Erythropoietin protects the subventricular zone and inhibits reactive astrogliosis in kaolin-induced hydrocephalic rats.

PURPOSE: To elucidate the potential role of erythropoietin (EPO) as a neuroprotective agent against reactive astrogliosis and reducing the thinning rate of subventricular zone (SVZ) in kaolin-induced hydrocephalic rats. METHOD: Thirty-six ten-week-old Sprague-Dawley rats were used in this study. Hydrocephalus was induced with 20% kaolin suspension injected into the cistern of thirty rats and leaving the six rats as normal group. The hydrocephalic rats were randomly divided into hydrocephalic and treatment group. The treatment group received daily dose of recombinant human erythropoietin (rhEPO) from day 7 to day 21 after induction. The animals were sacrificed at 7 (only for hydrocephalic group) and 14 or 21 (for both groups) days after induction. Brain was removed and was prepared for histological analysis by hematoxylin and eosin staining as well as immunohistochemistry for 4-HNE, GFAP, Iba-1, and Ki-67. RESULTS: Histopathological analysis showed that animals treated with rhEPO had a reduced astrocyte reactivity displayed by lower GFAP expression. Hydrocephalic rats received rhEPO also displayed reduced microglial activation shown by lower Iba-1 protein expression. Exogenous rhEPO exerted its protective action in reducing astrogliosis by inhibiting lipid peroxidation that was documented in this study as lower expression of 4-HNE than non-treated group. The SVZ thickness was progressively declining in hydrocephalus group, while the progression rate could be reduced by rhEPO. CONCLUSION: Erythropoietin has a potential use for inhibiting lipid peroxidation, and reactive astrogliosis in hydrocephalic animal model. The reduced thinning rate of SVZ demonstrated that EPO also had effect in reducing the hydrocephalus progressivity. Further research is warranted to explore its efficacy and safety to use in clinical setting.

Use of neuron-specific enolase to predict mild brain injury in motorcycle crash patients with maxillofacial fractures: A pilot study.

PURPOSE: Mild traumatic brain injury (TBI) is common but accurate diagnosis and its clinical consequences have been a problem. Maxillofacial trauma does have an association with TBI. Neuron-specific enolase (NSE) has been developed to evaluate neuronal damage. The objective of this study was to investigate the accuracy of NSE serum levels to detect mild brain injury of patients with sustained maxillofacial fractures during motor vehicle accidents. METHODS: Blood samples were drawn from 40 healthy people (control group) and 48 trauma patients who had sustained isolated maxillofacial fractures and mild brain injury in motor vehicle accidents. Brain injuries were graded by Glasgow Coma Scale. In the trauma group, correlations between the NSE serum value and different facial fracture sites were also assessed. RESULTS: The NSE serum level (mean ± SD, ng/ml) in the 48 patients with maxillofacial fractures and mild TBI was 13.12 ± 9.68, significantly higher than that measured in the healthy control group (7.72 ± 1.82, p < 0.001). The mean NSE serum level (ng/ml) in the lower part of the facial skeleton (15.44 with SD 15.34) was higher than that in the upper facial part (12.42 with SD 7.68); and the mean NSE level (ng/ml) in the middle-and lower part (11.97 with SD 5.63) was higher than in the middle part (7.88 with SD 2.64). CONCLUSION: An increase in NSE serum levels can be observed in patients sustained maxillofacial fractures and mild brain injury.

Correlation between the skull base fracture and the incidence of intracranial hemorrhage in patients with traumatic brain injury.

