi pada pasien CSM.Kata kunci: Cervical spondylosis myelopathy, hipointens, mielum, MRI, skala Nurick

PERBEDAAN NILAI LEUKOSIT PRA- DAN PASCAOPERASI SEBAGAI PREDIKTOR LUARAN FUNGSIONAL PERDARAHAN INTRASEREBRAL SPONTAN Hanif Gordang Tobing; Bismo Nugroho PPR; Mohamad Saekhu; Setyo Widi Nugroho; Affan Priyambodo; Wismaji Sadewo; Syaiful Ichwan; Renindra Ananda Aman; David Tandian; Samsul Ashari
NEURONA Vol 36 No 2 (2019)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v36i2.68

DIFFERENCES BETWEEN PRE- AND POST-SURGERY LEUKOCYTE COUNTS AS FUNCTIONAL OUTCOME PREDICTOR IN SPONTANEOUS INTRACEREBRAL HEMORRHAGEABSTRACTIntroduction: Hematoma in spontaneous intra-cerebral hemorrhage (SICH) results inflammation due to secondary brain injury. Leukocyte, an inflammation indicator which is routinely examined, known as an outcome predictor in non- operated SICH. The role of inflammation in operated SICH is still unknown, however, pre- and post-surgery leukocyte counts can be a marker of brain tissue damage (brain injury).Aim: This study investigated the characteristics of leucocyte parameters in operated SICH patients and its correlation to functional outcome based on Glasgow Outcome Scale (GOS).Methods: This was a retrospective cohort study for SICH patients who underwent surgery at Department of Neurosurgery in Dr. Cipto Mangunkusumo National General Hospital from January 2012–March 2017. This study analyzed the association between pre-operative leucocyte level with age, pre-operative GCS, hemorrhage volume, length of hospitalization, and six-month post-operative GOS. The correlation of differences of pre-operative and one-day post- operative leucocyte counts with six-month post-operative GOS and hematoma evacuation percentage were analyzed. The analysis was done using Pearson correlation test, Spearman, Chi-square χ2 test, Fisher exact test, and Anova test.Results: There was a significant correlation between differences of leukocyte counts in pre- and post-surgery with GOS. A higher post-surgery leukocyte difference would lower GOS; there was a significant correlation between the leukocytes counts in pre-operative leucocyte and GCS. A higher pre-operative leukocytes counts would lower the GCS.Discussion: The differences of pre-operative and post-operative leucocyte counts is a functional outcome predictors within 6 months in operated SICH patients.Keywords: Leukocyte, outcome, spontaneous intracerebral hemorrage, surgeryABSTRAKPendahuluan: Hematoma pada perdarahan intraserebral spontan (PISS) menyebabkan inflamasi akibat cedera otak sekunder. Leukosit sebagai indikator inflamasi yang rutin diperiksa, diketahui memiliki peranan sebagai prediktor luaran pada PISS yang tidak dioperasi. Sejauh ini belum diketahui peranan inflamasi pada PISS yang dioperasi, namun kadar leukosit pra- dan pascaoperasi dapat menjadi penanda adanya kerusakan jaringan otak (brain injury).Tujuan: Untuk mengetahui karakteristik parameter leukosit pasien PISS yang dioperasi dan kaitannya dengan luaran fungsional berdasarkan skor Glasgow Outcome Scale (GOS).Metode: Studi kohort retrospektif pada pasien PISS yang dioperasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo periode Januari 2012-Maret 2017. Dilakukan analisis antara nilai leukosit praoperasi dengan usia, GCS praoperasi, volume perdarahan, lama rawat inap, dan skor GOS 6 bulan pascaoperasi. Dilakukan analisis perbedaan nilai leukosit praoperasi dibandingkan hari pertama pascaoperasi dengan skor GOS 6 bulan pascaoperasi dan persentase evakuasi hematoma. Analisis dilakukan menggunakan korelasi Pearson, Spearman, uji Chi-square χ2 test, Uji Fisher exact test, dan Anova.Hasil: Pada uji statistik didapatkan korelasi bermakna antara perbedaan nilai leukosit pascaoperasi dibandingkan praoperasi dengan skor GOS. Semakin tinggi nilai perbedaan leukosit pascaoperasi akan menurunkan skor GOS; didapatkan korelasi bermakna antara leukosit praoperasi dengan GCS praoperasi. Semakin tinggi leukosit praoperasi, semakin rendah GCS.Diskusi: Perbedaan nilai leukosit pascaoperasi dibandingkan praoperasi merupakan prediktor luaran fungsional dalam 6 bulan pada pasien perdarahan intraserebral spontan yang dioperasi.Kata kunci: Leukosit, luaran, operasi, perdarahan intraserebral spontan

