SANS Maret 2013 Flashcards
VASKULAR
Apakah komplikasi utama dari StereoElectroEncephalography (SEEG)? A. Intracranial Hematome B. Status Epileptikus C. Infeksi D. MIgrasi Elektroda
A. Intracranial Hematome The most common complication reported for the SEEG procedure is intracranial hemorrhage (1% incidence),;most commonly manifested as an intraparenchymal hematoma at electrode implantation site, as well as epidural and subdural hematomas. In the series reported by Cardinale and colleagues, encephalitis was only reported in 2 cases (0.4%) and status epilepticus only in 1 case (0.2%). Electrode migration was not reported as a complication rate, although there was one complication of a retained broken electrode. Of note, all 5 intracranial hematomas occurred using the traditional methodology. No major complication related to intraparenchymal hematoma was reported using the new workflow.
Bagaimana alur kerja baru untuk SEEG (akuisisi otak angiografi 3-D dan MRI dalam kondisi frameless dan markerless, perencanaan multimodal advance dan robot-assisted implantation merubah entry-point localization error (EPLE) dan target-point localization error (TPLE) dihubungkan dengan alur kerja tradisional untuk SEEG? A. Peningkatan EPLE dan Peningkatan TPLE B. Penurunan EPLE dan Penurunan TPLE C. Peningkatan EPLE dan Penurunan TPLE D. Penurunan EPLE dan Peningkatan TPLE
B. Penurunan EPLE dan Penurunan TPLE A significant reduction of both EPLE and TPLE were seen with the new workflow. EPLE > 2mm and > 3 mm was 3.7% and 0.5% of electrodes implanted using the new workflow as compared to 29.5% and 11.4% using the traditional workflow, respectively. The Median TPLE was reported as 1.77 mm using the new workflow as compared to 2.69 mm using the traditional workflow. This reduction is possibly related to the lower distortion and smaller voxel size as obtained by the O-arm as compared to MRI. The authors feel that bending of the drill is the most important variable determining large placement errors. With use of an adequate feedback system, the use of a robot to drill the skull can lead to decreased error.
Bagaimana paparan radiasi dari StereoElectroEncephaloGraphy (SEEG) dibandingkan terhadap CT scan standar otak? A. 10 Kali B. 5 Kali C. 2 Kali D. 20 Kali
C. 2 Kali Stereoelectroencephalography (SEEG) has twice the radiation exposure of a standard CT scan of the brain. The SEEG procedure can be performed in one surgical step following 3-D digital subtraction angiography. In this report, the most complicated cases required six CT datasets: 4 for 3-D-DSA (baseline, left and right internal carotid artery, one vertebral artery injection) and 2 intraoperative (one at the beginning of the procedure for registration purposes, the last one for verifying the implantation). Radiation exposure of each run amounts to about 1/3 of a standard brain CT (at 3.5 mm thick slices), meaning overall radiation exposure for modern SEEG methodology to identify the epileptogenic zone of patients with refractory epilepsy corresponds to about 2 standard CT scans. Surgery is an effective therapeutic option for treatment of refractory epilepsy, based on defining an epileptogenic zone - an area of cortex that is necessary and sufficient for initiating seizures and whose removal is necessary for abolition of seizures. In most cases, non-invasive scalp EEG and brain imaging are sufficient for the definition of this epileptogenic zone but in 25 - 50% of patients intracranial EEG via subdural grids and strips are necessary. SEEG is a safe and accurate procedure for invasive assessment of the epileptogenic zone via multimodal planning and robot-assisted surgical placement of direct electrical recording grids.
Seberapa efektifkah posterior lumbar interbody fusion (PLIF) pada spondylolisthesis untuk pengobatan gejala nyeri punggung? A. Meningkatkan SF-36 Scores B. Meningkatkan VAS Scores C. Tidak Bermanfaat D. Menurunkan ketergantungan narkotik E. Menurunkan kejadian operasi ulang
C. Tidak Bermanfaat With respect to relief of back pain, the epidemiology literature shows that there is no statistically significant relationship between spondylolisthesis and back pain. The source and mechanism of back pain have not been established in patients with spondylolisthesis. Although back pain might theoretically be attributed to instability, or some
Apakah keuntungan dalam outcome dari minimal access posterior lumbar interbody fusion (MPLIF) dibandingkan dengan open access posterior lumbar interbody fusion (OPLIF) untuk spondylolisthesis? A. Meningkatkan penyembuhan nyeri punggung B. Meningkatkan penyembuhan nyeri tungkai C. Tidak ada keuntungan D. Restorasi Superior dari tinggi diskus E. Meningkatkan reduksi listesis
C. Tidak ada keuntungan In this retrospective study by Cheung et.al., the authors demonstrated that there was no statistically significant difference in the various outcome criteria between the OPLIF and MPLIF approaches for spondylolisthesis. Both techniques achieved similar improvement of leg pain, back pain, disc height and listhesis. The results for both arms remain durable at over 3 years follow-up.