PURPOSE: A head injury (HI) may cause a skull fracture, which may or may not be associated with injury to the brain. In essence, a skull base fracture (SBF) is a linear fracture at the base of the skull. Loss of consciousness and Glasgow coma score (GCS) may vary depending on an associated intracranial pathology. The pathomechanism is believed to be caused by high energy impact directly to the mastoid and supraorbital bone or indirectly from the cranial vault. Aim of this study is to define the correlation between SBF and intracranial hemorrhage (ICH) in patients with HI. METHODS: Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to diagnostic criteria of SBF patients based only on clinical symptoms associated with ICH caused by HI treated in the Department of Neurosurgery at Dr. Hasan Sadikin Hospital, Bandung, Indonesia from January 1, 2012 to December 31, 2017. The exclusion criteria included age less than 15 years and no head computed tomography (CT) scan examination provided. RESULTS: A total of 9006 patients were included into this study in which they were divided into 3 groups: group 1, HI with no ICH; group 2, HI with single ICH and group 3, HI with multiple ICH. In all the SBF cases, SBF at anterior fossa accounted for 69.40% of them, which were mostly accompanied with mild HI (64.70%). Severity of HI and site of SBF correlated with the existence of traumatic brain lesions on CT scan, thus these factors were able to predict whether there were traumatic brain lesions or not. Most of the patients with epidural hemorrhage (EDH) has single traumatic lesion on CT scan, whereas most of the patients with cerebral contusion (CC) has multiple traumatic lesions on CT scan. On patients with both traumatic brain injury and SBF, most of the patients with anterior fossa SBF has EDH; whereas most of the patients with middle fossa SBF were accompanied with CC. Surgery was not required for most of the patients with SBF. CONCLUSION: SBFs were strongly correlated with traumatic ICH lesions patients with anterior fossa SBF were more likely to suffer EDH whereas with middle fossa SBF were more likely to suffer CC.

Frontoethmoidal encephalocele: clinical presentation, diagnosis, treatment, and complications in 400 cases.

PURPOSE: The purpose of this study is to review a large series of frontoethmoidal encephalocele (FEE) regarding their clinical presentation, the progressiveness of the mass volume, the skin stigmata as well as its surgical approach and post-surgical complications. METHOD: Records of all FEE patients treated in Soetomo General Hospital, Surabaya, and Charity Foundation Program from 2008 to 2015 were reviewed. Detailed patient's demography, clinical findings, radiology results, operative procedures, and complications were documented. Follow-up was organized in weekly basis for the first 1 month after surgery or more often when situation or complication occurred. Wound healing, neurological assessment for new or progressive deficit, pseudomeningocele, skin breakdown, cerebrospinal fluid (CSF) leakage, exposed implant, recurrent mass, and cosmetic results were documented. Since most of the patients had no direct phone line at their hometown, we relied on social worker to contact them. RESULTS: One-stage surgery was performed for 400 patients with FEE (212 were male and 188 were female). Of 400 patients, 388 (97%) were younger than 18 years old. Most FEEs were nasoethmoidal, either isolated or combined with nasoorbital type (347 cases [86.75%]); nasofrontal subtypes were seen in 34 cases (8.5%) and nasoorbital in 14 cases (1.5%). The mean operative time was 2 h (range 30 min-3 h). There were only two patients (0.5%) needed postoperative blood transfusions. Mean hospitalization time was 5 days (range 4-7 days). Overall, complication rate in our series was 12.5%, mostly was CSF leakage and wound dehiscence. CONCLUSION: The current socioeconomic conditions and local facility should be considered to treat these specific disease processes. The refined and meticulous technique, especially in choosing the approach and handling the dural closure, is essential in lowering the complication rate.

The Bandung neurosurgery patient outcomes project, Indonesia (Part I): Methods, participant characteristics, and pre-discharge outcomes.

INTRODUCTION: Little is known about neurosurgery patient outcomes in Indonesia. Our study sought to describe patient characteristics, health care pathways, health-related quality of life, and health/rehabilitation care needs of patients admitted to, and discharged from, a major neurosurgery department. METHODS: Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in a regional referral hospital in Bandung, Indonesia. Baseline data was collected on admission. An in-person interview (in the Indonesian language) was held 1 to 2 days pre-discharge. Sociodemographic along with clinical characteristics, Glasgow Coma Scale (GCS), and EQ-5D-5L data were collected. RESULTS: A total of 217 patients were admitted, 37 died before discharge, and a pre-discharge interview was undertaken by 178 (82%). Almost half (48%) were admitted because of injury, 38% brain tumour, 10% acute illness, and 4% other conditions. The mean age was 41 years. On admission, 63% had a mild Glasgow Coma Scale, 31% moderate, and 3% severe. The average hospital stay was 8 days for injury and 24 days for illness patients. Prior to discharge, one-third, or less, of the 178 patients interviewed reported "no problems" in the EQ-5D dimensions of mobility (32%), self-care (27%), usual activities (16%), and pain/discomfort (32%), whereas 70% reported "no problems" with anxiety/depression. CONCLUSION: A large proportion of patients are being discharged with considerable levels of difficulty in four of the five EQ-5D dimensions. This stresses the importance of providing good follow-up and support of patients and their families.

