dr. Endro Basuki, Sp.BS (K), M.
Kes
Cognita Manu Melia Cultu Neurosurgery Division
dr. ENDRO BASUKI, Sp.BS (K), M.Kes
Jakarta, 8 Januari, 1953
Dokter Umum – FK UGM, 1979
Spesialis Bedah Saraf – FK UNPAD, 1989
Vrije Universiteit Amsterdam, 1987 – 1988
Magister Kesehatan – FK UGM, 2000
Puskesmas Kec. Lamuru, Bone, 1979 – 1982
Staf KSM Bedah Saraf RS Dr Sardjito
As. WaDek bidang penelitian, kerjasama
dan pengabdian masyarakat FK-UGM 2013-
2017
Pengurus Harian Komite Medik RSUP Dr
Sardjito/ Ketua Sub Komite Etik dan
Disiplin Profesi
Ketua Perhimpunan Spesialis Bedah Saraf
Indonesia (PERSPEBSI), 2005-2009, 2013 –
2017
Ketua Medical Advisory Board (Dewan
Pertimbangan Medik) BPJS kesehatan 2016-
2017
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Cognita Manu Melia Cultu Neurosurgery Division
Introduction
Head injuries are among the most common types of trauma
encountered in emergency departments (EDs).
Many patients with severe brain injuries die before reaching a
hospital; in fact, nearly 90% of prehospital trauma-related deaths
involve brain injury.
Approximately 75% of patients with brain injuries who receive
medical attention can be categorized as having mild injuries, 15% as
moderate, and 10% as severe.
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Introduction
Most recent United States data estimate 1,700,000 traumatic brain
injuries (TBIs) occur annually, including 275,000 hospitalizations
and 52,000 deaths.
TBI survivors are often left with neuropsychological impairments
that result in disabilities affecting work and social activity.
Every year, an estimated 80,000 to 90,000 people in the United
States experience long-term disability from brain injury
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Anatomy and Physiology Review
SKIN
CONNECTIVE TISSUE
APONEUROSIS/GALEA
LOOSE AREOLAR TISSUE
PERICRANIUM
Because of the scalp’s generous blood supply, scalp lacerations can
result in major blood loss, potential to hemorrhagic shock
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Anatomy and Physiology Review
Skull
Meningen
Brain
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Anatomy and Physiology Review
TENTORIUM
- Supratentorial
- Infratentorial
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Anatomy and Physiology Review
CSF ( Cerebrospinal fluid)
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Anatomy and Physiology Review
Intracranial Pressure
Normal ICP = 10 mmHg ( 136 mmH2O)
Monro–Kellie Doctrine
Principle :
The total volume of the intracranial contents must
remain constant, because the cranium is a rigid
container incapable of expanding.
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Anatomy and Physiology Review
Monro–Kellie Doctrine
Vk = V darah + V likuor + V parenkim
mmHg
Tekanan Fatal 60
100
Intrakranial
50
Disfungsi
40
50
Otak
30
Obati
20
Volume Intrakranial Normal
10
0
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Anatomy and Physiology Review
CEREBRAL PERFUSION PRESSURE ( CPP )
CPP = MAP – ICP
CEREBRAL BLOOD FLOW ( CBF )
50 ml/100 gr / minute
If 5 ml/ minute :
cell death & irreversible damage
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Glascow Coma Scale ( GCS )
E : Oye Opening : 1 – 4
M : Motoric Response : 1 – 6
V : Vocal Response: 1 – 5
Best possible score 15; worst possible score 3.
