Agung Budi Sutiono
Department of Neurosurgery, Faculty of Medicine, Universitas Padjajaran-Dr. Hasan Sadikin General Hospital
Articles
9
Documents
Anterior Transpetrosal Untuk Lesi pada Fosa Kranialis Media dan Posterior: Review Literatur dan Diseksi Kadaver

Majalah Kedokteran Bandung Vol 42, No 2 (2010)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Reseksi selektif pada bagian anterior piramid os petrosus (segitiga Kawase), dengan terlebih dahulu melakukan kraniotomi pada dinding lateral fosa kranialis media, dapat memberikan lapang pandang bedah yang cukup luas dari parasellar, clivus dan cerebellopontine angle (CPA), tanpa mengorbankan struktur organ pendengaran dalam (internal acoustics organ). Keuntungan utama teknik anterior transpetrosal ini adalah dapat langsung mengakses tumor yang melekat pada klivus melalui rongga kecil yang dibuat pada apeks os petrosus. Pengangkatan tumor dengan perdarahan yang minimal dapat dicapai dengan melakukan koagulasi pada arteri tentorium dan akses langsung ke arah anterior kanalis auditorius internus, juga dapat mengurangi cedera pada nervus fasialis dan vestibulokoklearis. Keuntungan lainnya, yaitu, rendahnya risiko komplikasi perdarahan vena, karena teknik ini tidak mengekspos sinus sigmoid ataupun vena Labbe. [MKB. 2010;42(2):86-91].Kata kunci: Anterior transpetrosal, fosa media dan posterior, diseksi kadaverAnterior Transpetrosal for Lession in Middle and Posterior Fossa: Literature Review and Cadaver DissectionResection of the anterior part of pyramid through the middle fossa craniotomy will give us a surgical field of the parasellar, clivus and cerebellopontine angle without sacrificing the auditory structure. The advantage of the anterior transpetrosal approach is the direct access to tumors that attached to the clivus via a keyhole created on the petrosus apex. Bloodless tumor removal can be achieved by detachment of the tentorial artery and direct access of the anterior internal auditory canal also can minimize the injury of the cranial nerve facialis and vestibulocochlearis. Another advantage is the low risk of venous damages since this approach is not exposing the sigmoid sinus and the vein of Labbe. [MKB. 2010;42(2):86-91].Key words: Anterior transpetrosal, middle and posterior fossa, cadaver dissection DOI: http://dx.doi.org/10.15395/mkb.v42n2.219

Cystic Meningioma in the Inter-Hemisferic Space Location

International Journal of Integrated Health Sciences VOL 4, NO 1, March (2016)
Publisher : International Journal of Integrated Health Sciences

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Abstract

Objective: The presentation of cystic meningioma in the inter-hemispheric near the falx cerebri is uncommon. It is difficult to differentiate it from intra-axial tumors, such as gliomas. Therefore, it is likely that it is misdiagnosed as other types of brain tumors.Methods: In this study, we reported a cystic meningioma case in the inter-hemispheric location, showing an intramural nodule on magnetic resonance imaging scans.Results: Patient underwent surgical treatment and pathological section confirmation revealing meningioma. The patient was a middle-age woman and had been misdiagnosed as suffering from glioma followed by slight hemipharesis on the right extremities.Conclusions: Although this is a rare case, it will be good if we always consider cystic meningioma in inter-hemispheric space when diagnosing this type of cystic lesion if the magnetic resonance imaging (MRI) shows a cystic lesion mimicking glioma image presentation.Keywords: Cystic meningioma, interhemispheric space, magnetic resonance imaging, diagnosis DOI: 10.15850/ijihs.v4n1.686

Fetus inside Brain - Mature Cystic Teratoma in Posterior Fossa

International Journal of Integrated Health Sciences VOL 4, NO 1, March (2016)
Publisher : International Journal of Integrated Health Sciences