PASCAOPERASI ADENOMA HIPOFISIS: HUBUNGAN ANTARA DURASI AWITAN DENGAN LUARAN KLINIS VISUS DAN LAPANG PANDANG Renindra Ananda Aman; Reki Setiawan; Retno Asti Werdhani; Samsul Ashari; David Tandian; Syaiful Ichwan; Affan Priyambodo; Setyo Widi Nugroho
NEURONA Vol 37 No 3 (2020)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v37i3.161

Introduction: Pituitary adenomas can cause decrease of visual acuity (VA), narrowing visual field (VF). Several studies have showed that the duration of complaints were related significantly with clinical outcomes. As a national referral center hospital, all pituitary adenoma patients who came to our institution were referred from ophthalmologists, neurologists, and neurosurgeons from other institutions. Aim: In this study, we investigated the relationship between duration, which is calculated from the time of symptoms first appeared to the time of surgery, and outcome (VA and VF) in pituitary adenoma patients who underwent transsphenoidal surgery. Methods: A retrospective design was used on pituitary adenoma patients that underwent transsphenoidal surgery between 2015-2017 in Cipto Mangunkusumo Hospital. The duration between symptoms’ onset and surgery was calculated in months. VA and VF examinations were performed 1 day before surgery and within 1 to 2 months postoperatively. Results: There were 71 patients (36 male, 35 female) with decreased VA and narrowed VF, with a median age of 42 years (20-77 years). The median length of duration of onset for both symptoms was 12 months (1-108 months). 40.5% patients had improved VA postoperatively, with median duration of onset of 11 months. Improvement in VF was experienced in 67.6% patients, with median duration of onset of 12 months. Discussion: There was a statistically significant relationship between the duration of onset and the VF outcomes. Improvements in the VF were found in patients who underwent surgery up to 12 months after the time of onset. Keywords: Pituitary adenoma, transsphenoidal surgery, visual acuity, visual field

KOMPLIKASI VENTRIKULOPERITONEAL SHUNT PADA PASIEN PEDIATRIK USIA 0-2 TAHUN DI RUMAH SAKIT UMUM PUSAT NASIONAL DR CIPTOMANGUNKUSUMO Samsul Ashari; Bhayu Rizallinoor; Hilman Mahyudin; Moh. Saekhu; Renindra Ananda Aman; David Tandian; Abdi Reza; Setyo Widi Nugroho
NEURONA Vol 38 No 2 (2021)
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Introduction: Ventriculoperitoneal shunt is the procedure of choice in the management of hydrocephalus. However,the ventriculoperitoneal shunt procedure also carries a risk of complications. In Indonesia, data on the incidence andprevalence of ventriculoperitoneal shunt complications have not been obtained.Aim: In this study, we examined the complications of shunts and the factors associated with the duration of timeMethods: This study is a retrospective study of pediatric patients aged 0-2 years with hydrocephalus who underwentventriculoperitoneal shunt surgery for the first time at Cipto Mangunkusumo Hospital in 2015-2020 and e????periencedcomplications. The duration of time the complications occurred was divided into before and after six months. Demographicdata, clinical data, and types of complications were analyzed descriptively.Result: From ????anuary 2015 to March 2020 at Cipto Mangunkusumo Hospital, 168 ventriculoperitoneal shuntoperations were performed at 0-2 years. It was found that 20 patients (12%) e????perienced complications with a duration offewer than si???? months by ????.8% and more than si???? months by 4.2%. The total complications that occurred were mechanicalcomplications (????.2%), infection (3.6%), and over drainage (1.2%).Discussion: The percentage of complications of ventriculoperitoneal shunt in patients aged 0-2 years at CiptoMangunkusumo Hospital, in the first si???? months was ????.8%, with the highest incidence was infection (3.6%) which waslower than the literature, while the percentage of complications of ventriculoperitoneal shunts which more than six monthswere 4.2% and caused mainly by distal malfunction (3%).Keywords: aged 0-2 years, complications, pediatric, ventriculoperitoneal shunt

