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Navigating Surgical Strategies for Symptomatic Tarlov Cysts: A Case Report of Successful Microsurgical Excision and Imbrication Arip Heru Tripana; Tondi Maspian Tjili; Afdal; Ismar; Eko Setiawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1413

Background: Symptomatic Tarlov (perineural) cysts are a rare but debilitating cause of chronic radicular pain, arising from cerebrospinal fluid (CSF) accumulation within the nerve root sheath. The diagnostic journey is often complex, requiring a definitive link between the lesion and the patient's symptoms, and the optimal surgical strategy remains a subject of considerable debate. Case presentation: A 56-year-old male presented with a six-month history of intractable right S2 radiculopathy (VAS 8/10) and severe functional impairment (Oswestry Disability Index 78%), which had failed a comprehensive trial of conservative management. Magnetic resonance imaging revealed a large cystic lesion at the right S2 level, with features characteristic of a Tarlov cyst, causing severe nerve root compression. Following a thorough discussion of the risks and benefits, the patient underwent an S2 laminectomy with microsurgical partial cyst excision and wall imbrication. Postoperative histopathology confirmed the diagnosis of a perineural cyst, identifying nerve fibers within the fibroconnective tissue of the cyst wall. Conclusion: The patient experienced immediate and sustained resolution of his radicular pain (VAS 0/10) and a profound improvement in functional status (ODI 12%) at one-year follow-up, with radiological confirmation of successful cyst obliteration. This case highlights the potential of a direct microsurgical approach, guided by a strong clinical-radiological correlation and confirmed by histopathology, to provide a durable and life-altering cure for patients disabled by symptomatic Tarlov cysts.

Functional Limb Salvage Following a 24-Hour-Delayed Fasciotomy for Pediatric Hand Compartment Syndrome: A Case Report Rohman Sungkono; Adri Yandra Hidayat; Andrea Valentino; Ade Wirdayanto; Arip Heru Tripana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1458

Background: Acute compartment syndrome (ACS) in the pediatric hand is a formidable surgical emergency where delayed diagnosis can lead to devastating neuromuscular deficits and limb loss. The narrow therapeutic window, often termed the "golden hours," is considered critical for preventing irreversible ischemic necrosis. Presentations delayed beyond this period, especially in pre-verbal children, pose a significant clinical and ethical dilemma regarding the utility and risks of surgical intervention. Case presentation: A 2-year-old female presented to our emergency department 24 hours after a severe crush injury to her right hand from a noodle-making machine. The hand was massively swollen, cyanotic, and insensate, with no detectable capillary refill or digital oximetry readings. A clinical diagnosis of advanced, multi-compartmental ACS was made. Emergency surgical decompression was performed via seven incisions, releasing all ten osteofascial compartments. Intraoperative assessment revealed dusky, non-contractile but bleeding muscle. Following staged debridements, the patient demonstrated remarkable recovery. At six months, she achieved full range of motion in all digits except the middle finger and demonstrated age-appropriate grip and pincer grasp, with the primary sequela being a fixed flexion contracture of the middle finger's proximal interphalangeal joint. Conclusion: This report highlights a case of unexpected functional recovery following a significantly delayed fasciotomy. The outcome supports a nuanced approach to delayed pediatric ACS, suggesting that in select cases, aggressive surgical decompression should be considered as the potential for a positive outcome may exist. This case serves as a powerful, hypothesis-generating observation that raises critical questions about the absolute temporal limits for surgical intervention and underscores the importance of individualized surgical judgment.

Navigating Surgical Strategies for Symptomatic Tarlov Cysts: A Case Report of Successful Microsurgical Excision and Imbrication Arip Heru Tripana; Tondi Maspian Tjili; Afdal; Ismar; Eko Setiawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i10.1413

Background: Symptomatic Tarlov (perineural) cysts are a rare but debilitating cause of chronic radicular pain, arising from cerebrospinal fluid (CSF) accumulation within the nerve root sheath. The diagnostic journey is often complex, requiring a definitive link between the lesion and the patient's symptoms, and the optimal surgical strategy remains a subject of considerable debate. Case presentation: A 56-year-old male presented with a six-month history of intractable right S2 radiculopathy (VAS 8/10) and severe functional impairment (Oswestry Disability Index 78%), which had failed a comprehensive trial of conservative management. Magnetic resonance imaging revealed a large cystic lesion at the right S2 level, with features characteristic of a Tarlov cyst, causing severe nerve root compression. Following a thorough discussion of the risks and benefits, the patient underwent an S2 laminectomy with microsurgical partial cyst excision and wall imbrication. Postoperative histopathology confirmed the diagnosis of a perineural cyst, identifying nerve fibers within the fibroconnective tissue of the cyst wall. Conclusion: The patient experienced immediate and sustained resolution of his radicular pain (VAS 0/10) and a profound improvement in functional status (ODI 12%) at one-year follow-up, with radiological confirmation of successful cyst obliteration. This case highlights the potential of a direct microsurgical approach, guided by a strong clinical-radiological correlation and confirmed by histopathology, to provide a durable and life-altering cure for patients disabled by symptomatic Tarlov cysts.

