BACKGROUND: Transorbital penetrating intracranial injury (TOPI) is rare lesions, representing about 0.4% of traumatic brain injury. This uncommon injury has potentially severe and fatalities brain damage with high mortality rate if not promptly treated. CASE REPORT: We presented three patients with TOPI following penetration by a homemade metal arrow; unfortunately, two patients (cases 1 and 2) death on arrival at our hospital. As a survival patient (case 3), a 15-year-old boy presented with a homemade metal arrow entered through a right superior orbital fissure into the right cerebral hemisphere. Plain skull radiograph showed that the tip of the shaft was located in the right of the posterior cerebral hemisphere and confirmed by computerized tomography (CT) and three-dimensional CT of his brain. Injury to the right middle cerebral arteries was apparent on non-contrast CT angiography. Using a right occipital craniotomy approach with C-arm radiography fluoroscopy guidance, we successfully removed the arrow. Follow-up studies confirmed an excellent outcome. CONCLUSIONS: Pre-operative imaging is mandatory to evaluate the trajectory, brain, and vascular injury for appropriate surgical planning and post-operative care of patients with TOPI.

Carbonate hydroxy apatite (CHA) and hydroxyapatite (HA) are calcium phosphate biomaterials for bone substitute which have the characteristics of biocompatibility, bioactivity, and osteoconductivity. Platelet rich plasma (PRP) has platelet concentration of 3-5 times above normal and contains growth factor. This study was aimed to compare the effectiveness of CHA-PRP and HA-PRP in the occlusion of calvaria deffect. This was a descriptive observational study. Subjects were 18 Wistar rats (Rattus norvegicus), aged 20-22 weeks, weighing 350-400 g. PRP was processed from 3 ml of intracardiac blood. Calvaria defect of 3 mm diameter was performed as a burr hole. Subjects were divided into 2 groups. Group 1 was treated with CHA-PRP meanwhile group 2 was treated with HA-PRP. The rats were terminated at weeks 2, 3, and 4, then the calvaria bone tissue was evaluated histopathologically. The results showed that at week-2, group 1 had inflammatory cells of 80-90% and immature bone formation of 10%, while group 2 had inflammatory cells of 60-70% and immature bone formation of 5%. At week-3, group 1 had inflammatory cells of 80% and immature bone formation of 10-45% while group 2 had inflammatory cells of 60-70% and immature bone formation of 10-20%. At week-4, group 1 had inflammatory cells of 80-90% and immature bone formation of 45-90% while group 2 had inflammatory cells of 20-70% and immature bone formation of 15-55%. Conclusion: In rats (Rattus norvegicus) with calvaria defects, CHA-PRP treatment could accelerate the occlusion process better than HA-PRP.Kata kunci: carbonate hydroxy apatite, hydroxyapatite, platelet rich plasmaAbstrak: Karbonat hidroksi apatit (KHA) dan hidroksi apatit (HA) merupakan biomaterial kalsium fosfat pengganti tulang yang bersifat biokompatibilitas, bioaktivitas, osteokonduktif. Plasma kaya trombosit (PKT) mempunyai konsentrasi trombosit 3-5 kali di atas normal dan mengandung faktor pertumbuhan. Penelitian ini bertujuan untuk membandingkan pengaruh pemberian KHA-PKT dan HA-PKT pada proses penutupan defek kalvaria tikus. Jenis penelitian ialah deskriptif observasional. Subyek penelitian berupa 18 ekor tikus putih (Rattus norvegicus) galur Wistar, umur 20-22 minggu, berat badan 350-400 gr. Pengambilan darah tikus 3 cc intrakardiak diolah menjadi PKT. Defek kalvaria dibuat berbentuk burr hole diameter 3 mm. Subyek dibagi atas dua kelompok. Kelompok 1 diberikan KHA-PKT sedangkan kelompok 2 diberikan HA-PKT. Tikus diterminasi pada minggu ke-2, 3, dan 4 dan jaringan tulang kalvaria dievaluasi secara histopatologik. Hasil penelitian memperlihatkan di minggu ke-2, pada kelompok 1 terdapat infiltrasi sel radang 80-90% dan pembentukan tulang imatur 10% sedangkan kelompok 2 infiltrasi sel radang 60-70% dan pembentukan tulang imatur 5%. Di minggu ke-3, pada kelompok 1 terdapat infiltrasi sel radang 80% dan pembentukan tulang imatur 10-45% sedangkan kelompok 2 infiltrasi sel radang 60-70% dan pembentukan tulang imatur 10-20%. Di minggu ke-4, pada kelompok 1 terdapat infiltrasi sel radang 80-90% dan pembentukan tulang imatur 45-90% sedangkan kelompok 2 infiltrasi sel radang 20-70% dan pembentukan tulang imatur 15-55%. Simpulan: Pada tikus (Rattus norvegicus) dengan defek kalvaria, pemberian KHA-PKT dapat lebih mempercepat proses penutupan defek dibandingkan pemberian HA-PKT.Kata kunci: karbonat hidroksi apatit, hidroksi apatit, plasma kaya trombosit

