Asian Australasian Neuro and Health Science Journal (AANHS-J)

C2 Lesion in An Adolescent Resembling Chordoma : Histopathological Confirmation of Rheumatoid Pannus Following Two-Stage Decompression : A Case Report

Syekh Ahmad Arafat, Sabri Ibrahim, Muhammad 'Azmi Hakim — Wed, 30 Apr 2025 00:00:00 +0700

Introduction: Chordomas prevalence peaks in men around late middle age. Mostly occur in the sacrococcygeal and around base of the skull. Chordoma of the cervical spine is observed only in 6% of all chordoma, which grows slowly in size before becoming symptomatic and encase surrounding vascular and nerve structures.

Case Presentation: A 17-years-old male with weakness in all extremities since 2 months with history of falling to the ground with his back landed first after somersault. After that, he began to felt numbness in all extremities. Urinary, fecal incontinence, and decrease of libido was found. Patient undergo CT scan and MRI that show canalis stenosis C2 d/t C2 Fracture Levine classification type 1A ASIA D dd spondilitis TB C2 dd susp. Pannus ec Rheumatoid arthritis. Patient underwent the occipitocervical fusion. He underwent the second operation which was trans-oral decompression and the pathology impression was chordoma.

Discussion: Chordomas are a family of primary bone tumors, originate from undifferentiated embryonic notochord remnants presenting in the midline, extending throughout the skull base and axial skeleton. Only 6% of all chordoma cases mainly affect the cervical spine, as chordomas can often be found in the cervical vertebrae, either a new primary tumor or a metastatic tumor

Conclusion: Chordoma is a malignant neoplasm and if the site lesion was in the cervical spine, the chief complaint was the effect of spaced-occupying lesion in cervical, like weakness in all extremities

Functional Surgical Resection in Glioma Patients: A Literature Review on Techniques and Outcomes

Brian Jovi Barus, Moriko Madadoni Sebayang, Muhammad Rafif Ginting — Wed, 30 Apr 2025 00:00:00 +0700

Background: Gliomas frequently invade eloquent cortical and subcortical regions, necessitating surgical strategies that optimize oncological resection while preserving neurological integrity. Functional surgical resection integrates advanced modalities to achieve maximal safe resection.

Method: A structured qualitative literature review was performed, synthesizing current evidence from high-impact databases on intraoperative techniques including awake craniotomy, cortical and subcortical mapping, fluorescence-guided resection, and intraoperative imaging and their impact on surgical outcomes in glioma patients.

Discussion: Functional mapping and imaging adjuncts significantly improve the extent of resection and mitigate postoperative deficits, particularly in IDH-mutant low-grade gliomas and eloquent high-grade lesions. However, limitations in fluorescence efficacy, imaging resolution, and resource availability persist across institutions.

Conclusion: Functional resection techniques enhance survival and quality of life by enabling individualized, anatomically precise glioma surgery. Future directions include integration of molecular diagnostics, intraoperative tools, and global standardization to reduce outcome disparities.

Keyword: Glioma, Functional Surgical Resection, Awake Craniotomy, Cortical Mapping, Neuronavigation, Electrophysiological Monitoring

The Role of Neurosurgery in Reducing Parkinson's Symptoms: A Case Study on the Use of DBS Technology

Edo Johanes Namalo Sihombing, Amira Puti Karima — Wed, 30 Apr 2025 00:00:00 +0700

Background: Parkinson’s disease (PD), a progressive neurodegenerative disorder, causes motor symptoms like tremors, rigidity, and bradykinesia, often complicated by non-motor issues and levodopa-related side effects. Deep Brain Stimulation (DBS) is a key neurosurgical intervention that modulates neural circuits to alleviate symptoms in advanced PD.

Method: A literature review analyzed peer-reviewed studies from the past 15 years, sourced from PubMed, ScienceDirect, and Google Scholar, focusing on DBS efficacy and safety. Thematic synthesis explored physiological mechanisms, clinical outcomes, and comparisons with other treatments, using triangulation to ensure robust findings.

Discussion: DBS, targeting the subthalamic nucleus or globus pallidus internus, reduces motor symptoms by up to 50% on the Unified Parkinson’s Disease Rating Scale, decreases levodopa reliance, and mitigates dyskinesias. Advances like directional electrodes enhance precision, but non-motor symptom relief varies, and risks, costs, and access disparities remain. Strict patient selection is vital, excluding those with atypical parkinsonism or severe cognitive issues.

Conclusion: DBS is a pivotal treatment for advanced PD, improving motor function and quality of life. Future innovations and research into non-motor effects, alongside equitable access, are crucial to optimize its impact.

