Publications by authors named "Agus Turchan"

20 Publications

  • Page 1 of 1

The Effect of Intrathecal Injection of Dextromethorphan on the Experimental Neuropathic Pain Model.

Anesth Pain Med 2021 Jun 29;11(3):e114318. Epub 2021 Jun 29.

Neurosurgery Department, Faculty of Medicine, Dr. Soetomo General Academic Hospital, Universitas Airlangga, Surabaya, Indonesia.

Background: Peripheral glucocorticoid receptors (GRs) are altered by peripheral nerve injury and may modulate the development of neuropathic pain. Two central pathogenic mechanisms underlying neuropathic pain are neuroinflammation and N-methyl-D-aspartate receptor (NMDAR)-dependent neural plasticity in the spinal cord.

Objectives: This study examined the effect of the non-competitive NMDAR antagonist dextromethorphan on partial sciatic nerve ligation (PSL)-induced neuropathic pain and the spinal expression of the glucocorticoid receptor (GR).

Methods: Male mice were randomly assigned into a sham group and two groups receiving PSL followed by intrathecal saline vehicle or dextromethorphan (iDMP). Vehicle or iDMP was administered 8 - 14 days after PSL. The hotplate paw-withdrawal latency was considered to measure thermal pain sensitivity. The spinal cord was then sectioned and immunostained for GR.

Results: Thermal hyperalgesia developed similarly in the vehicle and iDMP groups prior to the injections (P = 0.828 and 0.643); however, it was completely mitigated during the iDMP treatment (P < 0.001). GR expression was significantly higher in the vehicle group (55.64 ± 4.50) than in the other groups (P < 0.001). The iDMP group (9.99 ± 0.66) showed significantly higher GR expression than the sham group (6.30 ± 1.96) (P = 0.043).

Conclusions: The suppression of PLS-induced thermal hyperalgesia by iDMP is associated with the downregulation of GR in the spinal cord, suggesting that this analgesic effect is mediated by inhibiting GR-regulated neuroinflammation.
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http://dx.doi.org/10.5812/aapm.114318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438745PMC
June 2021

Chronic subdural hematoma-induced parkinsonism: A systematic review.

Clin Neurol Neurosurg 2021 Sep 21;208:106826. Epub 2021 Jul 21.

Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical cases, especially in elderly individuals. Secondary parkinsonism due to CSDH is a rare entity. The mechanism of parkinsonism symptoms in chronic subdural hematoma has been suggested to include direct mechanical compression of the basal ganglia due to hematoma or indirectly through brain structure changes due to space lesions and vascular disorders. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms.

Objectives: To systematically review the literature on CSDH-induced parkinsonism.

Search Methods: This is a systematic review on case reports. Literature search was performed using the predefined keywords on PubMed, ProQuest, and Google Scholar. We also provided our own case report and compared it with published studies.

Result: Sixteen cases from 13 case reports/series were identified, predominantly consisting of male patients with the mean age of 66.5 ± 9.73 years. The most common symptoms were rigidity, gait disturbance, and bradykinesia, observed in 12 (75%) cases each. The second and third most common symptoms were tremor (11; 68.75%) and facial masking (8; 50%), respectively. Other reported symptoms were dysphasia (3; 18.75%), dysarthria (3; 18.75%), and urinary incontinence (2; 12. 5%). Time gap between the symptom onset and CSDH diagnosis and unilateral location seemed to influence the outcome.

Conclusion: Only 16 CSDH-induced parkinsonism were identified since the 1960s. This condition is thought to occur due to basal ganglia compression. Surgery on the subdural hematoma provides a favorable outcome for parkinsonism symptoms. Timely CSDH diagnosis might yield better outcome. However, further research on CSDH-induced parkinsonism is needed, especially in the mechanisms and treatment outcomes.
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http://dx.doi.org/10.1016/j.clineuro.2021.106826DOI Listing
September 2021

Commentary: Percutaneous Full-Endoscopic C2 Ganglionectomy for the Treatment of Intractable Occipital Neuralgia: Technical Note.

Oper Neurosurg (Hagerstown) 2021 Sep;21(4):E397-E398

Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

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http://dx.doi.org/10.1093/ons/opab248DOI Listing
September 2021

VIM Line Technique for Determining the Ventral Intermediate Location.

Turk Neurosurg 2021 ;31(4):601-606

Universitas Airlangga, Faculty of Medicine, Post Graduate Doctoral Program, Surabaya, Indonesia.