The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow-up.

INTRODUCTION: Support of neurosurgery patients following discharge from hospital is important. Currently, little is known about patients' in low- and middle-income countries before and after their hospital treatment. This companion paper reports patients' pathways before and after hospital admission and the feasibility of following up this ill-patient population by telephone. METHODS: Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in Dr. Hasan Sadikin Hospital-a regional referral hospital in Bandung City, Indonesia. Clinical data were collected on admission by clinicians. In-person interviews were undertaken with a clinical research nurse 1 to 2 days pre-discharge, and telephone follow-up interviews at 1, 2, and 3 months post-discharge. Information was also collected on pathways prior to admission and following discharge. The number of contact attempts for each patient interview was documented, as was the overall acceptability of undertaking a telephone interview. RESULTS: Of 178 patients discharged from hospital, 12 later died. Of the remaining 166 patients, 95% were able to be followed up to 3 months. Two-thirds of patients had been referred from another hospital. Patients came from, and were discharged to, locations throughout the West Java region. At the 1-month interview, 84% participants reported that they had had a follow-up consultation with a health professional-mostly with a neurosurgeon. CONCLUSION: This study has shown that, with a neurosurgery nurse delegated to the role, it is feasible to conduct follow-up telephone interviews with patients after discharge from a neurosurgery ward and that in fact such follow-up was appreciated by patients.

Development of pediatric neurosurgical service at Dr. Soetomo Hospital, Surabaya, Indonesia.

PURPOSE: This review traces the history of pediatric neurosurgery at Dr. Soetomo General Hospital (DSGH) and its role in advancing the field of pediatric neurosurgery. METHODS: The history, the founding fathers, and the next generations of the pediatric neurosurgery in DSGH were traced back from original sources and authors' life stories. RESULT: Pediatric neurosurgical service at DSGH has its own unique perspective being a pediatric service in general hospital setting. It serves second largest city of Indonesia - the fifth most populated country in the world. Historical vignette and future perspectives are narratively presented. CONCLUSION: As a pediatric neurosurgical service at general hospital in developing country, its development deserves a special mention.

Silver nanoparticles-based localized surface plasmon resonance biosensor for Escherichia coli detection.

