Introduction: Meckel’s cave meningioma is an intracranial tumor located in close proximity to critical neurovascular structures. An effective anesthetic strategy is essential to optimize outcomes and minimize complications. Case: A 38-year-old woman with progressive ptosis, diplopia, and proptosis was diagnosed with Meckel’s cave meningioma. She underwent craniotomy with intraoperative neurophysiological monitoring (IOM) under general anesthesia managed with Target-Controlled Infusion (TCI) of propofol and dexmedetomidine. TCI of propofol, with Schnider mode was adjusted to a target effect concentration of 2-6 μg/mL. Dexmedetomidine was administered at a dose of 0.3-0.7 mcg/kg/hour. A multimodal analgesic approach, including scalp block with ropivacaine and dexamethasone was performed to reduce opioid consumption and manage pain. The procedure was completed without complications. Postoperatively, the patient demonstrated stable hemodynamics, no new neurologic deficits, and effective pain control. Discussion: Anesthesia protocol, including propofol TCI and dexmedetomidine, was performed to maintain signal integrity, allowing safe tumor resection while minimizing the risk of postoperative deficits. The combination of propofol TCI, dexmedetomidine, and multimodal analgesia was shown to achieve stable hemodynamic and neurophysiological conditions during craniotomy for Meckel’s cave meningioma. Conclusion: The combination of propofol TCI, dexmedetomidine, and multimodal analgesia is effective in maintaining stable hemodynamic and neurophysiological conditions during craniotomy for Meckel’s cave meningioma
Introduction: Brain tumors have a high morbidity and mortality rate in Indonesia. According to data from the Ministry of Health, in 2020 the incidence of brain tumors was around 1.5 percent of all tumor cases. Anesthesia for brain tumor removal surgery has a high risk of postoperative complications such as hypotension, bleeding and intracranial infection. Propofol and dexmedetomidine are often used as anesthetic agents in neurosurgery that affect hemodynamics, depth of anesthesia and blood gas analysis. This study aims to determine the comparative effectiveness of propofol compared to dexmedetomidine on Bispectral Index (BIS), mean arterial pressure (MAP), and blood gas analysis (BGA) in patients undergoing intracranial tumor removal surgery. Subject and Method: This study is an unpaired numerical comparative analytical observational study. A total of 42 participants who met the inclusion and exclusion criteria were randomly assigned into 2 groups, namely the propofol and dexmedetomidine groups. Furthermore, an assessment of mean arterial pressure, BIS, and BGA was carried out. Results: Based on statistical tests using the unpaired T test, it was found that intraoperative MAP was significantly different between the two groups (p<0.05), where dexmedetomidine had a more stable MAP. While in BIS and BGA there was no significant difference in the two groups (p>0.05) statistically using the Mann Whitney test. Conclusion: Dexmedetomidine has an effect that is not much different compared to propofol in maintaining changes in MAP, BIS and BGA in patients with intracranial tumor removal surgery.
Processed electroencephalography (pEEG) has become an integral tool in modern anesthesia and critical care, enhancing the precision of anesthesia depth monitoring, reducing the risk of accidental awareness under general anesthesia (AAGA), and postoperative cognitive issues. Unlike raw EEG, which records cortical electrical activity directly, pEEG applies mathematical and algorithmic analyses, such as spectral analysis and Fourier transformation, to generate numerical indices that are more interpretable for clinicians. Several commercial systems, including the Bispectral Index (BIS), Entropy, Conox, and SedLine, are widely available. For neuroanesthesiologists, understanding core EEG principles and advanced metrics, such as the Density Spectral Array (DSA), Spectral Edge Frequency (SEF), and Burst Suppression Ratio (BSR), is crucial for accurate interpretation. Moreover, recognizing EEG patterns characteristic of various anesthetic agents, including propofol, inhaled agents, dexmedetomidine, ketamine, and opioids, further refines clinical decision-making. Mastery of EEG interpretation ultimately supports better safety, individualized neuroanesthesia practice aligned with the principles of precision medicine
Intracranial aneurysm is a cerebrovascular disease with a high mortality rate, particularly in cases of rupture. Aneurysm clipping surgery is one of the definitive management methods; however, it involves significant hemodynamic fluctuations that may lead to intraoperative complications and worsen prognosis. Hemodynamic stability and rapid anesthetic recovery are crucial aspects for the success of this procedure. We report a case of a 57-year-old female with a saccular aneurysm in the right M1 segment of the middle cerebral artery, scheduled for aneurysm clipping surgery. The patient had previously undergone decompressive craniectomy and hematoma evacuation due to non-traumatic intracranial hemorrhage, which was not initially diagnosed as an aneurysm, and showed no significant improvement postoperatively. In anesthetic management, dexmedetomidine was used as an adjuvant to maintain hemodynamic stability and support rapid recovery. Throughout the procedure with TIVA- Propofol, dexmedetomidine effectively maintained stable blood pressure without episodes of hypertension, hypotension, or bradycardia. The patient did not experience significant intraoperative complications, and postoperative recovery was optimal. This emphasizes the critical role of dexmedetomidine within modern anesthetic approaches to the management of intracranial aneurysm cases.
