Lombok Health And Science Journal

INITIAL HFRT EXPERIENCE ON TREATING LARGE BRAIN METASTASES LESION: A CASE REPORT

Hadi Nurhadi — 2024-02-18

Abstract

Background: Brain metastases in cancer patients are increasing, due to advances in imaging and systemic treatment. Stereotactic Radiosurgery (SRS) is a high-end radiotherapy technique that is preferred to treat small brain metastases. Hypofractionated Radiotherapy (HFRT) is an alternative technique that demand lower requirements and ideal for treating larger brain metastases. This case report intended to report our institution initial experience using HFRT in limited setting to treat a patient with large brain metastases.

Case Presentation: A-43 years old women with previous breast cancer history was admitted with general weakness and severe headache since 2 weeks before admission. A CT scan exam shows multiple metastatic lesions on both parietal lobe, the largest lesion measures ≥ 3cm in diameter with a prominent vasogenic edema that caused lateral ventricle compression and mild midline shift.

Discussion: SRS is preferred to treat brain metastases due to its efficacy and excellent therapeutic ratio. Unfortunately it has limitation in treating large metastatic lesions. For such lesions, HFRT being a simpler radiation technique can be opted to achieve acceptable local control and low toxicities profile. We use HFRT to treat a patient with large brain metastases lesion using IMRT with 10 x 4Gy fractionation scheme. The evaluation results 6 weeks later shows no viable brain lesion without any cognitive deterioration reported.

Conclusion: HFRT for large brain metastases treatment is safe and viable to conduct in institution with limited resources. This relatively simpler technique compared to SRS should be considered to achieve acceptable therapeutic ratio with minimal toxicities.

LITERATUR REVIEW : DIAGNOSIS AND TREATMENT OF TRAUMATIC BRAIN INJURY 2022

Mitha Yunda Pertiwi — 2024-02-18

Abstract

Traumatic brain injury (TBI) is one of the leading cause of morbidity and mortality from neurological cases worldwide. TBI can result in cognitive deficits, endocrine, psychiatric disorder and affecting the capacity to work and impair the quality of life of the patients. TBI classified as mild, moderate, and severe according to the Glasgow Coma Scale (GCS). TBI can be detected from neuroimaging. This is a review from a new guideline for diagnosis and treatment of traumatic brain injury: the neuroscience of traumatic brain injury 2022.

Keyword : Traumatic brain injury, neuroimaging, management, new guideline

Anal Fissure: Clinical Practice, Diagnosis in Primary Care and Management Guideline. A Literature Reviews

Arif Zuhan — 2024-02-18

ABSTRACT

Anal fissures or tears in the anus are very common. At least 1 in 350 people have experienced an anal fissure. About 20% of anal fissures are accompanied by hemorrhoids. However, there are still few patients or sufferers of anal fissure who know about this condition. Not many doctors or health workers are aware of how to diagnose to primarytreatment or treatment of anal fissures, so patients with anal fissures are often referred directly for surgery. In fact, anal fissures can be treated without surgery, such as dietary modifications. Surgery also has several indications and needs to be considered regarding post-operative complications that can actually be avoided. This article discusses the clinicalmanifestations, diagnosis and management of anal fissures.

Keyword: anal fissure, clinical practice, primary care, management.

CASE REPORT : OLFACTORY GROOVE MENINGIOMA

Alifia Firdiansari — 2024-02-18

Abstract

Background: Olfactory Groove Meningiomas (OGM) are a rare cause of olfactory dysfunction. OGMs are benign, slow-growing tumors that cause non-specific symptoms, such as headaches, olfactory impairment, and psychiatric symptoms, such as depression, personality changes, decreased cognitive function, visual problems, or seizures.

Aim: In this case report we would like to discuss about a rare case of olfactory groove meningioma with non-spesific symptoms presented in 47-year old female patient

Case report: A 47-year old female with progressive blurred vision in the right eye for 3 months. Negative light perception in the right eye and fundus of the right eye indicated papillary atrophy. The direct and indirect light reflexes were negative in the right eye. We found Strong homogenous contrast enhancement extraaxial lesion accompanied by multiple dural tails in the left frontal convexity UK approximately 3.2 x 2.8 x 3.1 cm, Tuberculum sellae approximately 2.7 x 2.9 x 3 cm. Cranial decompression, frontal bone reconstruction, and tumor removal were performed. It was found that there was microcystic growth of tumor tissue, consisting of proliferation of meningoethelial cells, round to oval nuclei, smooth chromatin, visible intranuclear inclusions

Discussion: OGM is a rare, benign tumor. Female patients were more likely to develop OGM than male patients. The ciliary ganglion of cranial nerve III may be affected by compression of the tumor, resulting in the absence of direct and indirect pupillary reflexes in the affected eyes.

Conclusion: OGM is a slow-growing tumor that does not show significant symptoms at an early stage, making early detection difficult.

Keyword: Olfactory Groove Meningioma, Blurred Vision, Meningioma

Factors Predicting Seizure Outcome After Surgical Excision Of Meningioma : A Systematic Review

Alifia Firdiansari — 2024-02-18

Abstract

Background Seizures in meningiomas occur in approximately 30% of patients. Meningiomas that press on the cortical area, as well as larger meningiomas have a greater tendency to cause focal or generalized seizures. The risk of seizures is increased in tumors that grow along the surface of the brain compared to the base of the calvaria because these tumors are more often located in areas where they can compress cortical tissue that is susceptible to epileptogenesis. The study also aimed to discuss the predictors of seizure/epilepsy in post-operative patients.

Methods We searched PubMed gateway database and searched the studies published between the years 2020 and 2023. The following keywords were used to search for the specific article, single and/or in combination: meningioma, seizure, epilepsy, primary brain tumor, craniotomy, predictor, and surgery. the inclusion criteria for the studies were published in English and with “human” specified as the study category. We excluded review articles, expert opinions, and other language articles.

Results We included 10 studies we found that most seizures in meningioma post-operative patients are male gender, size > 8 cm, cortical location, peritumoral edema, and history of previous seizures. The occurrence of early in-hospital seizures was associated with motor cortex involvement, postoperative Karnofsky performance score <70, postoperative complications, and preoperative seizures

Conclusion This systematic review shows are several predictors that can used to predict the seizure/epilepsy outcome in patients who underwent surgery for meningioma

Keywords: meningioma, post-operative, seizure, epilepsy, predictors