Escherichia coli (E. coli) bacteria with varying solution concentrations have been successfully detected using silver nanoparticles (Ag NPs)-based localized surface plasmon resonance (LSPR) biosensors. The Ag NPs were effectively synthesized by a chemical method using trisodium citrate with L-Histidine (L-His) and deposited on the surface of Au thin film-coated half-cylinder BK-7 prisms. He-Ne laser with a wavelength of 632.8 nm was used to generate LSPR phenomena in Kretschmann configuration with prism/Au thin film/His-Ag NPs/E. coli bacteria/air structure arrangements. The variation of E. coli bacteria concentration was carried out to determine the effect of E. coli bacteria concentration on the LSPR curve characteristics. The characterization results showed that the size of Ag NPs was 18.7 nm, and that of His-Ag NPs was 17.9 nm. Selected area electron diffraction results indicated the formation of diffraction rings with the presence of lattice planes (111), (200), (220), and (311), proving the face-centered cubic crystal structure of silver. The absorbance peak of Ag NPs shifted from a wavelength of 421-414 nm with an increase in band gap energy from 2.94 eV to 2.99 eV, along with a decreased average particle size. The functional groups observed in His-Ag NPs showed wavenumbers at 3320 to 3318 cm-1, 2106 to 2129 cm-1, and 1635 cm-1, showing the OH, CH, and C CO bonds, respectively. The SPR angle of the prism/Au thin film/air structure is 44.80°. Meanwhile, the LSPR angle for the prism/Au thin film/His-Ag NPs/air structure is 44.92°. There is an increase in the LSPR angle by 0.12°. Moreover, the minimum reflectance increases by 0.02. After detecting E. coli bacteria, the LSPR angle shifted by 0.26°, 0.38°, and 0.49° for concentrations of 6.0 × 108 CFU/mL, 6.0 × 107 CFU/mL and 6.0 × 106 CFU/mL respectively. However, the minimum reflectance rose from 0.09° to 0.14°, 0.20°, and 0.22°. Moreover, SPR testing with the structure of the prism/Au thin film/E. coli bacteria/air was carried out to determine the contribution of His-Ag NPs for detecting E. coli bacteria. The results showed that no angular shift occurs. These results indicate that using Ag NPs encapsulated with L-His is essential in amplifying the SPR signal and detecting E. coli bacteria. There was a notable alteration in both the LSPR angle and minimum reflectance indicating that adding His-Ag NPs facilitated the interaction between the E. coli and the sensor surface, thereby enhancing the performance of LSPR-based sensors for E. coli detection for low limit of detection value at 0.47 CFU/mL.

Intervention empowerment of families in preventing and controlling overweight and obesity in children: A systematic review.

There have been an increasing overweight and obesity in very anxious children. Furthermore, obesity is a condition that occurs due to the accumulation of excess or abnormal fat. This disorder is believed to be the most significant public health problem that affects children in the 21st century. This study aimed to examine the literature review, articles and research results analyzing the effectiveness of family or parent empowerment interventions through health education. Many research articles were searched on several databases such as PubMed and PreQuest, using the following keywords which include "family empowerment", "overweight", "obesity", "health lifestyle", "BMI", "children", "RCT" starting from 2014 to 2019. The searched results obtained 162 articles on family empowerment, overweight and obesity. Out of the 162 articles, 20 were selected that discussed family empowerment interventions for overweight and obesity. Critical analysis of the 20 articles was carried out based on design, sample, treatment, parameters, findings and conclusions. The literature review analysis showed that family empowerment interventions in the form of health education or promotion activities vary widely in terms of methods, components, duration, individuals involved, specificity and effectiveness. Furthermore, this intervention consists of training activities, courses, and teaching practices. Statistical analysis showed that all these methods significantly increased the ability and independence of the family in controlling overweight and obesity. In conclusion, health education interventions that are packaged in various programs are proven to significantly improve the ability of families or parents in preventing and controlling overweight and obesity in children.

Delayed definitive treatment of life-threatening neurosurgery patient with suspected coronavirus disease 2019 infection in the midst of pandemic: Report of two cases.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has affected global health system; in the context of the COVID-19 pandemic, both surgeon and anesthesiologist often dealt with emergency situation, optimal timing of surgery and safety protocol in hospital setting must be implemented with many facets for both patients and health-care providers. CASE DESCRIPTION: We reported two cases. Case#1 - A 16-year-old male was referred to our hospital, due to a decreased of consciousness following a motor vehicle accident. Head CT scan revealed an epidural hemorrhage on the left temporoparietal. The patient was suspected for having COVID-19 from the reactivity of his serum against SARS-CoV-2 antigen. Procedures for the confirmation of COVID-19 and surgical preparation caused 12 h delayed from the admission. Nevertheless, the patient was deteriorated clinically before he was transported to the operating room and died after 6 cycles of cardiopulmonary resuscitation. Case#2 - A 25-year-old male was referred to RSHS, due to a decreased of consciousness, diagnosed as bilateral proximal shunt exposed with suspected COVID-19; delay occurred due to unavailability of negative pressure intensive unit for postoperative care. This caused 5760 h (4 days) delayed for bilateral shunt removal and temporary extraventricular drainage. CONCLUSION: Optimal timing of surgery, a good safety, and health protocol during pandemic in emergency setting are an obligation to protect health providers and patients. A decision-making plan must be organized precisely to maintain alertness, achieve the highest possible standard of care, and outcome in emergency surgical cases. Lack of monitoring must be abated to avoid fatality for patient, especially in emergency surgery setting.