Introduction: Traumatic brain injury (TBI) affects 27-69 million people annually, with over 55 million living with long-term disability. A major management challenge is disruption of cerebral autoregulation, a mechanism that maintains stable cerebral blood flow (CBF) despite systemic pressure changes. Impaired cerebral perfusion pressure (CPP) autoregulation promotes ischemia, edema, and metabolic imbalance, worsening neurological outcomes. Method: This narrative review synthesized literature from PubMed, Google Scholar, ScienceDirect, and the Cochrane Library, focusing on studies from the past decade. Keywords included “cerebral perfusion pressure,†“autoregulation,†“traumatic brain injury,†“TBI,†“mechanism,†“pressure reactivity index,†and “monitoring.†Discussion: TBI-related autoregulation impairment stems from vascular injury, inflammation, and myogenic dysfunction, with patterns ranging from intact to delayed or absent responses. The pressure reactivity index (PRx) enables continuous autoregulation assessment and determination of patient-specific optimal CPP (CPPopt). Observational data link maintaining CPP near CPPopt with better outcomes, while time below CPPopt increases mortality risk. Experimental models identify endothelin-1, ERK1/2, and interleukin-6 as key mediators, with targeted interventions showing potential to preserve reactivity. Conclusion: Integrating mechanistic insights with invasive monitoring and PRx-guided CPP optimization offers a promising, individualized strategy for TBI care, warranting confirmation in large clinical trials.
Infratentorial brain tumors such as medulloblastoma have serious neurological implications, particularly in children and adolescents. Re-craniotomy for infratentorial lesions increases the risk of anesthetic complications due to altered anatomy, tissue adhesions, and proximity to vital structures such as the brainstem and cranial nerves. The anesthetic approach must be tailored to support real-time intraoperative monitoring, such as Intraoperative Neurophysiological Monitoring (IONM), to prevent neurological injury. A 16-year-old male with a WHO Grade IV medulloblastoma in the left cerebellum extending to the vermis underwent re-craniotomy tumor removal. The patient presented with balance disturbances, diplopia, and dysphagia. CT scan revealed a solid mass measuring 6.6 × 5.96 × 6.71 cm with peritumoral edema and compression of the fourth ventricle. Anesthetic management included TIVA using propofol TCI Schneider 2–4 mcg/ml, dexmedetomidine 0.2–0.7 mcg/kg/hr, and intermittent rocuronium. The surgery lasted 8 hours and was complicated by cerebral edema managed with mannitol 1 g/kgBW. IONM detected prolonged activation of the left cranial nerve VIII. Intraoperative bleeding reached 1600 ml, managed with 465 ml of PRC. Hemodynamics remained stable with ConnX ranging from 34 to 80. Postoperatively, the patient was admitted to the ICU with mechanical ventilation and continuous sedation. Anesthetic management of infratentorial re-craniotomy requires an individualized approach encompassing hemodynamic stability, neural protection through IONM, and multimodal strategies to prevent postoperative complications. TIVA techniques and ConnX monitoring play an important role in maintaining optimal anesthetic balance and neurological function.
