HYPERGLYCEMIA AS A PREDICTOR OF OUTCOME IN PAEDIATRIC SEVERE TRAUMATIC BRAIN INJURY PATIENTS UNDERWENT SURGERY: A SINGLE CENTER EXPERIENCE FROM EASTERN INDONESIA FROM 2017-2022.

OBJECTIVE: The aim: Traumatic Brain Injury (TBI) remains a significant health burden worldwide. This study aimed to describe, determine and recommendation concerning the impact of hyperglycemia on pediatric TBI. PATIENTS AND METHODS: Materials and methods: Paediatric trauma patients with severe TBI event were identified and admitted to our Dr. Soetomo General Hospital, Surabaya, the regional Trauma Center of East Java, Indonesia between calendar year of 2017 and 2022. Our institutions trauma database was utilized to select the patient included in this study. Patients with GCS ≤ 8 who underwent neurosurgical interventions were included to the study. Neurosurgical interventions are craniotomy for clot evacuation and decompressive craniectomy. We excluded patients with GCS > 8 and/or treated with conservative therapy (no surgery needed). Data collected for analysis as independent variables included patient age, admission GCS score and admission serum glucose score, mechanism of injury, type of intracranial lesion and type of surgery. Outcome of the patients included was examined at discharge which sub-grouped by Glasgow Outcomes Scale (GOS) score. Independent variables were entered into the logistic model in a stepwise fashion with a significant cutoff of p< 0,05. RESULTS: Results: Patients with worse neurological outcomes (GOS score 1-2) had a mean serum glucose value of over 200 mg/dL. Patients who died (GOS score of 1) had higher mean admission glucose values (226.44 ± 62,00) than the patients who had survived with a GOS score of 3 (139.80 ± 10.87), 4 (87), or 5 (134). Patients who resulted in a vegetative state (GOS score of 2) had higher mean admission serum glucose values than patients who were discharged with a GOS score of 5 (205.14 ± 36.17 vs. 134; p = 0.003). CONCLUSION: Conclusions: Hyperglycaemia in pediatric TBI patients that underwent neurosurgical intervention is associated with worse outcomes, even mortality. We believe that prospective evaluation of glucose normalization in the context of acute management of pediatric head injuries is both appropriate and necessary for the next study.

One-stage anterior approach for long-segment subaxial cervical spondylitis tuberculosis: A case report.

BACKGROUND: Spondylitis TB on cervical region is a rare disease, that may lead to severe neurological complications. The anterior approach is considered as a gold standard for cervical spine tuberculosis. Available studies and literature have not precisely mentioned on how many levels are acceptable for this disease and still up for discussion. CASE PRESENTATION: A 45-year-old Asian male was brought from a rural hospital to our outpatient clinic with progressive weakness of all extremities for 3 months. Cervical x-ray and MRI showed three-levels of vertebral body destruction, suggesting a cervical spondylitis TB. Patient had debridement, corpectomy on C4, 5, 6, fusion with cage, and anterior plating from C3 to Th1 in a one-stage anterior approach. Immediately after the surgery, the patient had no complaints of pain, and he was able to walk on his own. One year follow-up after the surgery, no residual neurological impairment is detected and had no limitation in daily activities. Cervical x-ray and MRI showed good ossification and improvement of lordotic curvature. CONCLUSION: Treatment of cervical spondylitis TB which involved three-levels of vertebrae using one-stage anterior approach provides a good rate of deformity correction along with clinical improvement and long-term well-being of the patient.

Remote extradural hematoma as a complication of endoscopic transsphenoidal surgery: A case report with literature review.

INTRODUCTION: The sellar region is one of the most areas to access in skull base surgery. The endoscopic transsphenoidal approach is a minimally invasive technique developed to create a clear trajectory to the sellar region through the sellar floor. Conversely, this area is surrounded by major intracranial vessels and multiple cranial nerves, hence, every surgical procedure to access this area carries dangerous complications, including hematoma. Remote extradural hematoma is an extremely rare complication following the endoscopic transsphenoidal approach, and the pathogenesis has not been elucidated. CASE PRESENTATION: This study reported a case of 38-years old female suffered from chronic cephalgia and bilateral vision loss since one year ago. Further neuroimaging examination showed solid extra-axial mass, suggesting pituitary adenoma. Laboratory result showed increased Prolactin (216,2 ng/dl) with no other hormonal disturbance. Urgent endoscopic transsphenoidal surgery was planned to excise the tumor. Post-operative CT showed acute right frontal extradural hematoma, in which the patient was planned to have immediate surgery afterwards. DISCUSSION: The specific mechanism of developing EDH post-surgery is unknown because it is an unusual consequence of endoscopic transsphenoidal surgery. Rapid CSF draining during surgery may have led to the formation of a remote extradural hematoma in our patient. CONCLUSION: Endoscopic transsphenoidal surgery also carries the potential risk of remote extradural hematoma, careful steps must be taken to prevent this serious complication during transsphenoidal surgery.

Modification of Periosteal Flap as Management of Cerebrospinal Fluid Leakage after Frontal Sinus Fracture Surgery in Moderate Traumatic Brain Injury Patients.

Main management for the frontal sinus fracture is using the pericranial flap. Pericranial flaps based on the supraorbital and supratrochlear vasculature have previously been used with significant success for the separation of intracranial and extracranial spaces after major trauma. Defect closure was modified due to lack of the frontal periosteum; the graft was made from the temporal side of periosteum to make primary periosteal flap longer. Defect closure could be optimum. Evaluation for 6 months showed a significant improvement without major complications. In this article, we propose a new modification technique as one of promising alternatives.