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Coiling Versus Stenting for Giant Cavernous Sinus Aneurysms: A Case Report on the Resolution of Oculomotor Nerve Palsy Nelsi Marintan Tampubolon; Geizar Arsika Ramadhana
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 3 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i3.712

Giant intracranial aneurysms (GIAs), defined as those exceeding 25 mm, represent a subset of cerebrovascular lesions with significant potential for morbidity due to mass effect and rupture. Compression of cranial nerves, particularly the oculomotor nerve (N. III), by these aneurysms can lead to debilitating symptoms such as ptosis, ophthalmoplegia, and diplopia. Endovascular management, including coiling and stenting, offers minimally invasive treatment options, but the optimal approach remains a subject of ongoing investigation. We present a case of a 28-year-old male with a giant aneurysm of the right cavernous sinus who presented with progressive right oculomotor nerve palsy, characterized by marked ptosis and visual impairment. Initially scheduled for stent placement, the patient underwent endovascular coiling following diagnostic digital subtraction angiography (DSA). Serial neurological assessments and follow-up DSA evaluations were conducted to monitor treatment efficacy and aneurysm stability. In conclusion, this case demonstrates that endovascular coiling can be a valuable therapeutic strategy for giant cavernous sinus aneurysms manifesting with oculomotor nerve compression. Despite the theoretical advantages of stenting in promoting aneurysm obliteration and reducing mass effect, coiling facilitated significant and sustained clinical improvement, specifically the resolution of ptosis and amelioration of visual deficits in this patient. This case underscores the importance of individualized treatment planning in the management of complex intracranial aneurysms.

Atypical Presentation of Cerebellopontine Angle Dermoid Cyst: A Case of Secondary Trigeminal Neuralgia Prima Budi Prayogi; Galih Indra Permana; Hanis Setyono; Ferry Wijanarko; Geizar Arsika Ramadhana; Muhammad Fauzan Jauhari
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 4 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i4.753

Dermoid cysts are rare congenital ectodermal inclusion cysts, accounting for a small percentage of all intracranial tumors. Their occurrence in the cerebellopontine angle (CPA) is infrequent, and presentation as isolated trigeminal neuralgia (TN) is considered atypical. This study underscores that rare congenital lesions like dermoid cysts can manifest with relatively common neurological symptoms, prompting clinicians to consider a broader differential diagnosis A 60-year-old female presented with a two-year history of paroxysmal, shock-like pain in the left cheek and intraoral area, triggered by light touch, consistent with trigeminal neuralgia. Neurological examination was otherwise largely unremarkable initially, though the pain significantly impacted her quality of life and nutritional intake, leading to weight loss. Magnetic Resonance Imaging (MRI) revealed an extra-axial lesion in the CPA, compressing the trigeminal nerve. The lesion exhibited characteristics suggestive of an epidermoid or arachnoid cyst initially, but with features also compatible with a dermoid cyst. The patient underwent a retrosigmoid craniotomy for microsurgical excision of the lesion. Intraoperatively, a cystic lesion with contents suggestive of a dermoid cyst was found adherent to the trigeminal nerve and surrounding structures. Histopathological examination confirmed the diagnosis of a dermoid cyst. Postoperatively, the patient experienced significant relief from her trigeminal neuralgia. In conclusion, CPA dermoid cysts, though rare, should be considered in the differential diagnosis of secondary trigeminal neuralgia, even in atypical presentations. MRI is crucial for diagnosis, and surgical excision aiming for maximal safe resection is the mainstay of treatment, offering potential for symptom resolution. Long-term follow-up is necessary due to the potential for recurrence if the residual cyst wall remains. This case underscores the importance of considering rare pathologies in common clinical presentations.

A 63-Year-Old Man with Neurofibromatosis Type 1 and Intracerebral Astrocytoma: A Case Report Wicaksana, Iman Hakim; Geizar Arsika Ramadhana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 1 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i1.911

Background: Neurofibromatosis type 1 (NF-1) is one of the hereditary neurocutaneous disorders. Neurofibromatosis type 1 has broad clinical manifestations that can occur in the skin, bones, eyes, and nervous system. In progressive cases, NF-1 can malign and cause intracerebral tumor lesions. Astrocytoma, especially pilocytic astrocytoma, is one of the tumor classes that patients with NF-1 can develop with far-reaching disease progression. This case report presents a case of NF-1 with intracerebral astrocytoma. Case presentation: A 63-year-old man with whole body lumps since childhood presented with weakness in the right limbs 1 month ago. 3 months earlier, the patient also had a full-body seizure for 1 minute twice. The patient then underwent a magnetic resonance imaging (MRI) examination of the brain and found a mass in the left centrum semiovale, left corona radiata, left insular, left external capsule, and left frontotemporoparietal lobe with a size of 7.2 x 5.3 x 6.2 cm. The patient then underwent a VP shunt followed by tumor resection. The tumor was successfully evacuated, and histopathological examination with hematoxylin & eosin (HE) staining revealed glioblastoma multiformis. The patient also underwent histopathologic examination with Ki-67 immunohistochemistry (IHC) staining and showed pilocytic astrocytoma. Conclusion: Craniotomy of tumor excision is the definitive therapy in neurofibromatosis patients accompanied by intracerebral astrocytoma.

A 63-Year-Old Man with Neurofibromatosis Type 1 and Intracerebral Astrocytoma: A Case Report Wicaksana, Iman Hakim; Geizar Arsika Ramadhana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 1 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i1.911

Background: Neurofibromatosis type 1 (NF-1) is one of the hereditary neurocutaneous disorders. Neurofibromatosis type 1 has broad clinical manifestations that can occur in the skin, bones, eyes, and nervous system. In progressive cases, NF-1 can malign and cause intracerebral tumor lesions. Astrocytoma, especially pilocytic astrocytoma, is one of the tumor classes that patients with NF-1 can develop with far-reaching disease progression. This case report presents a case of NF-1 with intracerebral astrocytoma. Case presentation: A 63-year-old man with whole body lumps since childhood presented with weakness in the right limbs 1 month ago. 3 months earlier, the patient also had a full-body seizure for 1 minute twice. The patient then underwent a magnetic resonance imaging (MRI) examination of the brain and found a mass in the left centrum semiovale, left corona radiata, left insular, left external capsule, and left frontotemporoparietal lobe with a size of 7.2 x 5.3 x 6.2 cm. The patient then underwent a VP shunt followed by tumor resection. The tumor was successfully evacuated, and histopathological examination with hematoxylin & eosin (HE) staining revealed glioblastoma multiformis. The patient also underwent histopathologic examination with Ki-67 immunohistochemistry (IHC) staining and showed pilocytic astrocytoma. Conclusion: Craniotomy of tumor excision is the definitive therapy in neurofibromatosis patients accompanied by intracerebral astrocytoma.

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