If an area cannot be assessed, no numerical score is given for that
region, and it is considered “non-testable”
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Glascow Coma Scale ( GCS )
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Glascow Coma Scale ( GCS )
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Glascow Coma Scale ( GCS )
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Classifications of Traumatic
Brain Injury
SEVERITY :
- Mild : GCS Score 13-15
- Moderate : GCS Score 9-12
- Severe : GCS Score 3-8
Morphology
- Skull
- Intracranial Lesions
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Classifications of Traumatic
Brain Injury
Linear vs Stellate
Vault
Depressed/
Nondepressed
Skull Fracture
With/ without
CSF Leak
Basilar
With/Without
Seventh nerve
palsy
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Classifications of Traumatic
Brain Injury Epidural
Focal Subdural
Intracerebral
Intracranial
Lesions Concussion
Multiple
Contusions
Diffuse
Hypoxic/
Ischemic Injury
Axonal Injury
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Normally Brain CT Scan
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Depressed
Fracture
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CT Scan of Depressed Fracture
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Cognita Manu Melia Cultu Neurosurgery Division
BASILAR SKULL
FRACTURES
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Epidural
Epidural
Hematome
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Clinical Progress of EDH
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EDH
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Cerebral Contusions
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Cerebral Laceration/ Multiple contusions
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Intracerebral Hematoma
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Intracerebral Hematoma
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Intraventricular
Hematoma
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Subdural Hematoma
Acute
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Subdural Hematoma
Sub-acute
( 4 - 21 days after injury )
Chronic
( more than 21 days after injury)
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Subdural Hematoma
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Subarachnoid
Hemorrhage
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Subarachnoid Hemorrhage
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Management Overview of
Traumatic Brain Injury
All patients: Perform ABCDEs with
special attention to hypoxia and
hypotension
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Management of Mild Brain Injury
(GCS Score 13–15)
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Management of Mild Brain Injury
(GCS Score 13–15)
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Management of Mild Brain Injury
(GCS Score 13–15)
Indications for CT
scanning in patients with mild
TBI
CT scanning is the preferred method of
imaging,
although obtaining CT scans should not delay
transfer of the patient who requires it.
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Management of Mild Brain Injury
(GCS Score 13–15)
Example of Mild TBI
Warning Discharge
Instructions
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Management of Moderate Brain
Injury (GCS Score 9–12)
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Management of Severe Brain
Injury (GCS Score 3–8)
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Neurosurgical consultation for
patients with TBI
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Goals of treatment of brain injury:
clinical, laboratory and monitoring
parameters
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DON’T FORGET ...
Before transported:
1. ABC clear
2. Head Elevated 30º
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Make a right and usefull
medical record
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Cognita Manu Melia Cultu Neurosurgery Division
Medical Therapies for Brain
Injury
Intravenous Fluids (Hypovolemia in patients with TBI is harmful)
Correction of Anticoagulation
Hyperventilation
Prophylactic hyperventilation (pCO2 < 25 mm Hg) is not recommended (IIB).
Use hyperventilation only in moderation and for as limited a period as possible
Mannitol
Use 0.25–1 g/kg to control elevated ICP ; arterial hypotension (systolic blood
pressure <90 mm Hg) should be avoided.
Use with ICP monitor, unless evidence of herniation, keep Sosm <320 mOsm,
maintain euvolemia, and use bolus rather than continuous drip.
Hypertonic Saline
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Medical Therapies for Brain
Injury
Barbiturates
Anticonvulsants
Anticonvulsants can inhibit brain recovery, so they
should be used only when absolutely necessary
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Surgical Management
Burr Hole
Craniotomy hematom evacution
Craniectomy decompressed hematom evacuation
Depressed fracture correction
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Burr Hole
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Craniotomy Hematom Evacuation
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Craniotomy Hematom Evacuation
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Craniectomy decompressed hematom evacuation
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Brain Death
Diagnosis of brain death requires meeting these criteria:
Glasgow Coma Scale score = 3
Nonreactive and midriatic pupils
Absent brainstem reflexes (e.g., oculocephalic, corneal, and doll’s
eyes, and no gag reflex)
No spontaneous ventilatory effort on formal apnea testing
Absence of confounding factors such as alcohol or drug intoxication
or hypothermia
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Cognita Manu Melia Cultu Neurosurgery Division
