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Delayed-Onset Surgical Site Infection after Sphenoid Wing Meningioma Resection: A Case Report Highlighting Diagnostic and Management Challenges Sumargo, Sheila; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (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.v8i12.1142

Background: Surgical site infections (SSIs) following craniotomy, while uncommon, pose significant risks. Delayed-onset infections can present diagnostic and management challenges. We report a case of delayed-onset SSI after sphenoid wing meningioma resection, emphasizing the importance of vigilance and prompt intervention. Case presentation: A 26-year-old male underwent craniotomy for a right sphenoid wing meningioma. He presented 13 days post-operatively with a fluctuant swelling at the surgical site. Imaging revealed a subgaleal and epidural abscess. He underwent craniectomy, debridement, and antibiotic therapy, resulting in complete resolution. Conclusion: Delayed-onset SSIs after craniotomy necessitate a high index of suspicion. Early diagnosis and aggressive management, including surgical debridement and appropriate antibiotics, are crucial for optimal outcomes.

Recurrent Giant Parasagittal Meningioma WHO Grade I: A Case Report Highlighting the Challenges of Management and the Role of Molecular Markers Sumargo, Sheila; Selfy Oswari; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (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.v8i12.1141

Background: Meningiomas are common intracranial tumors, but their recurrence, especially in giant parasagittal locations, presents significant management challenges. This case report underscores these challenges and emphasizes the potential role of molecular markers in improving prognostication and treatment strategies. Case presentation: A 31-year-old female presented with recurrent giant parasagittal meningioma WHO Grade I. She underwent multiple surgeries and embolizations due to persistent tumor regrowth despite histologically benign features. The tumor's location, size, and involvement of critical structures posed surgical difficulties, highlighting the limitations of current management approaches. Conclusion: This case emphasizes the need for a more nuanced understanding of meningioma recurrence beyond histological grading. Molecular markers may offer valuable insights into tumor behavior and guide personalized treatment decisions, potentially improving outcomes for patients with recurrent meningiomas.

Determinants of Recurrence in Intracranial Meningioma: A Decade of Experience with Surgical and Pathological Correlations in Bandung, Indonesia Sumargo, Sheila; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1321

Background: Intracranial meningiomas are common primary central nervous system tumors, mostly benign, yet recurrence remains a significant clinical challenge influencing patient prognosis. Understanding the characteristics and determinants of recurrence, particularly in specific populations, is crucial. Data on recurrent meningioma from developing countries like Indonesia are limited. This study aimed to describe the clinicopathological features and surgical management experience of recurrent intracranial meningiomas over a 10-year period at a tertiary referral hospital in Bandung, Indonesia. Methods: A retrospective analysis was conducted on all adult patients (≥18 years) surgically treated for recurrent intracranial meningioma at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, between January 2012 and December 2022. Patients with incomplete records were excluded. Data collected included demographics, clinical presentation, radiological findings (tumor location, bone infiltration, tumor invasion), surgical history (number of resections, time to recurrence), and histopathological results. Descriptive statistics were used for analysis. Results: Twenty-eight patients met the inclusion criteria. The cohort was predominantly female (n=24, 85.7%) with a median age of 46 years (range 26-67). The most common presenting symptoms were protrusion (n=11, 39.3%) and headache (n=7, 25.0%). Tumors were most frequently located in the parietal (n=10, 35.7%) and sphenoorbital (n=9, 32.1%) regions. Significant bone infiltration was observed in 75.0% (n=21) of cases. Tumor invasion into adjacent structures occurred in 21.4% (n=6), most commonly involving the cavernous sinus (n=2, 7.1% of total / 33.3% of invaded). The median time to recurrence detection was 36 months (range 6-144). Most patients (n=22, 78.6%) underwent two tumor removal surgeries during the study period. Based on available histopathology (n=17), meningothelial (n=10, 35.7% of total / 58.8% of available) and transitional (n=3, 10.7% of total / 17.6% of available) subtypes were the most common WHO Grade 1 diagnoses. One case each of atypical (Grade 2) and malignant (Grade 3) meningioma were identified. Conclusion: Recurrent intracranial meningiomas predominantly affected middle-aged females, often presenting with symptoms related to mass effect in parietal and sphenoorbital locations. High rates of bone infiltration and significant tumor invasion, particularly involving the cavernous sinus, were characteristic features. Recurrence was typically diagnosed within 3 years, with meningothelial and transitional subtypes being the most frequent histologies observed in this recurrent group. These findings underscore the complex nature of meningioma recurrence and highlight the need for tailored management strategies and long-term surveillance, particularly in cases with high-risk features like bone and sinus invasion.