Postoperative Evaluation of the Quality of Life, Depression, and Anxiety of Temporal Lobe Epilepsy Cohort: A Single Institute Experience in Indonesia.

Background: Besides seizure control, quality of life (QoL) should be considered as an equally important outcome for epilepsy surgery service providers. The paucity of QoL reports from developing countries has enlarged the representation gap between wealthy countries and countries with fewer resources. In this study, we evaluated postoperative QoL in the Indonesian drug-resistant epilepsy cohort where the epilepsy surgery service faces limited resource availability. Methods: We evaluated the QoL in patients with temporal lobe epilepsy who underwent surgery in our epilepsy surgery center in Semarang, Indonesia, from 2001 until 2015. The follow-up period started in 2018 through 2019. Postoperative QoL, depression, and anxiety were evaluated with self-reporting questionnaires including the Quality of Life in Epilepsy Inventory-31, Beck Depression Inventory-II, and Zung Self-Rating Anxiety Scales. Results: Forty returned questionnaires were included in the analysis (male 25, 62.5%; mean age 27.6 ± 9.05 years). The seizure-free cohort (n = 22, 55.0%) reported higher scores in most QoL dimensions particularly adjustment, overall QoL, and seizure worry compared to those with persistent seizures. The overall QoL level was correlated with seizure freedom and surgery type. QoL dimensions were negatively correlated with anxiety and depression levels. Conclusions: Postoperative seizure freedom was a major factor of postoperative QoL level. Besides seizure freedom, anxiety and depression levels were also negatively correlated with QoL levels in the Indonesian population.

Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review.

BACKGROUND: Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low-middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. CASE PRESENTATION: We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with "lockjaw." Perioperative management of this rare case is reported and discussed. CONCLUSION: The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

Analysis of Mutant Isocitrate Dehydrogenase 1 Immunoexpression, Ki-67 and Programmed Death Ligand 1 in Diffuse Astrocytic Tumours : Study of Single Center in Bandung, Indonesia.

OBJECTIVE: Diffuse astrocytic tumour (DAT) is a diffuse infiltrative astrocytoma tumour accompanied by molecular parameters such as the presence or absence of isocitrate dehydrogenase (IDH) gene mutations. Ki-67 is a marker for DAT proliferation, while programmed death ligand 1 (PD-L1) indicates an immune evasion mechanism. This study aimed to analyze the correlation among mutant IDH1 R132H, Ki-67, and PD-L1 immunoexpression in the DAT. METHODS: A cross-sectional study was carried out on 30 paraffin blocks of DAT cases. Paraffin block samples consist of grade II (n=14), grade III (n=8), and grade IV (n=8). In this study, the immunohistochemistry-staining of mutant IDH1 R132H, Ki-67, and PD-L1 were carried out to determine the frequency of DAT with IDH1 mutations. RESULTS: Our study shown the frequency of IDH1 mutations in grade II 50.0% (7/14), grade III 37.5% (3/8), and grade IV 12.5% (1/8). Our study also showed a difference in Ki-67 and PD-L1 expression between each the degree of DAT histopathology (p=0.0001 and p=0.002, respectively). There was an association between both mutant IDH1 R132H, and Ki-67 with PD-L1 expression in DAT (p=0.0087 and p=0.0049, respectively). CONCLUSION: DAT with the mutant IDH1 is frequently observed in grade II and small number of grade III. The expression of wild type IDH1, Ki-67, and PD-L1 were found to be higher in high grade DAT (grade III and grade IV). There is a correlation between each of mutant IDH1 status and Ki-67 with PD-L1 expression in DAT.

Indonesian online newspaper reporting of suicidal behavior: Compliance with World Health Organization media guidelines.

