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The Key role of MRI modalities in En Plaque Meningioma Novita Tirtaprawita; Wiradharma Wiradharma; Julius July
Medicinus Vol 6, No 2 (2017): February 2017 - May 2017
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v6i2.1145

En plaque meningioma is at frontal region is difficult to be differentiated from osteoma, based on CT scan only. En plaque meningioma represents in 2-9% of all meningioma cases. Usually en plaque meningioma grows on the sphenoid wing, whereas only 1 % grows on the frontal and temporal bone. This case is female 37 year- old who presents with chronic headache and huge lump on her right forehead that she believes it slowly enlarges for the last 5 years. The Computerized Tomography scan (CT scan) shows thickening of the right fronto-temporal bone (3-4 cm) with the diameter of 12 cm and bony hard. Initial impression suggests it could be osteoma or fibrous dysplasia. After the MRI (Magnetic Resonance Imaging) with contrast, it shows a carpet like tumor underline the thickening bone, and it suggest an en plaque meningioma. For en plaque meningioma, we have to remove the abnormal duramater. We suggest that for a case with a wide thickening calvarian bone, it’s better to get the MRI of the head with contrast.

The Importance of Immunohistochemical Analysis in Silent Pituitary Adenoma Ivan William Harsono; Nathania Victoria Stevina; Vivien Puspitasari; Julius July
Medicinus Vol 6, No 3 (2017): June 2017 - September 2017
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v6i3.1150

Pituitary adenoma contributes to 15% of all intracranial neoplasm. It is usually following benign course and some of them are silent (asymptomatic clinically, but hormone-secreting). Silent adenoma usually found incidentally or when the patients show mass effect (neurological deficits). Many of histologically aggressive silent adenoma subtypes are associated with invasiveness, recurrence and progression to clinically functioning adenomas. Aggressive silent adenoma radiologically tends to invade in downward direction, invading bone, sinus cavernosus, parasellar region. The nature of aggressive silent adenoma subtypes is differing in nature compared to benign nature of pituitary adenoma and should be confirmed immunohistochemically to determine the prognosis and anticipate the risk of recurrence or progression. The case illustration show a real case of 46 years old female progressive headache and visual disturbance diagnosed with non-functional pituitary macroadenoma but positive for more than one immunochemistry biomarker (plurihormonal aggressive silent adenoma).

Pengaruh Asam Traneksamat Pra-operasi Terhadap Pendarahan Perioperatif Tumor Otak Glioma yang Sedang Mendapat Deksametason Julius July
Jurnal llmu Bedah Indonesia Vol. 35 No. 2 (2007): Desember 2007
Publisher : Ikatan Ahli Bedah Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46800/jibiikabi.v35i2.126

Case Report : Management Penetrating Brain Injury Across Middle Third of Superior Sagittal Sinus Achmad Chumaidi; Julius July
Medicinus Vol 10, No 2 (2022): June 2022 - September 2022
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i2.5681

Background: Penetrating cranial injuries are rarely reported on thick parietal bone. Goal of its management include removal of the foreign object while minimizing furher damage to the brain and associated neurovascular structures, also prevent further complications.Case Description: We report a case of a 22-year-old male presented with machete stucked in his head following an accidentally fell down of the weapon from a coconut tree. The cranial location affected were midparietal. He was disoriented on admission, with neither neurological focal signs nor seizure. Computed tomography (CT) revealed that the object penetrate middle superior sagittal sinus. After emergency craniotomy to remove the objects, debridement, dural sinus repair were performed. Recovery was complete without sequelae.Conclusion: Laceration of the middle thirds of the superior sagittal sinus require special handling and care during surgery. Operative approach and treatment strategies are among the most important considerations to achieve the best patient outcomes

Surgery of Intramedullary Tumours Julius July
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
Publisher : Indoscholar

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Surgery still offers a cure to the majority of intramedullary tumours. The challenge of the surgery is taking out the tumour while preserving the function. Very often the patient has a huge tumour with very minimal symptoms, such as mild numbness. The slow growth of the tumour nature provides enough time for the cord fibres to adapt accordingly. Usually, the motor function is preserved and most of the pathologies are benign. For this reasons, the majority of cases have good long-term tumour control. The functional outcome is depending on the preoperative functional state, especially for motor function. The patient should be educated prior to surgery, especially to anticipate the post-surgical rehabilitation period. The surgical technique should preserve the motor function, but the fine movement usually gets worst for several months after surgery and slowly recover within 6 months. We share our experience of 45 surgical cases with intramedullary tumour (14F;31M), the pathologies distributions are 20 ependymomas, 8 astrocytomas (1/8 anaplastic astrocytoma), 7 cavernomas, 8 hemangioblastomas, 1 glioblastoma multiforme, and 1 tuberculoma. The location distribution varied from 27 at the cervical cord, 11 thoracal, 4 thoracolumbal, and 3 MO-upper cervical. The surgical outcome for all cases experienced sensory changes and recovered over 6 months. Almost all cases experienced some degree of spasticity and fine movement difficulty and they are improving over 6 months. Motor strength is usually preserved. One case of GBM, improve gradually for the first two months then followed by the disease course regardless of the treatment. The tuberculoma case required one year to recover her neurological function with adequate treatment.