The incidence of traumatic brain injury that concurrent with injuries such us traumatic spinal injuries is relatively high. When considering anesthetic management for patients with acute traumatic brain injury undergoing non-brain surgery procedures, understanding of the implications of traumatic brain injury on anesthesia management is essential for achieving favorable surgical results while minimizing the risk of secondary brain injury to ensure patient safety and optimal outcomes. We report a case of a 25 years old man who presented with decrease of consciousness 3 days prior admission to the hospital after sudden fall in the bathroom. Complaints were accompanied with vomiting, weakness and paresthesia in both bilateral upper extremities and lower extremities. Supportive examination revealed an epidural hematoma at regio frontoparietal sinistra, minimal subdural hematomas at regio anterior falx cerebelli and bilateral tentorium cerebelli, subgaleae hematomas at regio bilateral parietal, with multiple cervical fracture at the C5 level with associated cervical canal narrowing. Due to the minor intracranial bleeding with no significant symptoms for days, patient then scheduled for elective C4-C6 laminectomy and posterior stabilization surgery. Anesthesia management for patient with traumatic brain injury that undergoes non-brain surgery comes with challenges, mainly on how to prevent secondary brain injury and minimizing complications. Comprehensive perioperative planning and vigilant monitoring are essential to ensure patient safety and optimal outcomes.
Cranioplasty is a surgical procedure that restores normal anatomy following craniectomy. Skull bone reconstruction ensures protection and normalizes physiology as well as cerebrospinal fluid dynamics. We present a case of a 37-year-old male following intracerebral hemorrhage (ICH) evacuation via craniotomy. The patient had uncontrolled hypertension and cardiomegaly on chest X-ray, with secondary hemiparesis. Scalp nerve block was employed as an anesthetic technique and for postoperative analgesia. Preoperatively, his heart rate was 70–80 beats/min, blood pressure 158/107 mmHg, and oxygen saturation 100% on room air. Intravenous dexmedetomidine infusion was started (loading dose 1 mcg/kg for 15 minutes, followed by 0.4–0.8 mcg/kg/h) along with 2% lidocaine infusion at 1 mg/kg/h titrated to the desired level of sedation and analgesia. A unilateral (landmark-guided) scalp block was performed using 22 mL of 0.5% levobupivacaine to block the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves. The patient also received intravenous paracetamol 1 g three times daily. Hemodynamics remained stable throughout surgery. The Numeric Rating Scale (NRS) score was 0 at 30 minutes to 6 hours postoperatively, and 1–2 between 8 and 48 hours. Awake regional anesthesia allowed sympathetic tone to remain intact and enabled rapid postoperative neurological assessment. Ultrasound-guided scalp block is an effective alternative anesthetic technique for awake cranioplasty, providing hemodynamic stability, optimal pain control, and faster recovery in high-risk patients
Introduction: Traumatic brain injury (TBI) remains a major global health challenge and frequently requires neurosurgical intervention. Various clinical, surgical, and systemic factors may influence postoperative morbidity and mortality. This study aimed to identify key predictors of postoperative outcomes in patients with TBI undergoing neurosurgical procedures. Subject and Method: A prospective cohort study was conducted at Dr. Zainoel Abidin General Hospital in Banda Aceh from July to October 2024, involving 48 TBI patients who were selected through total sampling. Statistical analysis using chi-square tests and multiple logistic regression identified significant predictors. Results: We enrolled 48 patients, with an overall postoperative morbidity rate at 58.3%, and the mortality rate was 22.9%. Morbidity was significantly associated with preoperative GCS score (p=0.001), injury-to-surgery time (p=0.039), respiratory (p=0.007), and cardiovascular system (p=0.001). Mortality was significantly associated with preoperative GCS score (p=0.002), surgery duration (p=0.041), respiratory (p=0.041), and cardiovascular system (p=0.004). Multivariate analysis confirmed the preoperative GCS score was the most significant predictor of both morbidity and mortality (p<0.05). Conclusion: A low preoperative GCS score is a strong predictor of poor postoperative outcomes in patients with TBI. Optimizing perioperative management may improve clinical outcomes in TBI patients undergoing neurosurgical intervention