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Abstract

Objective: To describe a rare case of posterior fossa cystic teratoma in central nervous system. Methods: A 2-year old boy was admitted with a chief complaint of decreased consciousness with tonic clonic seizure. Non-Contrast Head Computed Tomography (NCCT) scan showed acute hydrocephalus and a well-defined extra-axial cystic lesion mass, 3.4x3.9x4.2 cm in size, in the posterior fossa.Results: Patient underwent a total resection of the tumor. No systemic complication was found in ten days following the surgery. There was no evidence of tumor recurrence one year after the surgery. The histopathologycal diagnosis of the tumor was cystic teratoma.Conclusions: Mature cyst teratoma located in the posterior fossa is a rare case. Total resection and long-term follow up is the treatment of choice for mature teratoma.Keywords: Hydrocephalus, posterior fossa, teratoma DOI: 10.15850/ijihs.v4n1.687

Histological Description of Meningeal and Periosteal Dural Layers at the Porus of Internal Acoustic Canal in the Vestibular Schwannoma

International Journal of Integrated Health Sciences VOL 1, NO 1, July (2013)
Publisher : International Journal of Integrated Health Sciences

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Objective: To study the transformation point of meningeal and periosteal dural at the porus of internal acoustic canal (IAC) in order to verify the different thickness of meningeal and periosteal dura in vestibular schwannomas (VS). Methods: Three IAC cadaver specimens and ten samples of VS patients from porus were obtained and analyzed. Samples were stained by using Masson trichrome technique after cutting in 6 micron of thickness. The samples were then observed under light microscopes to understand the meninges pattern in the IAC. Results: The meningeal dura is becoming thin at the porus and disappears at the meatal portion to form epineurium. However, the periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick and forms a pseudo-capsule in the middle of meatus, known as perineurium. The residual nerve filament was compressed by the tumor parenchyma. Between the tumor and nerve interface, three or more perineureal layers are seen. The perineurium in the cisternal portion was consistently loose and forms the tumor and arachnoid nerve interface. Almost all the nerve filaments are displaced to the tumor periphery near the pseudocapsule. In contrast, the periosteal dural of VS is becoming thin and disappear nearby the middle of meatal portion. This changing site establishes “meningo-periosteal ring” of VS because of the encircling nearby the porus. Conclusions: In IAC, the meningeal dural becomes thin. The periosteal dura is lining continuously to the fundus. In VS, the meningeal dura becomes thick, joins perineurium and forms pesudocapsule near the porus, but the periosteal dura disappeared. This changing point is called meningo-periosteal ring.     Keywords: Meningeal,  periosteal, porus, vestibular schwannomasDOI: 10.15850/ijihs.v1n1.104

Modifikasi Metode Isolasi Sel Endotel Pembuluh Darah Otak (EPDO) Tikus: Teknik Dasar Kultur Sel Primer di Bidang Neurosains

