NEURO PEDIATRIK

DT
I. IdentitAS

• Nama : Muhammad Rasyid

• Jenis Kelamin: Laki-Laki
• Usia : 1.5 bulan
• Med Rek : 1157693
• Diagnosis : penurunan kesadaran ec SDH
frontoparietal sinistra + SAH + edema
serebri
• Pro : Craniotomi dekompresi
subjective

3 minggu yang lalu orang tua pasien mengeluh anak demam tinggi kemudian kejang
3x lamanya 30-60 menit, setelah kejang anak sadar (+), muntah (-), penurunan kesadran
(-)
1 minggu yang lalu anak kejang hingga 7 jam, kejang umum, tonik-klonik, setelah
kejang anak sadar
Riwayat lahir cukup bulan, spontan, lahir di dukun, bbl 3800gram langsung menangis
Batuk(+), pilek(+), asma(-), alergi(-)
objective

Hipoaktif, HR 110x/m, RR 24x/m SpO2 : 98%

Status Generalis :
Kepala : Conjungtiva Anemis -/- SI=skelera ikterik -/-
Leher : massa (+)
Thorax : Cor = SI-S2 reguler, Murmur(-), Gallop (-)
Pulmo = Vesikuler+/+ , Wheezing-/- Rhonki -/-
Abdominal : BU (+)N
Extremity : edema -/-
Laboratorium

Laboratory test (22-1-20)

 Hb : 11.9
• Leucocyte : 10.400
• Trombocyte : 509.000
• HT : 36
• Ur/Cr : 13/0,39
Laboratory test (27-1-20)
• Na/K : 141/5.5
• Ca/Cl : 9.4/107
CT Scan 15-01-20
Expertise ct scan

 SDH di fronto temporoparieto occipital kiri

 SAH
 Cerebral edema
 Edema herniasi subfalcine dan herniasi transtentorial
Assessment

General Anestesi
Intubasi Napas Kendali
ASA II
 CRANIOTOMY FOR TRAUMA

Emergent surgical
procedure to evacuate
mass lesion or debride
contused or cotaminated
brain

 Epidural Hematoma
 Subdural hematoma
 Intracerebral hematoma
 Depressed skull frakture
 Gunshot wound of the
brain
CRANIOTOMY FOR TRAUMA
Procedure

Avijit Sarkari
 CRANIOTOMY FOR
Summary of
TRAUMA
Procedure
 Position :
Supine, lateral, prone or sitting
 Surgical Time :
1,5-6 hour
 EBL :
25-500 ml
 Post operation care :
ICU or Close observation unit
 Mortality and Morbidity :
10-50% , higher for acute subdural hematoma,
endocrine disorder : SIADH, Neurologic disability
and Infection
 CRANIOTOMY FOR TRAUMA

Preoperative
Surgery is necessary to evacuate
hematomas, control intracranial
bleeding, to débride the wound, and
to remove bone fragments, foreign
material, and damaged brain so that
the cranial vault can better
accommodate the brain swelling that Epidural hematomas form between the
inevitably occurs skull and dura, and are usually due to
bleeding from an artery (e.g., anterior
cerebral or middle meningeal
Subdural bleeding occurs between the
dura and the leptomeninges lining the
brain surface. This bleeding is usually
venous in origin, and usually occurs
more gradually
Preoperative

 Serangan kejang
 Mual dan muntah
 Asma
 Riwayat keluarga yang berkaitan dengan reaksi terhadap obat obat
tertentu
 Penilaian neurogonik: derajat kesadaran, hipertensi intracranial,
perubahan sensorik, respon pupil, serta fungsi syaraf cranial
 Evaluasi tanda vital dan berat badan apakah sesuai umur tumbuh dan
kembang. Lingkar kepala di ukur
Umur
Preoperative
berat Tek darah Detik
jantung
Frekuensi
napas
Prematur < 2.5 50/30 140 35-80
Aterm > 2.5 60/40 140 35-60
1 tahun 10 tanda vital
 Nilai rerata 90/65 120 20-40
6 tahun 20 100/60 100 20-25
12 tahun 40 115/60 90
 CRANIOTOMY FOR TRAUMA

Intra operatif Post operatif

Control of ICP : Adequate anesthesia Complications : Seizures

Head up 20–30° Neurologic deficits
Keep SBP ≤ 90 mmHg Hemorrhage
STP or propofol infusion SIADH/DI

Hyperventilation to NPE
PaCO2 = 25–30 mmHg ↑ICP
PaO2 > 100 mmHg DIC

Keep CPP 60–70 mmHg Pain management : Fentanyl/propofol

infusion
Mannitol 0.25–1.0 g/kg

Furosemide 10–20 mg
II. Identitas

 Name : Zeline Zakeisha

 Sex : Perempuan
 Age : 1 tahun
 Med Rec: 1119492
 Diagnosis: Hidrosefalus comunicans + dandy walker
syndrome
 Pro : VP Shunt
subjective

Kepala membesar sejak usia 4 bulan secara tiba-tiba

Kejang(-), muntah(-), penuruna kesadaran(-)
Batuk(-), pilek(-), allergi (-), asthma (-) VACTERL(-)
Riwayat kelahiran kurang bulan (7bulan), spontan, BBL 1600 gram, tidak
langsung menangis
objective

Sense : aktif
HR :110 beats/mnt, RR : 24 beats/mnt, SpO2 : 99%,
Temp : 36.5
Status Generalis :
Head :CA -/- SI -/-
Neck : mass (-)
Thorax : Cor = SI-S2 reguler, Murmur(-) Gallop (-)
Pulmo = Vesikuler +/+ N, Wheezing-/- Rhonki -/-
Abdominal : normally
Extremity : oedem (-)
Laboratorium

Lab test (3/1/20)

 Hb : 11,5
• Leucocyte : 14.440
• Trombocyte : 361.000
• HT : 37
• BSS : 108
• Na/K : 139/3.7
Expertise Ct scan 19-12-19

 Hidrocefalus comunicans
 Dilatasi kistik ventrikel 4
Assessment

General Anestesi Intubasi Napas Kendali

ASA II
VP SHUNT
 VENTRICULAR SHUNT PROCEDURE

to shunt CSF from the ventricles to

another body cavity where it can be
absorbed readily.
The most common condition is
hydrocephalus, where there is dilation
of the ventricular system due to an
obstruction in the flow of CSF or
decreased absorption of CSF by the
arachnoid villi.
diverting CSF to the peritoneal cavity
via a ventriculoperitoneal shunt (VP
shunt
To insert a VP shunt, the patient is
positioned so that the cranial incision
and abdominal incision are aligned in
the same plane
 Procedure

Patient is positioned so The cranial incision is

the cranial incision and madeover over the
abdominal incison are intended of cannulation
aligned in the same of the ventricle and
plane. The sclap is bore hole is made in the
shaved and surgical cranium. Catheteter
field is created from passed subcutaneously
 Summary of
 Position :
Procedure
Supine with head turned to contralateral
 Incision : Scalp, coronal and retroauricular
 Surgical Time :
1 Hour
 EBL :
5-25 ml
 Post operation care : PACU room (24
hr)
 Mortality and Morbidity :
Infection < 15 %
Thank you