RASIO NEUTROFIL LIMFOSIT SEBAGAI PREDIKTOR LUARAN KASUS CEDERA KEPALA SEDANG DAN BERAT: STUDI MULTISENTER Hanif Gordang Tobing; Yovanka Naryai Manuhutu; Syaiful Ichwan; Renindra Ananda Aman; Setyo Widi Nugroho; Samsul Ashari; David Tandian; Mohammad Saekhu; Wismaji Sadewo; Affan Priyambodo; Kevin Gunawan; Ande Fachniadin
NEURONA Vol 38 No 3 (2021)
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Introduction: Traumatic brain injury (TBI) is the most common cause of death in populations less than 40 years old in developed and developing countries. The clinical outcome after TBI is still an issue and difficult to predict. Besides Glasgow Coma Scale (GCS), neutrophil to lymphocyte ratio (NLR) as one of the neuroinflammation biomarkers also can predict outcomes after TBI Aim: To measure the association between NLR and GCS as predictors of moderate and severe TBI outcomes. Methods: This prospective study included moderate and severe TBI patients who underwent craniotomy in a multicenter hospital from November 2019 to November 2020. Chi-square analytic test was used to determine the relationship between demographics, clinical symptoms, NLR and GCS as predictors outcome of moderate and severe TBI. Results: About 54 patients with moderate and severe TBI consist of 41 (75.9%) male and 13 (24.1%) female patients, mean age 27.6 ± 15.3 years, preoperative GCS is 13 (7 - 13), with asymmetric pupil 33 (61.1%), seizures 5 (9.3%), hemiparesis 1 (1.86%), and GCS postoperative on the fifth and seventh day is 14 (6 - 15). Preoperative NLR was 7.4 (1.9-26.2), the cut-off for NLR as a predictor for improved GCS was at 9.8 with a specificity and sensitivity of 87%. Discussion: Low NLR had an association with the patient’s improved GCS, while a high NLR had an association with a non-improving GCS, so that the relationship between RNL and GCS could be used as an outcome predictor of moderate and severe traumatic brain injury patient. Keywords: glasgow coma scale, neutrophil to lymphocyte ratio, predictor, traumatic brain injury

Luaran Pendekatan Operasi Mikroskopis dan Endoskopik pada Pasien Kraniofaringioma di RSUPN Dr. Cipto Mangunkusumo Ashari, Samsul; Saekhu, Mohamad; Tandian, David; Ray, Laode Maly; Nugroho, Setyo Widi
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 39 No 4 (2023): Vol 39 No 4 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i4.286

ABSTRACTIntroduction: Advances in neurosurgery technology are rising quickly. The Neurosurgery Department RSCM is currently developing minimally invasive surgical technique using transcranial endoscopy. This minimally invasive procedure have been carried out to date. However, the patient's outcome after surgery is not yet known.Aim: Acknowledging the outcome of microscopic and endoscopic surgical approaches in craniopharyngioma patients at dr. Cipto Mangunkusumo Hospital.Methods: This was a retrospective cohort study of craniopharyngioma patients who underwent either endoscopic or microscopic surgery. This study used a consecutive sampling technique, using samples from 2012 to 2021 at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The inclusion criteria were craniopharyngioma patients who were admitted to the hospital for craniotomy tumor removal procedure with an endoscopic or microscopic approach, never had surgery, had diagnosis of craniopharyngioma confirmed by clinical findings and supporting investigation. Exclusion criteria were patients with extracranial problems and endoscopic patients with extensive craniotomy. Demographic data such as age, gender, tumor location, consistency, anatomical pathology results, and history of radiotherapy were recorded. Clinical outcomes were pre- and postoperative complaints, intraoperative bleeding, postoperative complications, and recurrence. Resectability is the size of the tumor pre- and 1-month after surgery. The data were analyzed using SPSS 25.0.Results: Thirty patients were enrolled in this study. A total of 22 subjects (73%) underwent microscopic surgery and 8 subjects (27%) underwent endoscopic surgery. Intraoperative bleeding was found to be significantly smaller on the endoscopic approach than on the microscopic approach (p=0.002). The operation time of endoscopic approach was significantly shorter than microscopic approach (p=0.002). There was no significant difference in pre- and postoperative complaints, postoperative complications, recurrence, resectability and duration of hospitalization in the endoscopic approach compared to the microscopic approach in the management of craniopharyngioma patients.Conclusion: Transcranial endoscopic approach in craniopharyngioma patients has good potential as an option for surgical management of craniopharyngioma patients.Keywords: Craniopharyngioma, Transcranial Endoscopy, Microscopy

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