Navigating Spheno-Orbital Meningioma in Indonesia: Clinical Characteristics and Diagnostic Considerations from a Decade of Experience Sumargo, Sheila; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1326

Background: Spheno-orbital meningiomas (SOM) represent a distinct subgroup of meningiomas originating from the sphenoid wing, characterized by orbital extension, significant bony invasion, and hyperostosis. These tumors present diagnostic and therapeutic challenges due to their complex anatomical location near critical neurovascular structures and a notable tendency for recurrence. Understanding the specific clinical profile of SOM patients is essential for timely diagnosis and effective management strategies. This study aimed to delineate these characteristics within an Indonesian population. Methods: A retrospective, descriptive, cross-sectional study was performed using medical record data from patients diagnosed with SOM between January 2012 and December 2022 at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Data collected included patient demographics, case history (new vs. recurrent), presenting symptoms, neurological status (Glasgow Coma Scale), and radiological findings (lesion singularity/multiplicity). Total sampling was employed, and data were analyzed descriptively. Results: The study included 252 subjects. A striking female predominance was observed (95.6%), with a mean patient age of 44.3 years (range 14-79). The vast majority were new cases (94.4%). Protrusion (proptosis) was the most frequent presenting symptom (79.0%), followed by headache (11.1%), blindness (5.2%), and blurred vision (4.0%). Most patients (97.2%) were fully conscious (GCS 15) upon admission. Radiological assessment revealed single lesions in 71.4% of cases. Conclusion: In this large Indonesian cohort, SOM predominantly affected middle-aged females and typically presented with proptosis. Awareness of this distinct clinical signature is crucial for improving diagnostic accuracy and facilitating prompt, comprehensive management. The findings underscore the need for high clinical suspicion, particularly in female patients presenting with orbital symptoms.

Determinants of Recurrence in Intracranial Meningioma: A Decade of Experience with Surgical and Pathological Correlations in Bandung, Indonesia Sumargo, Sheila; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1321

Background: Intracranial meningiomas are common primary central nervous system tumors, mostly benign, yet recurrence remains a significant clinical challenge influencing patient prognosis. Understanding the characteristics and determinants of recurrence, particularly in specific populations, is crucial. Data on recurrent meningioma from developing countries like Indonesia are limited. This study aimed to describe the clinicopathological features and surgical management experience of recurrent intracranial meningiomas over a 10-year period at a tertiary referral hospital in Bandung, Indonesia. Methods: A retrospective analysis was conducted on all adult patients (≥18 years) surgically treated for recurrent intracranial meningioma at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, between January 2012 and December 2022. Patients with incomplete records were excluded. Data collected included demographics, clinical presentation, radiological findings (tumor location, bone infiltration, tumor invasion), surgical history (number of resections, time to recurrence), and histopathological results. Descriptive statistics were used for analysis. Results: Twenty-eight patients met the inclusion criteria. The cohort was predominantly female (n=24, 85.7%) with a median age of 46 years (range 26-67). The most common presenting symptoms were protrusion (n=11, 39.3%) and headache (n=7, 25.0%). Tumors were most frequently located in the parietal (n=10, 35.7%) and sphenoorbital (n=9, 32.1%) regions. Significant bone infiltration was observed in 75.0% (n=21) of cases. Tumor invasion into adjacent structures occurred in 21.4% (n=6), most commonly involving the cavernous sinus (n=2, 7.1% of total / 33.3% of invaded). The median time to recurrence detection was 36 months (range 6-144). Most patients (n=22, 78.6%) underwent two tumor removal surgeries during the study period. Based on available histopathology (n=17), meningothelial (n=10, 35.7% of total / 58.8% of available) and transitional (n=3, 10.7% of total / 17.6% of available) subtypes were the most common WHO Grade 1 diagnoses. One case each of atypical (Grade 2) and malignant (Grade 3) meningioma were identified. Conclusion: Recurrent intracranial meningiomas predominantly affected middle-aged females, often presenting with symptoms related to mass effect in parietal and sphenoorbital locations. High rates of bone infiltration and significant tumor invasion, particularly involving the cavernous sinus, were characteristic features. Recurrence was typically diagnosed within 3 years, with meningothelial and transitional subtypes being the most frequent histologies observed in this recurrent group. These findings underscore the complex nature of meningioma recurrence and highlight the need for tailored management strategies and long-term surveillance, particularly in cases with high-risk features like bone and sinus invasion.