A transorbital-penetrating intracranial injury (TOPI) is an unusual traumatic brain injury. This rare injury has the potential to result in serious and fatal brain damage with a high mortality rate and requires prompt multidisciplinary surgical intervention. Here, we describe an interesting case in which a patient who presented with accidental penetrating injuries of the brain was found to have a transorbital-penetrating intracranial injury (TOPI). We chose an anterior approach to the foreign body above the entrance wound for removal in a retrograde manner with fluoroscopic guidance. The patient remained well with no complications and was discharged on postoperative day 10. Reasonable diagnostic imaging, surgical planning, and careful post-surgery management can increase patients successful outcomes.

Maxillofacial structure is an unprotected part of the head and is easily exposed to blunt trauma. This structure functions as a safety cushion for the brain when a trauma occures. This study was conducted at Prof. Dr. R. D. Kandou Hospital Manado and aimed to obtain the relationship between maxillofacial fracture and intracranial lesion. Subjects were patients at the emergency unit with traffic accident associated with maxillofacial fracture with or without intracranial lelsion. GCS examination and CT scan of the head were performed to evaluate the intracranial lesion and the maxillofacial fracture (mild, moderate, or severe depended on the type of fracture). Data were tabulated and analyzed with Spearman correlation test using SPSS 2.2 program. The results showed that there were 50 patients with maxilllofacial injury, consisted of: 19 patients with mild injury, 25 patients with moderate injury, and 6 patients with severe injury. There were 13 patients with intracranial lesion and 37 patients without intracranial lesion. The Spearman correlation test showed an X2 = 32,60 and a P < 0.0001. Conclusion: There was a significant correlation between maxillofacial fracture and intracranial lesion.Keywords: maxillofacial fracture, intracranial lesionAbstrak: Struktur maksilofasial merupakan bagian dari tubuh yang tidak terlindungi, mudah terpapar oleh trauma tumpul, dan merupakan bantal pengaman untuk otak saat trauma terjadi. Penelitian ini bertujuan untuk mendapatkan hubungan antara fraktur maksilofasial dengan lesi intracranial dan dilakukan di RSUP Prof. Dr. R. D. Kandou Manado. Subyek penelitian ialah pasien yang datang ke unit gawat darurat yang mengalami kecelakaan lalu lintas dengan fraktur maksilofasial serta ada atau tidaknya lesi intrakranial. Pemeriksaan GCS serta CT scan kepala dilakukan untuk menilai lesi intrakranial sekaligus menilai fraktur maksilofasial (ringan, sedang, atau berat, tergantung dari jenis fraktur). Data ditabulasi dan diuji kemaknaannya dengan korelasi Spearman menggunakan program SPSS 2.2. Hasil penelitian memperlihatkan dari 50 pasien dengan cedera maksilofasial didapatkan: 19 pasien cedera ringan, 25 pasien cedera sedang, dan 6 pasien cedera berat. Terdapat 13 pasien yang disertai lesi intrakranial, sedangkan yang tanpa lesi intrakranial sebanyak 37 pasien. Uji statistik mendapatkan nilai X2 = 32,60 dengan P <0,0001 yang menunjukkan hubungan bermakna antara fraktur maksilofasial dan lesi intrakranial. Simpulan: Terdapat hubungan bermakna antara fraktur maksilofasial dan lesi intrakranial.Kata kunci: Fraktur maksilofasial, lesi intrakranial