Aim: To prove that VIM line technique created by using a mathematical model, can be used to identify the location of the ventral intermediate nucleus of the thalamus (VIM) MATERIAL and METHODS: Eleven patients with Parkinson?s disease (PD) were assessed. To determine the VIM location, 3-T magnetic resonance imaging and stereotactic protocol 128-slice computed tomography were used. The VIM line technique was performed by drawing a line from the end-point of the right external globus pallidus to that of the left external globus pallidus in the intercommissural plane. PD severity was measured using the Unified Parkinson?s Disease Rating Scale (UPDRS).

Results: A mathematical model was constructed to describe the VIM line technique for determining the VIM location. UPDRS scores before and after thalamotomy showed a significant decreasing trend (p=0.003).

Conclusion: The VIM line technique using the mathematical model can be considered a referential method to determine the VIM location. Its effectiveness was demonstrated by decreased UPDRS scores in patients after VIM thalamotomy.
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http://dx.doi.org/10.5137/1019-5149.JTN.31961-20.2DOI Listing
July 2021

Evaluation of nerve growth factor serum level for early detection of leprosy disability.

Pan Afr Med J 2020 13;37:145. Epub 2020 Oct 13.

Department of Neurosurgery, Faculty of Medicine, Airlangga University, Surabaya 60132, East Java, Indonesia.

Introduction: this research aimed to analyze nerve growth factor (NGF) contents as diagnostic tools for early disability in leprosy patients and the cut-off point value.

Methods: research samples consisted of 79 leprosy patients with disability grade 0 or 1 who met the clinically approved inclusion criteria. The age of patients ranged from 14 to 50 years. For both sample groups, blood serum was collected to determine NGF concentration. NGF level was analyzed by enzyme-linked immunosorbent assay (ELISA) according to the manual guide of the kit insert from Cussabio®. Statistical analysis used SPSS 17 software for Windows. A comparison was performed with the Student's t-test and the NGF concentration cut-off point was determined using a receiver operating characteristic (ROC) curve.

Results: the research result demonstrated that NGF concentration in multibacillary leprosy with disability grade 0 was higher than in grade 1. Leprosy with disability grade 0 had an NGF content reaching 100.46 pg/mL, while those with grade 1 had a lower concentration of NGF at 30.56 pg/mL. The higher disability grade indicated a lower NGF concentration in the blood serum. Based on the ROC analysis result, the NGF cut-off was shown to be 81.43 pg/mL. This result indicated that low NGF in nerve and skin lesions of leprosy patients contributes to early peripheral nerve malfunction due to Mycobacterium leprae infection.

Conclusion: these results prove that NGF can be used as a marker of early disability in leprosy, with the cut-off value at 81.43 pg/mL.
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http://dx.doi.org/10.11604/pamj.2020.37.145.15213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757272PMC
January 2021

Complete resolution of recurrent piriformis syndrome after piriformis resection with 3 years' follow up: A case report.

Int J Surg Case Rep 2020 20;77:576-579. Epub 2020 Nov 20.

Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Neurosurgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Introduction: Piriformis syndrome (PS) is an uncommon neuromuscular condition characterized by buttock pain radiating to the leg. Although the goal of PS treatment is symptom relief, it is difficult in some patients using conservative treatment alone.

Presentation Of Case: A 72-year-old male underwent piriformis resection after failed sequential steroid injection of the piriformis. The patient ultimately underwent surgery for resection of the piriformis muscle and experienced satisfactory pain relief (pain reduction > 75% according to visual analog scale for at least 12 months) following surgery and in the 3-year follow-up period.

Discussion: Conservative treatment is first-choice treatment for managing PS. Surgery was indicated when the patient did not achieve satisfactory pain relief with conservative treatment. Surgical resection of the piriformis muscle has been shown to be effective and feasible.

Conclusion: Piriformis resection is effective and can be a feasible option for the treatment of PS following failure of appropriate conservative treatment(s).
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http://dx.doi.org/10.1016/j.ijscr.2020.11.099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708764PMC
November 2020

Vim line technique thalamotomy for Parkinson tremor: Case series.

Int J Surg Case Rep 2020 20;77:573-575. Epub 2020 Nov 20.

Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Introduction: The ventral intermediate (Vim) nucleus of the thalamus is difficult to identify even with 3 T magnetic resonance imaging. Stereotactic Vim thalamotomy is a usual procedure to control Parkinson tremor. Successful relieving of the tremor depends on the accuracy of defining the Vim location.

Presentation Of Cases: Three patients with Parkinson tremor were subjected to stereotactic thalamotomy using the Vim line technique (VLT) so as to precisely determine the Vim location. All patients showed good results, with improved tremors, as indicated by the UPDRS score, without any complications.

Discussion: The precise targeting of the Vim nucleus is crucial importance for the successful Vim thalamotomy. Various method has been developed to determine Vim location. Atlas based and Guiot's technique routinely used by neurosurgeon. VLT is a new technique that has been developed to determine the Vim location on MRI.

Conclusion: VLT is useful for the determination of the Vim location. However, further research is warranted to prove its effectiveness.
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http://dx.doi.org/10.1016/j.ijscr.2020.11.096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708753PMC
November 2020

Neurosurgery at the epicenter of the COVID-19 pandemic in Indonesia: experience from a Surabaya academic tertiary hospital.

Neurosurg Focus 2020 12;49(6):E5

1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and.

Objective: Global outbreak of the novel coronavirus disease 2019 (COVID-19) has forced healthcare systems worldwide to reshape their facilities and protocols. Although not considered the frontline specialty in managing COVID-19 patients, neurosurgical service and training were also significantly affected. This article focuses on the impact of the COVID-19 outbreak at a low- and/or middle-income country (LMIC) academic tertiary referral hospital, the university and hospital policies and actions for the neurosurgical service and training program during the outbreak, and the contingency plan for future reference on preparedness for service and education.

Methods: The authors collected data from several official databases, including the Indonesian Ministry of Health database, East Java provincial government database, hospital database, and neurosurgery operative case log. Policies and regulations information was obtained from stakeholders, including the Indonesian Society of Neurological Surgeons, the hospital board of directors, and the dean's office.

Results: The curve of confirmed COVID-19 cases in Indonesia had not flattened by the 2nd week of June 2020. Surabaya, the second-largest city in Indonesia, became the epicenter of the COVID-19 outbreak in Indonesia. The neurosurgical service experienced a significant drop in cases (50% of cases from normal days) along all lines (outpatient clinic, emergency room, and surgical ward). Despite a strict preadmission screening, postoperative COVID-19 infection cases were detected during the treatment course of neurosurgical patients, and those with a positive COVID-19 infection had a high mortality rate. The reduction in the overall number of cases treated in the neurosurgical service had an impact on the educational and training program. The digital environment found popularity in the educational term; however, digital resources could not replace direct exposure to real patients. The education stakeholders adjusted the undergraduate students' clinical postings and residents' working schemes for safety reasons.

Conclusions: The neurosurgery service at an academic tertiary referral hospital in an LMIC experienced a significant reduction in cases. The university and program directors had to adapt to an off-campus and off-hospital policy for neurosurgical residents and undergraduate students. The hospital instituted a reorganization of residents for service. The digital environment found popularity during the outbreak to support the educational process.
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http://dx.doi.org/10.3171/2020.9.FOCUS20559DOI Listing
December 2020

P2X3 receptor expression in dorsal horn of spinal cord and pain threshold after estrogen therapy for prevention therapy in neuropathic pain.

Ann Med Surg (Lond) 2020 Dec 11;60:389-395. Epub 2020 Nov 11.

Research Unit, Faculty of Medicine, Al Azhar Islamic University, Mataram, Indonesia.

Introduction: Neuropathic pain may arise from conditions that affecting the central or peripheral nervous system. This study was held to determine the difference P2X3 receptor expression in the dorsal horn of the spinal cord and pain threshold after estrogen therapy in neuropathic pain.

Methods: This study design was an experimental research laboratory. The 24 mice samples divided into negative control group, positive control, and treatment groups. The treatment groups were given subcutaneous injections of estrogen 0.4 ml and also examined for the onset of thermal hyperalgesia in every rat. On day 15, an autopsy was performed on rats, and the spine was taken. The spinal cord was stained by hematoxylin-eosin, and the expression of P2X3 receptors was investigated. P2X3 receptor expression was examined in the dorsal horn on each sample.