Navigating Spheno-Orbital Meningioma in Indonesia: Clinical Characteristics and Diagnostic Considerations from a Decade of Experience Sumargo, Sheila; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1326

Background: Spheno-orbital meningiomas (SOM) represent a distinct subgroup of meningiomas originating from the sphenoid wing, characterized by orbital extension, significant bony invasion, and hyperostosis. These tumors present diagnostic and therapeutic challenges due to their complex anatomical location near critical neurovascular structures and a notable tendency for recurrence. Understanding the specific clinical profile of SOM patients is essential for timely diagnosis and effective management strategies. This study aimed to delineate these characteristics within an Indonesian population. Methods: A retrospective, descriptive, cross-sectional study was performed using medical record data from patients diagnosed with SOM between January 2012 and December 2022 at the Department of Neurosurgery, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Data collected included patient demographics, case history (new vs. recurrent), presenting symptoms, neurological status (Glasgow Coma Scale), and radiological findings (lesion singularity/multiplicity). Total sampling was employed, and data were analyzed descriptively. Results: The study included 252 subjects. A striking female predominance was observed (95.6%), with a mean patient age of 44.3 years (range 14-79). The vast majority were new cases (94.4%). Protrusion (proptosis) was the most frequent presenting symptom (79.0%), followed by headache (11.1%), blindness (5.2%), and blurred vision (4.0%). Most patients (97.2%) were fully conscious (GCS 15) upon admission. Radiological assessment revealed single lesions in 71.4% of cases. Conclusion: In this large Indonesian cohort, SOM predominantly affected middle-aged females and typically presented with proptosis. Awareness of this distinct clinical signature is crucial for improving diagnostic accuracy and facilitating prompt, comprehensive management. The findings underscore the need for high clinical suspicion, particularly in female patients presenting with orbital symptoms.

Recurrent Giant Parasagittal Meningioma WHO Grade I: A Case Report Highlighting the Challenges of Management and the Role of Molecular Markers Sumargo, Sheila; Selfy Oswari; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (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.v8i12.1141

Background: Meningiomas are common intracranial tumors, but their recurrence, especially in giant parasagittal locations, presents significant management challenges. This case report underscores these challenges and emphasizes the potential role of molecular markers in improving prognostication and treatment strategies. Case presentation: A 31-year-old female presented with recurrent giant parasagittal meningioma WHO Grade I. She underwent multiple surgeries and embolizations due to persistent tumor regrowth despite histologically benign features. The tumor's location, size, and involvement of critical structures posed surgical difficulties, highlighting the limitations of current management approaches. Conclusion: This case emphasizes the need for a more nuanced understanding of meningioma recurrence beyond histological grading. Molecular markers may offer valuable insights into tumor behavior and guide personalized treatment decisions, potentially improving outcomes for patients with recurrent meningiomas.

Delayed-Onset Surgical Site Infection after Sphenoid Wing Meningioma Resection: A Case Report Highlighting Diagnostic and Management Challenges Sumargo, Sheila; Guata Naibaho; Roland Sidabutar
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 12 (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.v8i12.1142

Background: Surgical site infections (SSIs) following craniotomy, while uncommon, pose significant risks. Delayed-onset infections can present diagnostic and management challenges. We report a case of delayed-onset SSI after sphenoid wing meningioma resection, emphasizing the importance of vigilance and prompt intervention. Case presentation: A 26-year-old male underwent craniotomy for a right sphenoid wing meningioma. He presented 13 days post-operatively with a fluctuant swelling at the surgical site. Imaging revealed a subgaleal and epidural abscess. He underwent craniectomy, debridement, and antibiotic therapy, resulting in complete resolution. Conclusion: Delayed-onset SSIs after craniotomy necessitate a high index of suspicion. Early diagnosis and aggressive management, including surgical debridement and appropriate antibiotics, are crucial for optimal outcomes.