Introduction: Scoliosis correction surgery requires careful anesthetic management because of potential perioperative complications, including excessive bleeding, hypothermia, complications related to patient positioning, and the need for spinal cord protection. Case: A 23-year-old woman weighing 32 kg with a height of 140 cm presented with a chief complaint of spinal deformity that had been present since childhood. On physical examination, her blood pressure was 119/79 mmHg, pulse rate was 112 beats/minute, respiratory rate was 20 breaths/minute, and SpO2 was 97% on room air and a Cobb angle of 90°. Anesthesia induction using propofol 70 mg, while tracheal intubation was facilitated with atracurium 0.5 mg/kg. Analgesia with fentanyl 2 µg/kg, and anesthesia with O2/air, sevoflurane, and atracurium infusion at 0.5 mg/kg/hour. Intravenous tranexamic acid 500 mg to minimize intraoperative bleeding. Intraoperative monitoring consisted of standard monitoring modalities, without the use of spinal cord monitoring. The surgical procedure lasted 4 hours and 20 minutes, with the patient positioned prone throughout the operation. Discussion: The most important principle of anesthetic management in spinal surgery is a comprehensive and meticulous approach to patient positioning, ensuring safe alignment while maintaining adequate spinal cord perfusion pressure. Spinal cord protection was provided with methylprednisolone, hemodynamic stable, normothermia, good patient position. Conclusion: Spinal cord protection did with avoid excessive bleeding, hypothermia, complications related to patient positioning, and maintaining adequate spinal cord perfusion pressure
Introduction: Neurosurgery in Tetralogy of Fallot (ToF) poses complex anesthetic challenges due to risks of hypoxemia and hemodynamic instability. The aim of this case report was to describe the general anesthesia and scalp block management of a boy with uncorrected ToF who developed a cerebral abscess requiring craniotomy for abscess drainage. Case: An 8-year-old boy with uncorrected ToF presented with headache, fever, and neurological deficits. Neuroimaging revealed a large frontal abscess necessitating urgent surgical intervention. Preoperative evaluation showed central cyanosis, digital clubbing, and oxygen saturation of 70% on room air, with echocardiography demonstrating a significant right-to-left shunt. The primary anesthetic objectives were to maintain systemic vascular resistance (SVR) and prevent increases in pulmonary vascular resistance (PVR). Anesthesia induction was achieved with ketamine 1 mg/kg and fentanyl 4 µg/kg to preserve SVR, followed by rocuronium 0.5 mg/kg for neuromuscular relaxation. A bilateral scalp block was administered with ropivacaine 0.25% (0.4 mL/kg per site) for regional analgesia. The surgery was completed without complications, and the patient was extubated safely after 24 hours in the pediatric intensive care unit. Discussion: Anesthetic management of uncorrected ToF during neurosurgery focuses on maintaining SVR and avoiding increases in PVR to prevent worsening right-to-left shunting and hypoxemia. Ketamine-based induction and bilateral scalp block provided hemodynamic stability and effective analgesia, facilitating successful surgical and postoperative outcomes without major complications Conclusion: Individualized anesthetic management that prioritizes SVR preservation, PVR control, and meticulous hemodynamic monitoring is essential for safe neurosurgical procedures in uncorrected ToF.
Neurosurgical emergencies demand rapid and coordinated anesthetic management to prevent secondary neurological injury and improve patient outcomes. Anesthesiologists play a critical role not only in facilitating surgical intervention but also in maintaining cerebral perfusion pressure (CPP), controlling intracranial pressure (ICP), and safeguarding neural function during periods of physiological instability. This review synthesizes current guidelines regarding anesthetic selection, hemodynamic targets, and specific neuroprotective strategies. Furthermore, optimal anesthetic management for acute ischemic stroke is re-evaluated based on recent research suggesting that conscious sedation may offer superior functional outcomes in minor anterior circulation strokes, whereas general anesthesia remains non-inferior for posterior circulation strokes. The review also highlights critical physiologic targets, emphasizing the strict avoidance of hypotension and the judicious use of moderate hypocapnia. By integrating these emerging evidence-based protocols, anesthesiologists can optimize management in neurosurgical emergencies settings, thereby improving patients’ functional recovery and survival rates.