Functional Limb Salvage Following a 24-Hour-Delayed Fasciotomy for Pediatric Hand Compartment Syndrome: A Case Report Rohman Sungkono; Adri Yandra Hidayat; Andrea Valentino; Ade Wirdayanto; Arip Heru Tripana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1458

Background: Acute compartment syndrome (ACS) in the pediatric hand is a formidable surgical emergency where delayed diagnosis can lead to devastating neuromuscular deficits and limb loss. The narrow therapeutic window, often termed the "golden hours," is considered critical for preventing irreversible ischemic necrosis. Presentations delayed beyond this period, especially in pre-verbal children, pose a significant clinical and ethical dilemma regarding the utility and risks of surgical intervention. Case presentation: A 2-year-old female presented to our emergency department 24 hours after a severe crush injury to her right hand from a noodle-making machine. The hand was massively swollen, cyanotic, and insensate, with no detectable capillary refill or digital oximetry readings. A clinical diagnosis of advanced, multi-compartmental ACS was made. Emergency surgical decompression was performed via seven incisions, releasing all ten osteofascial compartments. Intraoperative assessment revealed dusky, non-contractile but bleeding muscle. Following staged debridements, the patient demonstrated remarkable recovery. At six months, she achieved full range of motion in all digits except the middle finger and demonstrated age-appropriate grip and pincer grasp, with the primary sequela being a fixed flexion contracture of the middle finger's proximal interphalangeal joint. Conclusion: This report highlights a case of unexpected functional recovery following a significantly delayed fasciotomy. The outcome supports a nuanced approach to delayed pediatric ACS, suggesting that in select cases, aggressive surgical decompression should be considered as the potential for a positive outcome may exist. This case serves as a powerful, hypothesis-generating observation that raises critical questions about the absolute temporal limits for surgical intervention and underscores the importance of individualized surgical judgment.

Penetrating Facial Injury by Motorcycle Gear Shifter Lever: A Case Report Zulfikar, Welli; Arip Heru Tripana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 4 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i4.494

Background: Penetrating facial injury can cause injury to the bone and soft tissue surrounding. Penetrating facial injury caused by organic foreign bodies or metal material increases the risk of infection in the wound. Identification of the location of the entry of foreign bodies, whether the vital organs, the presence of injury to the nerves, vascular, visual, and other muscle damage is very important to do. For that immediate and optimal treatment can be applied to reduce morbidity and mortality. Case presentation: A 13 years old boy arrived in ER admission with penetrating facial injuries. A corpus alienum penetrated the patient’s face at the medial meatus of the right eye along with bleeding from the nose and around the wound. Evaluation and management of the penetrating facial injury were performed in accordance with the ATLS protocol. The aim of management in penetrating facial injuries is to remove the foreign body with minimal trauma to surrounding structures and to maintain normal function and optimal appearance. The patient underwent emergency surgery the remove corpus alienum and wound exploration under general anesthesia. Postoperative evaluation shows no bleeding or signs of infection, no visual impairment, and tear flow were found. Conclusion: Penetrating facial injury due to motorcycle gear shifter lever is rare. Good Management of penetrating facial injury will give satisfactory results.

Penetrating Facial Injury by Motorcycle Gear Shifter Lever: A Case Report Zulfikar, Welli; Arip Heru Tripana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 4 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i4.494

Background: Penetrating facial injury can cause injury to the bone and soft tissue surrounding. Penetrating facial injury caused by organic foreign bodies or metal material increases the risk of infection in the wound. Identification of the location of the entry of foreign bodies, whether the vital organs, the presence of injury to the nerves, vascular, visual, and other muscle damage is very important to do. For that immediate and optimal treatment can be applied to reduce morbidity and mortality. Case presentation: A 13 years old boy arrived in ER admission with penetrating facial injuries. A corpus alienum penetrated the patient’s face at the medial meatus of the right eye along with bleeding from the nose and around the wound. Evaluation and management of the penetrating facial injury were performed in accordance with the ATLS protocol. The aim of management in penetrating facial injuries is to remove the foreign body with minimal trauma to surrounding structures and to maintain normal function and optimal appearance. The patient underwent emergency surgery the remove corpus alienum and wound exploration under general anesthesia. Postoperative evaluation shows no bleeding or signs of infection, no visual impairment, and tear flow were found. Conclusion: Penetrating facial injury due to motorcycle gear shifter lever is rare. Good Management of penetrating facial injury will give satisfactory results.

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