Majalah Kedokteran Bandung Vol 42, No 4 (2010)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Metode konvensional isolasi sel endotel pembuluh darah otak (EPDO) masih tergolong sulit, sehingga upaya mendapatkan populasi murni sel ini adalah tantangan. Pada penelitian ini dilakukan isolasi endotel dari tikus Wistar dan mencit C57/Bl6, berdasarkan protokol the care and use of laboratory animals, Universitas Gunma, Jepang. Modifikasi metode isolasi adalah menggunakan gradasi bovine serum albumin (BSA), bukan Dextran-70 yang umumnya dipakai, untuk memisahkan sel EPDO yang bersatu menjadi sel EPDO tunggal. Penelitian ini dilakukan di laboratorium sel kultur, Universitas Padjadjaran bekerjasama dengan Universitas Gunma, Jepang, Januari 2008–Juni 2009. Uji hasil isolasi dan karakteristik sel EPDO dilakukan dengan teknik imunofloresen. Ekspresi tight junction ZO-1, menunjukkan sel EPDO membentuk selapis sel utuh, rapat, tidak bertumpuk dan kompak, sesuai dengan karakteristik dinding EPDO. Fenotip sel EPDO dikonfirmasi dengan acethylated LDL, faktor von Willebrand dan CD31. Penghancuran kapiler dengan collagenase/dispase masih menghasilkan populasi sel yang terkontaminasi perisit. Kontaminasi dimurnikan dengan menggunakan puromycin, tingkat pemurnian sel EPDO mencapai 98,3%. Simpulan, teknik modifikasi berhasil mengisolasi sel EPDO tikus dan mencit, tanpa melakukan intervensi genetik. Puromycin dapat digunakan untuk memurnikan sel EPDO. [MKB. 2010;42(4):161–8].Kata kunci: Metode modifikasi isolasi sel EPDO, pembuluh sawar otak, teknik pemurnian Isolation Modified-Method of Mouse-Brain Microvessel Endothelial Cells: Primary Cell Culture Technique in NeuroscienceIsolation method to obtain pure BMVECs is hard to be done consistently and remains a challenge. In this study, we isolated BMVECs from Wistar rat and C57/Bl6 mouse from Japan SLC. All procedures performed according to guidelines for the care and use of laboratory animals of Gunma University, Japan. The modification of isolation method was using bovine serum albumin (BSA) gradation, not Dextran-70 in which generally used, to separate clusters of BMVECs into single cell. This study was done at Universitas Padjadjaran, in colaboration with Gunma University, Japan, January 2008–June 2009. Further,characteristic and purification results were proven by imunofluorescene staining. The results showed that staining of tight junction, ZO-1, formed a monolayer, tightly packed, non-overlapping and contact-inhibited BMVECs, as expected for a vessel wall endothelial. ECs phenotype confirmed by acethylated LDL, von Willebrand and CD31. The digestion of capillaries generated contaminating pericytes. Contamination was purified using puromycin and the results considered satisfactory (98.3%). In conclusion, our modification procedure allows the isolation of primary rat and mouse BMVECs, which form an endothelial-like monolayer in few days. Puromycin can be used for purification of primary rat and mouse BMVECs. [MKB. 2010;42(4):161–8].Key words: Blood brain barrier, isolation modified-method of mouse-BMVECs, purification methods DOI: http://dx.doi.org/10.15395/mkb.v42n4.30

Anterior Interhemispheric Approach for Olfactory Groove Meningioma

International Journal of Integrated Health Sciences VOL 4, NO 2, September (2016)
Publisher : International Journal of Integrated Health Sciences

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Objective: To evaluate the surgical technique with bifrontal interhemispheric approach for total removal of tumor in olfactory groove meningioma (OGM). Methods: This study described a case of a 38-year-old woman with bilateral blindness, anosmia, and behaviour changes. Imaging studies show a tumor mass in midfrontal base. Surgery using a bifrontal interhemispheric approach was performed and total removal was achieved and postoperative computed tomography (CT) scan was performed to confirm the result. Histopathological findings established a diagnosis of meningioma.Results: A coronal skin incision behind the hairline was utilized. The scalp was elevated, taking care to reserve the vascularized pericranium medial to the linea temporalis of each side, and preserving the 2 supraorbital nerves. Eight burr holes were used, with the two initial holes made on each side of the orbitotemporal region, and the other four holes at the midline. A bifrontal craniotomy was performed. The tumor was first detached from its attachment with bipolar cautery and debulked. During this step, the main tumor feeder arteries from the anterior and posterior ethmoidal artery were interrupted, and the tumor devascularized. Total tumor removal through surgical intervention was achieved and confirmed by head CT-scan postoperatively.Conclusions: This case report supports the suitability of the bifrontal interhemispheric approach for OGM resection with additional radiation therapy.Keywords: Anterior interhemispheric approach, olfactory groove meningioma DOI: 10.15850/ijihs.v4n2.838

Pattern of Prostate Specific Antigen and Gleason Score in Relation to Imunohistochemistry Features in Prostate Adenocarcinoma Patients in Dr. Hasan Sadikin General Hospital

International Journal of Integrated Health Sciences VOL 4, NO 1, March (2016)
Publisher : International Journal of Integrated Health Sciences

