TRANSIENT GERSTMANN-SYNDROME FOLLOWING FLOW

DIVERSION OF LEFT OPHTHALMIC ARTERY GIANT ANEURYSM: A

CASE-REPORT
Muhammad Fahriza, Affan Priyambodo Permana, Renindra Ananda
Aman, Setyo Widi Nugroho
1
Department of Neurosurgery, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo National
General Hospital, Jakarta, Indonesia

INTRODUCTION
Cerebral aneurysm accounted for 0.5–6% cases
worldwide. However, many showed no symptom,
and therefore left untreated, causing them to
continue to expand. Giant cerebral aneurysms
(diameter >25 mm) were found in 5% of all aneurysm
patients, with a rupture rate of 8–10% and a mortality
rate of 65–100% in the subsequent 2–5 years. Surgical
therapy remains as treatment of choice, although
intraoperative complications such as rupture were
not uncommon. In such cases, endovascular
intervention may be considered by using stent- Fig3. CT Brain 3 hours after onset shows no abnormalities
assisted coiling or flow diverter. The latter diverter
might be beneficial as the complication were DISCUSSION
relatively less serious and often transient The flow diverter is an alternative treatment choice
for giant cerebral aneurysms with relatively less
CASE REPORT serious side effects and often transient. For this case
of 57 years old woman with giant left ophtalmic
CHIEF OF COMPLAINT: AGRAPHIA ONE DAY AFTER artery giant aneurysm, flow diverter can be superior
FLOW DIVERSION TREATMENT
to stent-assisted coil for the complete occlusion.
OTHER COMPLAINTS: However, several complications can happen during
ACALCULIA, FINGER AGNOSIA, AND HEMINEGLECT
ON THE FOLLOWING DAY AFTER TREATMENT or after flow diverter placement. The most common
complications were stenosis (3-6%) and hemorrhage
HISTORY OF DISEASE: SPORADIC SEVERE
HEADACHE SINCE 8 YEARS due to rupture (0,6-1,6%), which were relatively rare
compared to surgical treatment. Our patient
presented with Gerstmann syndrome that most
likely caused by stenosis following procedures, as no
abnormalities were found in the CT evaluation.
Symptoms were completely resolved as the patient
was given double antiplatelet therapy to prevent
occlusion.

Fig1. Pre Flow Diversion DSA

CONCLUSION
A B C
Flow diverters have expanded the therapeutic
options for treatment of cerebral aneurysms and
represent a welcomed paradigm shift. Previously
untreatable intracranial aneurysms can now be
safely treated. Although some complications can be
occurred after the treatment that must be evaluated.
And it requires further study to evaluate whether the
Fig2. Post Flow Diversion DSA (A),after evaluation there was LICA
benefit exceeds the risks.
stenosis (B), and it was released after papaverine administration (C)
 CLINICAL PROFILE AND SURGICAL OUTCOMES
OF MENINGIOMA EN PLAQUE: A CASE-SERIES IN
NATIONAL REFERRAL HOSPITAL
M u h a m m a d F a h r i z a 1, M u h a m m a d R e z a a l k a H e l t o 1,
A f f a n P r i y a m b o d o P e r m a n a 1, R e n i n d r a A n a n d a A m a n 1,
Setyo Widi Nugroho1
1
Department of Neurosurgery, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo National
General Hospital, Jakarta, Indonesia

INTRODUCTION RESULTS
Meningioma is the most common type of primary Nine subjects were included in this study. All of
brain tumor. Meningioma en plaque (MEP) the subjects were women. The mean of age was
accounted for 2-9% of all meningiomas. It is 41.9 ± 7.7 years old. Sphenoorbita was the most
characterized by “carpet-like” invasion of adjacent
common region affected (77.8%), followed by
bone with extensive hyperostosis and dural
thickening. Boney invasion, hyperostosis and
frontal (16,1%) and parietooccipital (16,1%). The
compression of neural structures caused most common symptoms were hyperostosis
proptosis, the most common symptoms of MEP. and proptosis. All subjects underwent one-step
The surgical approach for MEP was considered surgery. Gross total resection tumor (Simpson
difficult, as it was challenging to achieve adequate grade I) was achieved in seven subjects (77.8%).
resection. This study aims to describe the clinical Proptosis index was significantly reduced
profile and outcomes of MEP patients who postoperatively from 0.44 ± 0.09 to 0.34 ± 0.04
underwent surgical resection in a national referral
(p=0.004).
hospital.

METHOD
A retrospective study was conducted in the
Neurosurgery Department of Cipto
Mangunkusumo National General Hospital
between 2016-2021. Data were collected from
medical records and radiology databases.
Incomplete data were excluded from this study.

CONCLUSION
Proptosis is one of the most common signs of
meningioma en plaque (MEP) since
sphenoorbita is the most common region
affected. Gross total resection can be done
through one-step surgery which will
significantly reduce the sign and symptoms of
MEP.
 CLINICAL PROFILE AND SURGICAL OUTCOMES OF
MENINGIOMA EN PLAQUE: A CASE-SERIES IN
NATIONAL REFERRAL HOSPITAL
1 1
Muhammad Fahriza , Muhammad Rezaalka Helto ,
1 1
Affan Priyambodo Permana , Renindra Ananda Aman ,
1
1 Setyo Widi Nugroho
Department of Neurosurgery, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo National General
Hospital, Jakarta, Indonesia

INTRODUCTION RESULTS
Meningioma is the most common type of primary Nine subjects were included in this study. All of
brain tumor. Meningioma en plaque (MEP) the subjects were women. The mean of age was
accounted for 2-9% of all meningiomas. It is 41.9 ± 7.7 years old. Sphenoorbita was the most
characterized by “carpet-like” invasion of adjacent
common region affected (77.8%), followed by
bone with extensive hyperostosis and dural
thickening. Boney invasion, hyperostosis and
frontal (16,1%) and parietooccipital (16,1%). The
compression of neural structures caused most common symptoms were hyperostosis
proptosis, the most common symptoms of MEP. and proptosis. All subjects underwent one-step
The surgical approach for MEP was considered surgery. Gross total resection tumor (Simpson
difficult, as it was challenging to achieve adequate grade I) was achieved in seven subjects (77.8%).
resection. This study aims to describe the clinical Proptosis index was significantly reduced
profile and outcomes of MEP patients who postoperatively from 0.44 ± 0.09 to 0.34 ± 0.04
underwent surgical resection in a national referral
(p=0.004).
hospital.

METHOD
A retrospective study was conducted in the
Neurosurgery Department of Cipto
Mangunkusumo National General Hospital
between 2016-2021. Data were collected from
medical records and radiology databases.
Incomplete data were excluded from this study.

CONCLUSION
Proptosis is one of the most common signs of
meningioma en plaque (MEP) since
sphenoorbita is the most common region
affected. Gross total resection can be done
through one-step surgery which will
significantly reduce the sign and symptoms of
MEP.