Longitudinal Observational Analysis of Traumatic Brain Injury Epidemiology and Pre-Hospital Intervals During the COVID-19 Pandemic in a West Java Tertiary Center Ni Wayan Lisa Suasti; Akhmad Imron; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1517

Background: The COVID-19 pandemic necessitated large-scale social restrictions (PSBB) in Indonesia, drastically altering population mobility and, consequently, the landscape of neurotrauma. While the reduction in road traffic Incidents (RTIs) during lockdowns is well-documented, the collateral impact on the golden hour—the critical pre-hospital interval for traumatic brain injury (TBI) resuscitation—remains under-researched in lower-middle income countries (LMICs). This study analyzes the longitudinal shifts in TBI epidemiology, injury mechanisms, and hospital admission intervals across pre-pandemic, pandemic, and relaxation phases. Methods: This retrospective observational study analyzed 1,519 TBI patients admitted to the Emergency Department of Dr. Hasan Sadikin General Hospital (RSHS), a tertiary referral center in West Java, from January 2019 to December 2021. The cohort was stratified into three phases: Pre-Pandemic (2019), Pandemic/PSBB (2020), and Relaxation (2021). Variables included demographics, injury mechanisms, Glasgow Coma Scale (GCS), loss of consciousness (LOC), and Hospital Admission Interval (MRS). Results: Total TBI admissions exhibited a sharp V-shaped trend, decreasing by 75% in 2020 compared to 2019, driven by a collapse in RTI volume (490 to 107 cases). Admissions rebounded in 2021 (n=705). Males (78.4%) and young adults (15-24 years) constituted the majority, with RTI accounting for 74.78% of all mechanisms. While pediatric (0-4 years) and geriatric (≥65 years) groups were prone to falls, the most critical finding concerned pre-hospital delays. Despite reduced traffic density, only 3.23% of patients arrived within the golden hour (<1 hour). The majority (40.42%) arrived between 5-12 hours, and a significant cohort (17.44%) experienced delays exceeding 12 hours, indicating persistent systemic barriers to rapid care regardless of road conditions. Conclusion: The pandemic successfully suppressed TBI volume through mobility restrictions but failed to improve pre-hospital admission times. The persistence of significant delays (>5 hours) for the vast majority of patients highlights that the barriers to the golden hour in Indonesia are structural rather than traffic-dependent. Future trauma systems must address these pre-hospital inefficiencies to improve outcomes.

Metabolic and Inflammatory Signatures of Neurotrauma: Correlating Early Glycemic and Leukocytic Shifts with Glasgow Coma Scale Scores Ni Wayan Lisa Suasti; Roland Sidabutar; Agung Budi Sutiono; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (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.v10i2.1519

Background: Traumatic brain injury (TBI) precipitates a profound systemic physiological stress response, often termed the sympathetic storm, characterized by neuroendocrine dysregulation and widespread inflammation. While admission biomarkers such as White Blood Cell (WBC) count and Blood Glucose levels are routinely measured, their comparative utility in stratifying injury severity—particularly in distinguishing between moderate and severe phenotypes—remains under-characterized. This study aimed to evaluate the discriminatory power of these markers, hypothesizing that metabolic and immune responses exhibit distinct saturation kinetics relative to the Glasgow Coma Scale (GCS). Methods: We conducted a retrospective analytical observational study at Dr. Hasan Sadikin General Hospital (RSHS), a level I trauma center in Bandung, Indonesia. From an annual pool of admitted neurotrauma patients (January–December 2021), a stratified sample of 238 patients aged 18-60 years was analyzed. Strict exclusion criteria were applied to minimize confounders, including a history of metabolic disease and alcohol intoxication. TBI severity was stratified into mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS 3-8). Statistical analysis utilized the Kruskal-Wallis and Mann-Whitney tests to assess non-parametric relationships. Results: The cohort was predominantly male (82.8%) and young (18-40 years, 68.9%). Both biomarkers correlated with overall severity; however, their trajectories diverged significantly. WBC counts exhibited a threshold effect, rising significantly from Mild (17.50 ± 6.56 x10³/µL) to Moderate (18.81 ± 5.27 x10³/µL) severity, but plateauing between moderate and severe groups (p>0.05), suggesting a saturation of the demargination response. Conversely, blood glucose displayed a graded linear escalation: Mild (133.11 ± 34.53 mg/dL), moderate (158.35 ± 49.59 mg/dL), and severe (226.14 ± 105.61 mg/dL) (p<0.001), with significant discrimination across all severity pairings. Conclusion: Admission hyperglycemia serves as a superior, graded biomarker for stratifying TBI severity compared to leukocytosis, which functions primarily as a binary threshold marker. The observed immune plateau contrasts with the linear metabolic scaling, highlighting stress-induced hyperglycemia as a critical indicator of severe neuro-metabolic derangement.

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