Parameter radiografi atau klinis manakah yang paling membaik setelah posterior lumbar interbody fusion (PLIF) untuk spondylolisthesis? A. Rate of fusion B. Nyeri Punggung C. Nyeri Tungkai D. Sudut Lordosis E. Sudut Segmental
According to recent studies, the PLIF procedure for spondylolisthesis demonstrates a significant and durable improvement of radicular leg pain. In Cheung et.al, radicular leg pain completely improved in 64% of patients after open access posterior lumbar interbody fusion (OPLIF) procedures and 43% of patients after minimal access posterior lumbar interbody fusion (MPLIF) procedures. A further 18% had at least 50% relief of leg pain after OPLIF, and 29% after MPLIF. Long term back pain relief was achieved in 33% of patients for OPLIF and 24% of patients for MPLIF. Lordosis angle and segmental angle was not significantly changed for these patients.
Setelah aneurysmal subarachnoid hemorrhage, pola yang berbeda dari tingkat IL-6 dapat diamati. Manakah dari pola tingkat IL-6 berikut yang paling berkorelasi dengan terjadinya DIND? A. Lebih tinggi antara hari 7 dan 11 B. Lebih tinggi antara hari 3 dan 7 C. Lebih tinggi pada hari ke 2 D. Lebih tinggi antara hari 11 dan 15 E. Tidak ada perbedaan
B. Lebih tinggi antara hari 3 dan 7 In the study by Muroi and colleagues, the authors compared the inflammatory parameters from day 3 to 14 after SAH and found significant differences in all parameters between patients with favorable and unfavorable outcome. IL-6 levels were significantly higher in patients with DIND between day 5 and 10. Higher IL-6 levels in the early phase (day 3-7 after SAH) were associated with the occurrence of DIND, which usually occurred after day 7. While PCT levels and luekocyte counts did not differ at any point of time, CRP levels were significantly higher between day 7 and 11. Multiple comparisons analysis within the DIND group showed IL-6 levels at the day of and at day 1 after DIND manifestation to be significantly elevated compared to IL-6 levels 2 days prior to DIND. CRP levels rose gradually from day to day. Statistical trends could be observed comparing levels at day 1 and 2 prior to with day 2 after occurrence of DIND. Significant differences could not be observed on PCT levels and Lc counts
Faktor klinis apakah yang paling mempengaruhi outcome setelah terjadinya aneurysmal subarachnoid hemorrhage (SAH)? A. Lokasi Aneurisma B. Jenis Kelamin C. Umur D. Modalitas Pengobatan E. WFNS Grade
E. WFNS Grade The impact of the initial clinical severity (measured by the WFNS scale) on the inflammatory parameters is well established, in concordance with earlier reports.4, 5, 22In this study, 138 patients with SAH were included. All patients reached the primary end point: After 3 months, 68% of patients (n=94) had a favorable (GOS 4-5) and 32% patients (n=44) an unfavorable outcome (GOS 1-3). As expected, there were significantly more patients with clinically (WFNS grade) and radiologically severe SAH among the patients with unfavorable outcome (p age fell short of significance (p=0.050). Aneurysm location and treatment modality (clipping vs. coiling) did not differ (p=0.170 and p=0.274, respectively). The occurrence of any infection in patients with unfavorable outcome was 68% (n=30). The difference was statistically significant compared to patients with favorable outcome (p=0.029).
Manakah dari parameter inflamasi berikut yang telah ditemukan untuk menjadi indikator awal dari delayed ischemic neurological deficits (DIND) dan outcome buruk yang mengikuti aneurysmal subarachnoid hemorrhage (SAH)? A. Peningkatan PCT B. Peningkatan awal Leukosit C. Peningkatan CRP D. Peningkatan IL-6
D. Peningkatan IL-6 Muroi et al. found that elevated IL-6 remained a significant predictor of both unfavorable outcome (OR=4.07) and DIND (OR=4.03) after controlling for clinically relevant factors. There is a large body of evidence that components of the inflammatory response including adhesion molecules, cytokines, leukocytes, immunoglobulins,and complement, contribute to the pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Higher CRP levels have been reported to correlate with worse outcome and/or occurrence of ischemic events after SAH. Possible confounding factors have not been analyzed in these studies. In the study by Muroi and colleagues, CRP was not predictive for worse outcome or occurrence of DIND after adjustment for confounding factors. Furthermore, when considering the time course, differences in CRP levels were only observed beyond post-bleed day 7. The relevance of leukocytosis on the outcome and/or occurrence of ischemic events after SAH has been repeatedly reported and described to be an independent risk factor. In the study by Muroi and colleagues, higher leukocyte counts remained a significant risk factor for worse outcome after adjustment for cofounding factors. Still, as significant differences in leukocyte counts were only observed from day 11 on, it might not act as an early indicator either. Furthermore, early leukocyte counts were not predictive for the occurrence of DIND. The usefulness of PCT in the differentiation between SIRS and sepsis has been a focus of interest recently. However, it has been reported that brain damage due to traumatic brain injury or SAH per se results in elevated PCT levels.18 Median PCT values were significantly higher in patients with unfavorable outcome; however, no significant association could be found in the regression analyses.
