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DIAGNOSA BANDING MAKROKRANIA

DIAGNOSA BANDING MAKROKRANIA. Megalensefali: Familier Patologis → hormon: gigantisme dan dwarfisme Edema otak kronis: Keracunan timah Hipoparatiroid Penebalan tulang kepala: Anemia Displasia Subdural: Hematom / efusi Higroma Empiema. DIAGNOSA BANDING MAKROKRANIA. Hidrosefalus

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DIAGNOSA BANDING MAKROKRANIA

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  1. DIAGNOSA BANDING MAKROKRANIA Megalensefali: Familier Patologis → hormon: gigantisme dan dwarfisme Edema otak kronis: Keracunan timah Hipoparatiroid Penebalan tulang kepala: Anemia Displasia Subdural: Hematom / efusi Higroma Empiema

  2. DIAGNOSA BANDING MAKROKRANIA • Hidrosefalus • Hidrosefalus arrested • TIK: Normal • Ada perkembangan motorik / kecerdasan • Lingkar fronto oksipital: klinis dan radiologisnya tidak aktif • Penyebab: Infeksi / perdarahan • Tumor otak

  3. PENATALAKSANAAN • Pilihan pengobatan tergantung: • Kelainan bawaan lain (otak dan luar otak) • Umur kehamilan • Infeksi otak • Usia saat datang berobat • Ketebalan sisa otak • Kelainan kromosom • Harapan orangtua

  4. PEMBEDAHAN INTERVENSI DINI !!! makin dini, makin baik Hindari atrofi otak

  5. PEMBEDAHAN Etiologis Tumor, papilloma plexus Choroid, kista intrakranial, ACM, DWM, stenosis Sylvii, hematoma intrakranial, edema serebri, infark serebri masif. → Trepanasi

  6. PEMBEDAHAN Drainage Prinsip dasar: alirkan CSS ke ruang lain dan TIK dijaga dalam batas normal. 1. ETV (V3 – subarakhnoid) 2. EVD (external ventricular drainage) 3. Shunting: - Peritoneum: VP (ventriculo-peritoneal) LP (lumbo-peritoneal) - Atrium: VA (ventrikulo-atrial) - Pleura (ventriculo-pleural)

  7. VPS - VAS placement LP Shunt

  8. KONTROL PASCA BEDAH Untuk menilai: 1. Komplikasi 2. Hasil terapi

  9. Komplikasi shunt • Disfungsi shunt • Shunt infection • Over drainage / siphon effect • Slit ventricle syndrome • Haemorrhage along the tract • Shunt migration • Seizure • Silicon allergy

  10. TIPS PERAWATAN HYDROCEPHALUS BATH HYDROCEPHALUS BED HEAD-UP BED HEAD-UP BED

  11. PROGNOSIS • Buruk bila: • Faktor prenatal: • Progresif (USG fetal serial) • Tebal otak < 15 mm • Durasi in utero > 4 minggu • Baik bila: • Isolated ventriculomegaly ringan • Tebal otak > 15 mm • Shunting saat neonatus !

  12. Angka infeksi • Operasi cukup umur: 3 – 10% • Prematur: 20%

  13. Kesimpulan • Hidrosefalus adalah problem jangka panjang • Operasi shunt, tidak menyembuhkan, hanya mengendalikan • Big head tidak selalu berarti bad thing • Terpenting adalah periksa kehamilan teratur, segera ke RS bila sudah dipastikan hidrosefalus

  14. Jangan tunggu hingga begini!

  15. Ada pertanyaan ???

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