Results: From 24 subjects of the study revealed an increase in the onset of thermal hyperalgesia on the estrogen group compared with the placebo group, a higher start. This study also obtained a decrease in the expression of P2X3 on the therapy group compared to the positive control group with significant differences. Statistical test results revealed the appearance of the P2X3 estrogen group had a substantial difference with the placebo group (p = 0.000) and the mean of the negative control group (p = 0.030). The placebo group had a significant difference from the negative control group (p = 0.035).

Conclusion: Estrogen could decrease the expression of P2X3 receptors and prolonged the onset of thermal hyperalgesia. So, both of these explained that estrogen has a role in preventing the occurrence of neuropathic pain after peripheral nerve lesions.
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http://dx.doi.org/10.1016/j.amsu.2020.11.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670236PMC
December 2020

Successful Relief of Abdominal Dystonia After Sequential GPi Pallidotomy with 2-Year Follow-Up.

World Neurosurg 2020 12 1;144:68-70. Epub 2020 Sep 1.

Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Background: Abdominal dystonia is very rare. To our knowledge, no clinical study has reported its specific treatment. Stereotactic therapy has been used to treat several movement disorders, including focal and general dystonia. We investigated the use of internal globus pallidum (GPi) pallidotomy for abdominal dystonia after failed oral medication.

Case Description: A 48-year-old man presented with abdominal dystonia and complaints of involuntary undulating and contraction movements of his left abdominal wall for 5 years. Treatment with oral medication for 4 years was ineffective. Lesioning of the right GPi successfully relieved his symptoms. The symptoms recurred at 3 months and right GPi pallidotomy was repeated with complete resolution of symptoms after the second procedure. There was no recurrence or focal deficit at the 2-year follow-up.

Conclusions: GPi pallidotomy is feasible and effective for the treatment of abdominal dystonia that is resistant to standard medical therapy.
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http://dx.doi.org/10.1016/j.wneu.2020.08.152DOI Listing
December 2020

Role of CAPE in reducing oxidative stress in animal models with traumatic brain injury.

Ann Med Surg (Lond) 2020 Sep 22;57:118-122. Epub 2020 Jul 22.

Department of Surgery Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.

Introduction: The central nervous system (CNS) is the most metabolically active organ characterized by high oxygen demand and relatively low anti-oxidative activity, which makes neurons and glia highly susceptible to damage by reactive oxygen and nitrogen byproducts as well as neurodegeneration. Free radicals are associated with secondary injuries that occur after a primary brain injury. Some of these free radical products include F2-Isoprostane (F2-IsoPs), malondialdehyde (MDA), 4-hydroxy-2-nonenal (4-HNE) and acrolein.

Methods: In this study we measured serum F2-IsoPs levels as markers of free radical activity in 10-12 week-old male Sprague-Dawley rats weighing 200-300 g, all rats (n = 10) subjected with a head injury according to the modified marmourou model, then divided into 2 groups, one group treated with CAPE (Caffeic Acid Phenethyl Ester) (n = 5) and the other not treated with CAPE (n = 5), serum levels in the two groups were compared starting from day-0 (before brain injury), day-4 and day-7.

Results: We found lower F2-IsoPs levels in the group that received the CAPE treatment compared to the group that did not receive the CAPE treatment.

Conclusion: CAPE is capable of significantly reducing oxidative stress in brain injury.
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http://dx.doi.org/10.1016/j.amsu.2020.07.036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390826PMC
September 2020

Stereotactic aspiration of spontaneous intracerebral hematoma: Case series.

Int J Surg Case Rep 2020 11;72:229-232. Epub 2020 Jun 11.

Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Indonesia.

Introduction: Minimally invasive techniques such as stereotactic aspiration of spontaneous intracerebral hematoma (SICH) evacuation can minimize brain tissue damage due to surgery. We share our experience of adopting stereotactic aspiration of SICH in our center without compromising safety.

Presentation Of Cases: Three stereotactic aspiration procedures for SICH immediately after 24 h of onset are reported. All cases showed good results. Level of consciousness of all the patient returned to normal. Two patients could carry out routine activities independently. One patient has left hemiparesis.

Discussion: Stereotactic aspiration of SICH has been newly implemented at our center with acceptable results achieved. Patient selection has an important role in determining the choice of technique. The procedures were done without anticoagulant agent. Stereotactic aspiration of SICH is associated with limited brain tissue damage, shorter duration of surgery, reduced length of stay, faster postoperative healing, and better functional improvement.