BACKGROUND: Despite the lack of attention, suicide is a major public and mental health problem in Indonesia. Research on how Indonesian newspapers portray suicide case has been lacking. AIM: To assess the quality of Indonesian online newspaper reporting suicide news and its compliance with the World Health Organization (WHO) mass media reporting guidelines. METHODS: The content of suicide news reported in online newspapers was searched and scrutinized against the WHO suicide reporting guidelines. RESULTS: Within the duration of 6 months, there were 548 suicide news reported. This consisted of 16.8% attempted suicide and 83.2% completed suicide. Approximately 90.3% reported age, 97.3% reported gender and 64.3% reported the marital status of the victims. Furthermore, 68% reported the methods of suicide in headline or title, 40.5% shown the picture of the victims and 56.6% shown illustration only, and 67.2% reported life event related to suicide act. CONCLUSION: The vast majority of online newspapers in Indonesia exaggerate suicide news. They rarely inform the readers that there is hope and help available. The majority also do not conform to the WHO media guidelines.

Identification of Periostin as a Potential Biomarker in Gliomas by Database Mining.

BACKGROUND: Bioinformatics analysis integrating microenvironmental factors and single cell analysis segregated the glioblastoma (GBM) subtype into 3 subtypes: proneural, classic, and mesenchymal. Mesenchymal GBM tends to have the worst survival but benefits from aggressive treatment protocols. Therefore, it is clinically meaningful to identify relevant biomarkers to distinguish the mesenchymal subtype. Moreover, in developing nations with limited resources, rigorous examinations are costly and inefficient for patient care. METHODS: In this study, we analyzed The Cancer Genome Atlas (TCGA)-Glioblastoma and TCGA-Low-Grade Glioma RNA sequencing (RNAseq) cohorts and confirmed that the mesenchymal subtype was associated with the worst prognosis. RESULTS: We identified periostin (POSTN) as a mesenchymal subtype biomarker with prognostic value across histologic grades and confirmed the reliability of POSTN by gene expression meta-analysis combining TCGA, Chinese Glioma Genome Atlas (CGGA) and REMBRANDT (Repository for Molecular Brain Neoplasia Data) GBM cohorts (hazard ratio, 1.71 [range, 1.47-2.07], n = 693) and LGG cohorts (hazard ratio, 2.55 [range, 1.61-4.05], n = 1226). CONCLUSIONS: By using available online glioma databases, our study provided an insight into the expression of POSTN as an independent predictor for patients with glioma (GBM and LGG) and could be useful for diagnostic simplification to identify high-risk groups.

The neurological significance of COVID-19: Lesson learn from the pandemic.

Coronavirus Infectious Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; previously known as 2019 novel coronavirus) is an emerging and rapidly evolving health issue that has been widespread globally and become a pandemic. The typical symptoms of COVID-19 are: a cough, shortness of breath and a fever; from the initial estimates, about 15% of COVID-19 patients present with severe respiratory symptoms and requires hospitalization and intensive care. Recent accumulated evidences showed that the neurological insults also occurred in patients with COVID-19, ranging from mild headache to severe neurological symptoms. In this review, we summarize the COVID-19 and neurological significance of COVID-19.

Feasibility of Online Traumatic Brain Injury Prognostic Corticosteroids Randomisation After Significant Head Injury (CRASH) Model as a Predictor of Mortality.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of mortality in many countries. According to the World Health Organization, traffic crashes are a leading cause of death, with 1.25 million deaths worldwide in 2013. A 2013 global road safety report listed 68 low-to-middle income countries that had an increased mortality rate owing to traffic accidents. The aim of this study was to analyze feasibility of use of an online prognostic model from the Medical Research Council Corticosteroids Randomization After Significant Head Injury (CRASH) trial collaborators in our center. METHODS: This is a cross-sectional retrospective study of 229 patients with TBI who were admitted to the Neurosurgery Unit at Dr. Hasan Sadikin Hospital, Bandung, from July to December 2016. RESULTS: During the study period, 495 patients with TBI were admitted; 229 patients were included in the study. Several variables were analyzed using independent statistical methods before being included in the online CRASH calculator, including Glasgow Coma Scale score (P = 0.000), pupillary reaction to light (P = 0.000), major extracranial injury (P = 0.002), and interval following incidence (P = 0.000). Statistical analysis showed that the online CRASH prognostic model reliably predicted 14-day mortality rate (P = 0.000) with 91.6% sensitivity and 95.1% specificity. CONCLUSIONS: The online CRASH model is a good prognostic model that can be used for patients with TBI in many developing countries.