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Objective: To review the correlation between prostate specific antigen (PSA) and Gleason score and Cav-1 for diagnosing prostate adenocarcinoma.Methods: Data were collected from one hundred fifty-nine patients with prostate adenocarcinoma at the Department of Urology, Dr. Hasan Sadikin General Hospital in the period of January 2008–December 2010. The PSA levels were measured and classified into <4 ng/ml, 4–10 ng/ml, and >10 ng/ml. The results were then analyzed and compared to the imunohistochemistry (caveolin-1) staining in the literature. The Gleason score was also noted and analyzed. Results: This study confirmed that positive caveolin-1 expression was related to the clinical markers of disease progression and was predictive of poor clinical outcome after surgery. The PSA results showed that one hundred fourty-one adenocarcinoma patients had a PSA level of >10 ng/ml with Gleason score of gleason 5–6 as the most common score. However, there was no correlation between PSA and Gleason score and caveolin-1 for diagnosing prostate adenocarcinoma.Conclusions: Caveolin-1 cannot be used to measure Gleason and PSA score due to different markers that have various advantages and disadvantages to predict carcinoma prostate. Therefore, further studies are needed. Keywords: Gleason score, imunohistochemistry, prostate adenocarcinoma, prostate specific antigen DOI: 10.15850/ijihs.v4n1.679

Morphometric Analysis of the Corpus, Spinal Canal and Torg Ratio Using Midsagittal Cervical Vertebrae Computed Tomography Scan: Indonesian Population

International Journal of Integrated Health Sciences VOL 2, NO 1, July (2014)
Publisher : International Journal of Integrated Health Sciences

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Objective: To determine the normal ranges of cervical spinal canal morphometry in Indonesian population and to compare the acquired data collected from other populationsMethods: Computed tomography measurements on the diameter of midsagital spinal canal and corpus of cervical vertebrae and its Torg ratio from the lower cervical (C3-C7) canal from 24 normal Indonesian adults were performed at the Radiology Department of Dr. Hasan Sadikin General Hospital. Patients who had cervical spine disorders and those under 20 years old were exluded.  We used computed tomography scan midsagittal view to measure the aforementioned parameters.    Results: The average diameter for the cervical spinal canals for the Indonesian population is comparable with those of other Asian populations such as Hongkong and India, albeit with smaller Torg ratio.     Conclusions: This study reports the normal radiological anatomy of the midsagital spinal canal and corpus of cervical vertebrae as well as Torg ratio from the lower cervical vertebrae among Indonesian population. The measurements result of this study shows that, although slightly smaller, the measurement results for those parameters are identical with other Asian populations.    Keywords: Corpus cervical vertebrae, midsagittal cervical spinal canal, Torg ratio DOI: 10.15850/ijihs.v2n1.285

Profile of traumatic brain injury (TBI) in relation with maxillofacial and thoracic injury Dr. Hasan Sadikin General Hospital, Bandung

Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 3 (2018)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

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Traumatic brain injury (TBI) has a relation with concomitant injuries, which are mostlymaxillofacial and thoracic injury. This study aimed to know which injury was common inTBI patients and the difference in the severity of TBI when patients were associated withone or both types of injuries. This was a descriptive retrospective study. The data used wasmedical records from Department of Neurosurgery, Dr. Hasan Sadikin General Hospital,Bandung, Indonesia from the period of August 2015 to July 2016. Total sampling methodwas used in this study. The variables were patients with TBI, maxillofacial injury, thoracicinjury, accident related mechanism and non-accident related mechanism and the GlasgowComa Score (GCS). The total cases for this study were 47 patients. The highest case wasmales with 37 cases and 10 for females. Accident related trauma had 23 cases whereasnon accident related trauma had 24 cases. The total cases of maxillofacial injury were 32,thoracic were 6 cases whereby for both injuries were 9 cases. Patients with mild TBI were28 cases, moderate TBI were 13 cases, and severe TBI had 6 cases in total. The rate ofTBI was higher in single injury which was the maxillofacial injury. However, the thoracicand both injuries combined had higher severity of TBI compared to maxillofacial injury.