Conclusion: Stereotactic aspiration of SICH is a minimally invasive defined strategy for hematoma evacuation without compromising safety.
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http://dx.doi.org/10.1016/j.ijscr.2020.06.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298528PMC
June 2020

Clinical Outcomes of MLC601 (NeuroAiD) in Traumatic Brain Injury: A Pilot Study.

Brain Sci 2020 Jan 21;10(2). Epub 2020 Jan 21.

Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Airlangga, 60111 Surabaya, Indonesia.

Background: MLC601 is a natural product formulation from Chinese medicine that is extensively studied in ischemic stroke. Traumatic brain injury (TBI) shares pathophysiological mechanisms with ischemic stroke, yet there are few studies on the use of MLC601 in treating TBI. This Indonesian pilot study aimed to investigate clinical outcomes of MLC601 for TBI.

Methods: This randomized controlled trial included subjects with nonsurgical moderate TBI allocated into two groups: with and without MLC601 over three months in addition to standard TBI treatment. Clinical outcomes were measured by the Glasgow Outcome Scale (GOS) and Barthel Index (BI) observed upon discharge and at months (M) 3 and 6.

Results: Thirty-two subjects were included. The MLC601 group ( = 16) had higher GOS than the control group ( = 16) at all observation timepoints, though these differences were not statistically significant ( = 0.151). The BI values indicated a significant improvement for the MLC601 group compared to the control group at M3 (47.5 vs. 35.0; = 0.014) and at M6 (67.5 vs. 57.5; = 0.055). No adverse effects were associated with MLC601 treatment.

Conclusion: In this cohort of nonsurgical moderate TBI subjects, MLC601 showed potential for a positive effect on clinical outcome with no adverse effects.
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http://dx.doi.org/10.3390/brainsci10020060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071378PMC
January 2020

Commentary: Pre- and Postoperative Gait Analysis and Video for Selective Dorsal Rhizotomy in Spastic Diplegia: 2-Dimensional Operative Video.

Oper Neurosurg (Hagerstown) 2019 09;17(3):E105-E106

Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya Indonesia.

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http://dx.doi.org/10.1093/ons/opz044DOI Listing
September 2019

Impar Ganglion Block with Combination of Neurolysis Drugs and Radiofrequency Thermocoagulation for Perineal Pain.

Asian J Neurosurg 2018 Jul-Sep;13(3):838-841

Department of Neurosurgery, Division of Stereotactic and Functional Neurosurgery, Faculty of Medicine, Airlangga University/Dr. Soetomo General Hospital, Surabaya, Indonesia.

Since it was first introduced, a variety of modification techniques to block the impar ganglion appear such as transsacrococcygeal ligament technique, sacrococcygeal transdiscal approach, paramedian approach, and a two-needle technique using fluoroscopy or computed tomography scan. For therapeutic purposes, a combination of steroid and local anesthetic, neurolysis agents such as alcohol, phenol, cryolesioning, and heat lesioning using radiofrequency thermocoagulation could be used. Here, we reported a successful outcome in treating chronic perineal pain in a 65-year-old patient using combination of neurolysis agent which was alcohol 96% and radiofrequency thermocoagulation.
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http://dx.doi.org/10.4103/ajns.AJNS_306_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159014PMC
October 2018

Duraplasty using amniotic membrane versus temporal muscle fascia: A clinical comparative study.

J Clin Neurosci 2018 Apr 7;50:272-276. Epub 2018 Feb 7.

Department of Neurosurgery, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Germany.

In the field of neurosurgery, often the dura mater cannot be sutured, and consequently, it requires a duraplasty procedure using a dural fascial graft. Since 1890, various materials have been researched as dura mater substitutes. Amniotic membrane, for example, is suitable as a dural graft material and has been used in neurosurgery since 2012. However, there has been little research on human patient's dural healing after the use of amniotic membrane in their duraplasty procedure. To address this gap, a clinical experimental study was undertaken to evaluate the human dural healing of 16 patients who had undergone duraplasty in decompressive craniectomy surgery at Dr. Soetomo General Hospital, Surabaya. The amniotic membrane allograft, was sutured to cover the dural defect for eight randomly chosen patients (Group I). The fascial autograft from the temporal muscle had been applied for eight other patients (Group II). Between 10 and 20 weeks after surgery, the patients underwent cranioplasty and dural healing evaluation by cerebrospinal fluid (CSF) leakage testing through the edge of the dural defect. The fibrocyte infiltration around the edge of the dural defect was examined histologically. Statistical analysis, using an independent t-test, was performed with a confidence interval of 95%. The results of the clinical and histological analysis suggest that an amniotic membrane graft was able to provide watertight dural closure and adequate fibrocyte infiltration comparable with that provided by temporalis muscle fascia. This study shows that using an amniotic membrane in neurosurgery has a potential advantage over an alternative dural healing.
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http://dx.doi.org/10.1016/j.jocn.2018.01.069DOI Listing
April 2018