Introduction: The incidence of subarachnoid hemorrhage (SAH) is approximately 9 per 100,000 population per year. SAH caused by ruptured brain aneurysm accounts for around 80% of non-traumatic events, followed by 10% perimesencephalic hemorrhage and another 10% due to arteriovenous malformation (AVM). Case: A 50-year-old female patient weighing 50 kg who presented on post-ictus day 14 with aneurysmal subarachnoid hemorrhage secondary to a ruptured middle cerebral artery (MCA) aneurysm with GCS 14 (E4V4M6) without any neurological deficit with WFNS grade II. Discussion: The patient underwent craniotomy and aneurysm clipping performed by a vascular neurosurgeon. A lumbar drain was inserted preoperatively to facilitate controlled cerebrospinal fluid (CSF) drainage and promote intraoperative brain relaxation. During aneurysm clipping, intraoperative neurophysiological monitoring (IONM) was performed by a neurophysiologist to continuously assess motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs), ensuring the preservation of neural pathway integrity throughout the procedure. Conclusion: The primary goal of anesthetic management was to prevent elevations in intracranial pressure (ICP) and carefully control mean arterial pressure (MAP) before vessel occlusion and throughout aneurysm clipping to maintain an optimal balance between cerebral perfusion pressure (CPP) and transmural pressure (TMP). Neuroanesthesia plays an important role in the perioperative management of patients from the initial stabilization in the emergency department, intraoperative neuroprotective strategies during surgical intervention, and postoperative care in the neurologic intensive care unit.
Background and Objective: Stroke is an economic and health burden for patients, society, and health services; and one is the length of stay hospitalization. Ischemic stroke patients with hospitalization <7 days indicate the quality of hospital stroke services. This study aimed to compare the clinical characteristics of ischemic stroke patients during hospitalization at Dr. Hasan Sadikin Hospital Bandung, Indonesia. Subject and Method: This study was cross-sectional, with a sample research subjects of all ischemic stroke patients from January to April 2023 at Dr. Hasan Sadikin General Hospital Bandung, Indonesia were divided into 2 groups, namely the ≤ 7 days and the > 7 days group. The indicators characteristics were age, onset, National Institute of Health of Stroke Scale (NIHSS), Neutrophyl-to-Lymphocyte Ratio (NLR), and complications obtained through medical records. Statistical analysis was calculated using the Mann-Whitney and Fisher correlation tests. Results: A total of 59 subjects, there are no significance difference (p>0.05) on variables of age (median 58 vs 63 years), onset (median 11 vs 7 hours), NIHSS (median 6 vs 8), and NLR (median 3.22 vs 4.41). In-hospital complications such as infection and hyponatremia, was significantly different between two groups (p<0.05). Conclusion: In-hospital complications are associated with prolonged length of stay in patients with acute ischemic stroke. This can be the basis for developing strategies to increase the indicators management of stroke services by reducing the complication ischemic stroke during hospitalization.