Correlation of Lactate Concentration in Peripheral Plasma and Cerebrospinal Fluid with Glasgow Outcome Scale for Patients with Tuberculous Meningitis Complicated by Acute Hydrocephalus Treated with Fluid Diversions.

BACKGROUND: Tuberculous meningitis (TBM) is an endemic infectious disease in developing countries, and it can become a serious illness in children. Treatment of TBM is more difficult and prone to failure than treatment of pulmonary tuberculosis. TBM causes hydrocephalus, cerebral edema, increased intracranial pressure, global ischemia, and neurologic deficits, which disturb cellular metabolism and increase lactate levels. A reliable, widely available clinical indicator of TBM severity is needed. Successful treatment of TBM is assessed using the Glasgow Outcome Scale (GOS). METHODS: This prospective cohort study included 34 patients with TBM and acute hydrocephalus who had undergone fluid diversions and were admitted to Dr. Hasan Sadikin Hospital in Bandung from 2014 to 2015. A portable machine for blood glucose measurement was used to measure lactate concentrations. Statistical significance was defined as P ≤ 0.05. RESULTS: Average levels of plasma and cerebrospinal fluid (CSF) lactate were 1.99 ± 0.70 mmol/L and 3.04 ± 1.05 mmol/L, respectively. A significantly higher level of lactate was observed in CSF compared with plasma. Preoperative plasma lactate was negatively correlated to GOS (r = -0.539; P = 0.013), and CSF lactate was negatively correlated to GOS (r = -0.412; P = 0.027). Average lactate levels in CSF (central) were higher than plasma (peripheral) levels. GOS scale of patients decreased with increased plasma and CSF lactate levels. CONCLUSIONS: Examination of plasma and CSF lactate levels should be included in routine examinations to determine extent of cellular damage and GOS score in patients with TBM and acute hydrocephalus who have undergone fluid diversions.

An Infratemporal Dermoid Cyst That Expanded the Foramen Ovale: A Case Report.

BACKGROUND: Dermoid cysts are rare tumors usually seen in the midline structure of the brain but rarely arise in the petrous apex and cavernous sinus. There have been very few reports of dermoid cysts arising in the infratemporal fossa, with scarce anatomic descriptions. Here we report the case of a patient with a dermoid cyst in the left infratemporal fossa. CASE DESCRIPTION: The patient was a 43-year-old female with complaints of nonspecific headaches. A computed tomography (CT) scan revealed a cystic lesion measuring 25 × 18 × 15 mm in the left infratemporal fossa that had expanded the foramen ovale. The same lesion was observed as a high-intensity area on T1-weighted magnetic resonance imaging (MRI) with fat saturation. Diffusion-weighted MRI showed no restriction, unlike in cases of epidermoid cysts. A left fronto-temporo-sphenoidal craniotomy with a detachment of the zygoma was performed to approach the lesion. The tumor wall was continuously attached to the dura, although the tumor itself was entirely extradural in location. The V3 branch of the trigeminal nerve was firmly attached around the tumor. The tumor was cystic, and it shrunk after the fatty yellowish contents were suctioned. Complete resection was achieved without complications. A pathological analysis enabled the diagnosis of a dermoid cyst. No tumor recurrences or associated complications were observed at the 1-year follow-up. CONCLUSIONS: Dermoid cysts in the infratemporal fossa are extremely rare. However, tumor resections can be performed safely and efficaciously using anatomically detailed preoperative planning.