Clinical Outcomes of Repeated Intraventricular Transplantation of Autologous Bone Marrow Mesenchymal Stem Cells in Chronic Haemorrhagic Stroke. A One-Year Follow Up.

Open Neurol J 2017 19;11:74-83. Epub 2017 Dec 19.

Department of Neurosurgery, Academic Teaching Hospital Munich-Bogenhausen, Technical University of Munich, Germany.

Object: Stroke, one of the most devastating diseases, is a leading cause of death and disability throughout the world and is also associated with emotional and economic problems. The main goal of this study was to investigate the clinical outcome of the intraventricular transplantation of bone marrow mesenchymal stem cells (BM-MSCs) in post-haemorrhagic stroke patients.

Method: This study was done consisting of eight patients with supratentorial haemorrhagic stroke, who had undergone 24 weeks of standard treatment of stroke with stable neurological deficits. All of the patients received stem cell transplantation intraventricularly using autologous BM-MSCs. Six months and Twelve months after stem cells treatment, the clinical outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and adverse effect also observed.

Result: The results of this study showed improvement of NIHSS score values before and after the treatment in five patients. No adverse effects or complications were detected during the 1-year observation.

Conclusion: Intraventricular transplantation of BM-MSCs has shown benefits in improving the functional status of post-haemorrhagic stroke patients with no adverse effect.
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http://dx.doi.org/10.2174/1874205X01711010074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738743PMC
December 2017

Upward migration and peroral extrusion of a peritoneal shunt catheter: Case report and review of the literature.

Surg Neurol Int 2017 9;8:178. Epub 2017 Aug 9.

Department of Neurosurgery, Medical Faculty, Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta, Indonesia.

Background: Various complications after ventriculoperitoneal (VP) shunt surgery have been reported, but peroral extrusion of peritoneal catheter is an extremely rare complication, and only 20 cases have been reported since 1987. The pathophysiology still remains unclear and the management is challenging.

Case Description: A 5-year-old boy presented with a catheter coming out of his mouth. The boy had a posterior fossa tumor surgery and had VP shunt insertion 1 year earlier. Clinical signs and imaging studies showed that the distal end of the catheter had perforated the gaster and migrated upward and extruded through the mouth. Emergency removal of the shunt and proper treatment were done and he made uneventful recovery.

Conclusion: Peroral extrusion of VP shunt is extremely rare. Clinicians should be aware of this complication. With early diagnosis and proper management, the prognosis for good recovery is excellent, with only two deaths being reported in the literature. Complication of shunt extrusion is difficult to avoid, but knowing the risk factors, pathophysiology and proper management will decrease the morbidity and mortality of such cases.
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http://dx.doi.org/10.4103/sni.sni_138_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569403PMC
August 2017

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

Childs Nerv Syst 2017 Sep 10;33(9):1451-1458. Epub 2017 Jul 10.

Department of Neurosurgery, Airlangga University Faculty of Medicine-Dr. Soetomo General 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.
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http://dx.doi.org/10.1007/s00381-017-3503-1DOI Listing
September 2017

A Rare Case of Repeated Migration and Transurethral Extrusion of Ventriculoperitoneal Shunt.

J Pediatr Neurosci 2017 Jan-Mar;12(1):96-98

Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia.

Bladder migration and transurethral extrusion is an extremely rare complication of ventriculoperitoneal (VP) shunt. Only eight cases have been reported in the English literature since 1995. We report a case of a 4-year-old boy with cerebral palsy, hydrocephalus, and VP shunted on both sides who presented with a protruded distal VP shunt from his urethral orifice. The patient was reported for having previous shunt extrusion through the anus. The patient was treated on by a multidisciplinary approach, involving a neurosurgeon and urologist. Shunt removal with simple procedure was smoothly achieved without morbidities. He was discharged home in satisfactory condition.
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http://dx.doi.org/10.4103/jpn.JPN_189_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437805PMC
May 2017
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