Keyword: Deep Brain Stimulation (DBS), Parkinson’s Disease, Tremors, Rigidity, Bradykinesia, Neurosurgical Therapy

Theoretical Approach to the Management of Epidural Hematoma (EDH): Optimal Timing for Surgical Intervention

Hafzul, Diwa Aulia Ahmad — Wed, 30 Apr 2025 00:00:00 +0700

Introduction: Epidural hematoma (EDH) is a life-threatening condition that requires timely surgical intervention to prevent irreversible neurological damage, with early decompression within the "golden hour" being critical for better outcomes.

Case Description: Two cases were discussed: Case 1, an 81-year-old female who underwent surgery within 12 hours with significant recovery, and Case 2, a 73-year-old male who showed deterioration after delayed intervention but improved following decompression within 12 hours.

Discussion: Early surgical intervention prevents brain herniation and secondary brain injury. The "golden hour" concept emphasizes decompression within hours of symptom onset. Access to timely care in rural settings can delay intervention, worsening outcomes. The timing of surgery must consider individual patient factors, such as comorbidities and hematoma size.

Conclusion: Optimal surgical timing, especially within the "golden hour," is critical in EDH management to prevent irreversible neurological damage. Individualized treatment plans should account for access to care and patient-specific factors for the best outcomes.

Craniotomy vs. Burr Hole in the Management of Chronic Subdural Hematoma: A Literature Review

Alpasca Firdaus, Untoro Danang Bagus — Wed, 30 Apr 2025 00:00:00 +0700

Introduction: Chronic subdural hematoma (CSDH) is a common condition, especially in the elderly, often requiring surgical intervention. Burr hole drainage and craniotomy are the two main surgical approaches. However, the optimal technique remains debated due to differences in recurrence rates, complications, and outcomes.

Methods: A comprehensive literature review was conducted using databases such as PubMed, Scopus, and Google Scholar to compare burr hole drainage and craniotomy in the management of CSDH. Studies were selected based on relevance to surgical technique, recurrence, complications, and patient outcomes. Results and Discussion: Burr hole drainage is less invasive, associated with shorter operative time, reduced hospital stay, and fewer complications. It is widely considered the first-line surgical option. However, some studies report higher recurrence rates compared to craniotomy. Craniotomy, while more invasive, may be more effective in cases with organized or recurrent hematomas, offering more thorough evacuation. It carries a higher risk of complications, particularly in elderly or comorbid patients. Clinical decision-making often depends on hematoma characteristics and patient condition.

Conclusion: Both burr hole drainage and craniotomy are effective for CSDH, but each has distinct advantages and drawbacks. Burr hole drainage is generally preferred due to its safety and efficacy, while craniotomy may be reserved for complex or recurrent cases. A patient-centered approach considering clinical and radiological factors is essential. Further randomized studies are needed to refine surgical guidelines.

Keywords: Chronic subdural hematoma, burr hole drainage, craniotomy, neurosurgery, recurrence, surgical outcomes, complications

Association Between Head Computed Tomography Scan Images and Electroencephalogram with Outcome In Post Stroke Seizure Patients

Armellia Solida Harefa, Arina Cut Aria, Fithrie Aida — Wed, 30 Apr 2025 00:00:00 +0700

Background: Seizures that occur after a stroke and have no previous history of epilepsy are referred to as post stroke seizures (PSS). Post stroke seizure increases patient mortality, disability at hospital discharge, as well as prolongation of hospital stay. Patients with post stroke seizure show poor functional outcome (mRS >2).

Objective: To determine the association between head CT scan images and electroencephalogram (EEG) with outcomes in post-stroke seizure patients at Adam Malik Hospital Medan.

Methods: This study is an observational analytic study with prospective cohort research methods with primary data sources obtained consecutively from all PSS patients who were hospitalized at Adam Malik Hospital Medan and had undergone head CT scan and EEG examinations. The outcome of PSS patients was assessed by mRS score on day 14 since seizure.

Results: There were 24 research subjects who met the inclusion and exclusion criteria aged between 18-74 years and consisted of 18 male subjects and 6 female subjects. There is a association between head CT scan images and clinical outcomes of post-stroke seizure patients based on the results of the chi square test with p value = 0.041 (<0.05) for lesion location and p = 0.018 (<0.05) for lesion size. There is a association between EEG and clinical outcomes of post-stroke seizure patients based on the results of the Chi Square test with p value = 0.001 (<0.05).

Conclusion: There is a significant association between head CT scan images and EEG images and patient outcomes.

Keyword: Post Stroke Seizure, Head CT Scan, EEG, outcome, mRS