Delayed Neurological Deficit after Traumatic Odontoid Fracture Yesaya Yunus; Julius July
Neurologico Spinale Medico Chirurgico Supplementary Issue - Conference Abstracts
Publisher : Indoscholar

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Fractures of the odontoid process can lead to gross instability of the atlantoaxial complex and present a significant risk for a potentially catastrophic spinal cord injury. Type II odontoid fractures are the most common odontoid fractures and are unstable that may displace anteriorly or posteriorly. If left untreated, the patient may develop atlantoaxial dislocation that causes neurological deficit also progressive myelopathy. We described the surgical management of four patients with a delayed neurological deficit after odontoid fracture with a history of trauma and after triggered by traditional massage. Traction several days before operation applied to achieve reduction of atlantoaxial dislocation. Posterior instrumentation and correction of atlantoaxial dislocation were performed with interarticular screw fixation (Harm technique) in all of the patients. All of the four patients showed a reduction of the atlantoaxial dislocation and also a neurological improvement. Cervical traction followed by posterior instrumented correction may be an effective alternative to treating delayed neurological deficits after traumatic odontoid fracture.

Intramedullary Spinal Cord Cavernoma: A Case Report and Literature Review Widjaya, Ingrid A; Yunus, Yesaya; Wahjoepramono, Eka Julianta; July, Julius
Medicinus Vol 13, No 1 (2023): October
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v11i2.7533

Background: Spinal cord intramedullary cavernous malformation (SICM) is kind of rare vascular disease, and the therapeutic strategy is still under debate. Cavernous malformation (CM) can be found throughout the central nervous system (CNS) but only rarely occur within the spinal cord. The purpose of this article is to describe natural history, clinical presentation and outcome of SICM case which treated surgicallyCase Presentation: A 70-year-old healthy woman presented with lower extremity weakness. A posterior laminectomy was performed, and a diagnosis of intramedullary spinal cord cavernous malformation was established. Neurological improvement was seen in one month after surgeryConclusion: Intramedullary CM is a rare disease but one with significant consequences if not managed appropriately. whenever safely feasible, gross total resection is suggested, to prevent rebleeding and further worsened of neurological deficit.

The Relationship Between Brain Tumor And Sleep Components (Psqi) In Siloam Hospitals Lippo Village 2015-2018 Uranus, Hans Christian; July, Julius
Medicinus Vol 8, No 2 (2019): February : 2019
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v7i4.2384

Introduction: Brain tumor can cause symptoms such as headache and seizure which might reduce sleep quality. Currently, sleep quality in brain tumor patients aren’t getting much attention. This study’s purpose is to determine the effect of brain tumor to sleep quality and its components in patients.Methods: The design of this study is a retrospective cohort, and it is done in Siloam Hospitals Lippo Village and Paviliun Umum Rumah Sakit Siloam from January-April 2019 with sample population consisting of brain tumor patients from age 19 until 59 years old. The sample amount is 29 subjects. PSQI is used to assess sleep quality and components. Data analysis uses the SPSS version 24.0 software and statistical analysis using chi2.Result: Brain tumor patients have worse sleep quality compared to the control, with 26 patients (89.7 %) having bad sleep quality. For the control, there are only 18 people (62.1%) who have bad sleep quality. The relationship between brain tumor and sleep quality have a p value of 0.032 and relative risk (RR) of 3,7. Brain tumor has a significant relationship with sleep latency (p value 0,015) and daytime dysfunction (p value 0,02)Conclusion: The relationship between brain tumor and sleep quality in brain tumor patients of Siloam Hospitals Lippo Village and Paviliun Umum Rumah Sakit Siloam, which was measured with the PSQI questionnaire is significant. Brain tumor also has a significant relation with sleep latency and daily dysfunction.

Case Report: Management Penetrating Brain Injury Across Middle Third of Superior Sagittal Sinus Chumaidi, Achmad; July, Julius
Medicinus Vol 12, No 1 (2022): October
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v10i2.7025

Background: Penetrating cranial injuries are rarely reported on thick parietal bone. Goal of its management include removal of the foreign object while minimizing furher damage to the brain and associated neurovascular structures, also prevent further complications.Case Description: We report a case of a 22-year-old male presented with machete stucked in his head following an accidentally fell down of the weapon from a coconut tree. The cranial location affected were midparietal. He was disoriented on admission, with neither neurological focal signs nor seizure. Computed tomography (CT) revealed that the object penetrate middle superior sagittal sinus. After emergency craniotomy to remove the objects, debridement, dural sinus repair were performed. Recovery was complete without sequelae.Conclusion: Laceration of the middle thirds of the superior sagittal sinus require special handling and care during surgery. Operative approach and treatment strategies are among the most important considerations to achieve the best patient outcomes.

Clivus Chordoma: Case Report and Current Considerations on Endoscopic Endonasal Trans-Sphenoid Surgery with Neurosurgeon-Otolaryngologist Collaboration Lekatompessy, Michael; Widyakrisna, Albertus Boyke Raditya; July, Julius
Medicinus Vol. 14 No. 1 (2024): October
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v14i1.9245

Chordomas, infrequent malignancies primarily located along the craniospinal axis, showcase gradual growth and localized bone destruction, with the clival region involved in approximately 25-35% of cases. Headaches accompanied by neurological deficits are the typical clinical presentations. Complete surgical resection is the mainstay, with recent collaborative efforts between otorhinolaryngologists and neurosurgeons leading to a positive shift from traditional craniotomic procedures to endoscopic endonasal approaches, fostering minimally invasive techniques and utilizing endoscopy for primary visualization across the neuraxis. Furthermore, the concept of team surgery has been introduced, involving simultaneous contributions from ENT surgeons and Neurosurgeons at all stages of the procedure, including the approach, resection, and reconstruction phases. This report presents a series of two successful cases of clival chordomas managed using the endoscopic endonasal approach at Siloam Hospital Lippo Village This indicates its potential as a viable surgical choice, particularly within medical centers that possess the necessary specialties. Successful implementation is notably enhanced through collaborative efforts between otolaryngologists and neurosurgeons, underscoring the significance of interdisciplinary teamwork.

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