Neurosurgical procedures during pregnancy, particularly ventriculoperitoneal (VP) shunt placement in the first trimester, pose substantive challenges for anesthetic practice. Drug selection must protect both mother and fetus while accommodating pregnancy-related alterations in pharmacokinetics and pharmacodynamics. Propofol administered via Target Controlled Infusion (TCI) has become a preferred option in neuroanesthesia because it enables rapid reduction in intracranial pressure and precise titration. Reports from neuro-obstetric practice, including VP shunt operations, indicate that TCI propofol maintains stable anesthetic depth with fewer hemodynamic fluctuations than inhalational techniques. In pregnant patients, dosing is individualized using the Marsh model, typically targeting a plasma concentration of 2–4 µg/mL with an induction dose of 1–2 mg/kg. Although propofol readily crosses the placenta, contemporary data show fetal concentrations remain low and are rapidly cleared. Moreover, recent studies have not associated appropriately dosed, closely monitored propofol with increased rates of miscarriage, major congenital anomalies, or reduced live births. Accordingly, for first-trimester neuroanesthesia, TCI propofol is a safe and effective choice that supports maternal cerebral protection while minimizing fetal exposure. When combined with vigilant physiologic monitoring, titration to effect, and adherence to neuro-obstetric best practices, maternal and fetal outcomes are comparable to those achieved with inhalational anesthesia. These findings support the judicious adoption of TCI propofol for VP shunt surgery in early pregnancy, emphasizing individualized dosing and multidisciplinary perioperative coordination to optimize safety and efficacy. This review synthesizes current evidence and offers pragmatic dosing guidance for clinicians, aligned with contemporary neuroanesthesia and obstetric anesthesia standards
Background and Objective: Craniotomy surgery can increase the body's inflammatory response through the neuroendocrine system. neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) are biomarkers of inflammation and immunosuppression. Scalp block using ropivacaine and intravenous dexmedetomidine are commonly used analgesic techniques to attenuate perioperative inflammatory responses. This study aims to determine the comparison of inflammatory marker values between ropivacaine 0.5% scalp block and intravenous dexmedetomidine in brain tumor craniotomy Subject and Methods: This study used a single-blind clinical trial with a two-group posttest-only design. This study collected 36 research subjects who met the inclusion criteria. The subjects were divided into 2 groups, Group A received 0.5% ropivacaine scalp block and Group B received intravenous. Blood tests to assess inflammatory: markers were performed before and 24 hours postoperatively. The data obtained were analysed using SPSS version 20. Results: The change value of CRP in the scalp block ropivacaine 0.5% group was 24.71± 7.25 mg/l, while the change value of CRP in the dexmedetomidine group was 61.02 ± 17.81mg /l. The change value of PLR in the scalp block ropivacaine 0.5% group was 50.57 ± 57.91 while the change value of PLR in the dexmedetomidine group was 105.26 ± 64.81. There was a significant change of CRP and PLR values in the scalp block group compared to the dexmedetomidine group (p<0.05). The change value of NLR in the scalp block group was 9.71 ± 5.75, while the change value of NLR in the demedetomidine group was 13.37 ± 5.55. There was no significant difference in the change value of NLR in the ropivacaine 0.5% scalp block group compared to dexmedetomidine (p>0.05). Conclusion: Scalp block ropivacaine 0.5% has better results than intravenous dexmedetomidine administration in suppressing the inflammatory response in patients undergoing tumour craniotomy surgery.
Introduction: Scalp block is one of the regional blocks that can be combined with neuroanesthesia in craniotomy of tumor resection (CTR) surgery. The advantages of scalp block can blunt the stress response during CTR, maintain hemodynamic stability, and reduce the use of opioid drugs during the operation. Subject and Method: This study is a double-blinded randomized controlled trial. The subjects consisted of 28 samples aged 18-65 years, GCS 15, ASA II-III physical status, with a diagnosis of intracranial tumor who underwent CTR at Mohammad Hoesin Hospital, Palembang. The samples were divided into two treatment groups using general anesthesia techniques with the addition of a scalp block using bupivacaine 0.125% and bupivacaine 0.25%. Patients who were allergic to bupivacaine, those in hemorrhagic shock, or those had undergone surgery lasting more than 6 hours were excluded from data collection. Data analysis was conducted by assessing hemodynamic changes, namely systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR). The data analysis methods used were the general linear model, specifically repeated measures ANOVA, paired t-test, and independent t-test with SPSS version 28. Results: There is no significance difference between two group in the hemodynamic changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean atrial pressure (MAP), and heart rate (HR) over time between the two groups using bupivacaine 0.125% and bupivacaine 0.25% with the independent t-test (p>0.05). The presence of significant hemodynamic changes in each treatment group over time with repeated-ANOVA and paired-t-test statistical tests (p<0.05). No side effects are observed. There is no significant proportional difference in the addition of fentanyl doses between the two groups (p>0.05). Conclusion: The addition of a scalp block with 0.125% bupivacaine is equally effective as 0.25% bupivacaine in maintaining hemodynamic stability during tumor resection craniotomy surgery. The need for opioids during the intraoperative period can be reduced
Introduction: Vasospasm and delayed cerebral infarction (DCI) are factors that influence the prognosis and clinical outcomes in subarachnoid hemorrhage (SAH). Although several pharmacological therapies are considered potentially effective in reducing vasospasm and DCI, only a few have shown significant benefits. This systematic review aims to evaluate the therapeutic benefits of cilostazol in patients with aneurysmal subarachnoid hemorrhage (aSAH). Subject and Methods: A systematic search was conducted on studies from January 2009 to March 2024 across five databases, guided by PRISMA 2021. The outcomes evaluated may include angiographic vasospasm, symptomatic vasospasm, the severity of vasospasm, new cerebral infarctions, delayed cerebral ischemia, and functional outcomes. Results: Following analysis, 9 studies were included in this systematic review, involving 627 patients in the cilostazol group and 631 patients in the control group. Most of these studies indicated that cilostazol administration in SAH yielded positive effects on cerebral vasospasm, new infarctions, and functional outcomes. However, there was no evidence to support the effectiveness of cilostazol in preventing DCI. Conclusion: Overall, cilostazol appears to be a promising therapy for SAH. However, the impact of cilostazol on DCI warrants further investigation, possibly due to the complex mechanisms of DCI.
Cerebral Vasospasm, characterized by the progressive constriction of cerebral arteries, often occurs following a subarachnoid hemorrhage (SAH) and is a leading cause of morbidity and mortality in affected patients. This condition can be resulted in cerebral ischemia, the severity of which correlates with the degree of vasospasm. The underlying pathophysiology involves the encasement of arteries by blood clots, although the intricate interactions between the hematoma and adjacent structures remain incompletely understood. The delayed onset of vasospasm offers a potential window for preventive interventions. However, recent randomized controlled trials have been discouraging, as they failed to demonstrate any significant improvement in patient outcomes with the use of clazosentan (an endothelin antagonist), simvastatin (a cholesterol-lowering agent), or magnesium sulfate (a vasodilator). Current best practices for managing vasospasm include minimizing ischemia by maintaining adequate blood volume and pressure, administering nimodipine (a calcium channel blocker), and, when necessary, performing balloon angioplasty. Over the past two decades, advancements in the management of vasospasm have significantly reduced associated morbidity and mortality rates. Nevertheless, vasospasm remains a critical determinant of clinical outcomes following aneurysmal rupture.
Spinal cord injuries (SCI) can be resulted in permanent disability, often caused by high-intensity incidents such as car accidents, falls, and violent crimes. Although relatively rare in children, they can have profound effects. This case report was aimed to elucidate the clinical symptoms of Th1-Th3 spinal contusion in a 2-year-old patient. A 2-year-old boy presented to a private peripheral hospital with complaints of back pain following a traffic accident. The examination revealed complete motor weakness (0/5) in both lower extremities, with preserved sacral sparing. Thoracolumbar MRI demonstrated spinal cord contusion and edema at the level of Th1-Th3. Based on history, physical examination, and supporting tests, the patient was diagnosed with SCI ASIA Impairment Scale B and upper thoracic spinal cord contusion, leading to the decision to perform laminectomy at the Th2-Th3 level. This case underscores the importance of recognizing initial symptoms in spinal cord injury cases and being vigilant for red flags in spinal trauma cases. Prompt initial trauma treatment, such as patient immobilization, is crucial. In this instance, laminectomy decompression was undertaken to address the contusion. A high level of vigilance was required as neurological symptoms could evolve or be initially obscured. Spinal cord injuries often manifest within days of an accident, although they can remain undetected for extended periods. Cord contusions may present with neurological symptoms, necessitating prompt diagnosis via spinal magnetic resonance imaging (MRI) and potential emergency surgical intervention, such as laminectomy.
