Cidera Kepala pada Anak

WIHASTO SURYANINGTYAS

Seksi Bedah Saraf Pediatrik Dan Bedah Epilepsi

Pediatrik
Departemen Bedah Saraf
FK Universitas Airlangga – RSU Dr. Soetomo,
Surabaya
2010
 Aspek Khusus Cidera kepala pada Anak

Cidera pada Otak

yg sedang Inflicted/ Non-
Accidental Injury
Tumbuh accidental Injury

• Immature Brain • Shaken Baby • Depressed Skull

• Developing Syndrome Fracture
Brain • Child Abuse • Growing Skull
Fracture
• Penetrating
Head Injury
• Perdarahan
Intrakranial
Cidera pada Otak yg sedang Tumbuh
Inflicted/ Non-accidental Injury

SHAKEN BABY SYNDROME

CHILD ABUSE
 Shaken Baby Syndrome

 Shaken baby syndrome is a serious and clearly

definable form of child abuse.
 It results from extreme rotational cranial
acceleration induced by violent shaking or shaking/
impact, which would be easily recognizable by others
as dangerous.
 In developed countries, the annual SBS incidence is
estimated of 24.6 per 100 000 children aged less
than 1 year
 In Indonesia, no report regarding the incidence rate.
 Shaken baby syndrome:
 a serious form of child maltreatment
 most often involving children younger than 2 years
 but may be seen in children up to 5 years old. It occurs
commonly,
 misdiagnosed in its most subtle form and underdiagnosed in
its most serious form.
 A victim of sublethal shaking may have a history of
poor feeding, vomiting, lethargy, and/or irritability
occurring for days or weeks.
 Accidental Injury

•D E P R E S S E D S K U L L F R A C T U R E
•G R O W I N G S K U L L F R A C T U R E
•P E N E T R A T I N G H E A D I N J U R Y
 Depressed Skull Fracture


Non Operatif Operatif Catatan

• Kecil • Terbuka • Risiko kejang

• Bukan di • Besar • Risiko defisit
daerah • Laserasi dura neurologis
“kosmetik” • Perdarahan
indikasi op
dibawahnya
• Daerah
kosmetik
• Menenangkan
Ortu
Ping-pong skull fracture
 Growing Skull Fracture

 Linear or non-linear skull fractures in children that

enlarge with time.
 90% occur under the age of 3 years.
 the lesion expands not only between the fracture
edges, but also intracranially and, thus, may cause
atrophy of underlying cerebral tissue
Type III
 Clinical Feature

Rapidly Progressive Gradually progressive Spontaneous

With high ICP with increasing Arrest and heal
underlying brain damage
 Treatment

 Standard surgical approach involves resection of the

leptomeningeal cyst and herniated brain, repair of
the dural defect with a graft and cranioplasty/ Skull
mozaicism.
 In GSF with high ICP: shunting should be considered
as initial or alternatif therapy.
 Penetrating Head Injury

 Early involvement of neurosurgeon.

 GCS 3-4 and posterior fossa involvement, likely to
die.
 Surgical intervention should be individualized to
site and extent of injury.
 Short course antibiotic for low-velocity injury
 Prophylactic AED during first week.
 Beware of delayed complication: infection,
wandering fragments, lead poisoning
Intracranial Hemmorhage in
Pediatric Population

EPIDURAL HEMATOMAS
SUBDURAL HEMATOMAS
INTRACEREBRAL
HEMATOMAS
 Epidural Hematomas

Surgical Indications Non-surgical/ Observation

• Focal neurologic deficit, • Neurologically intact, no

3rd nerve palsy, drowsy headache, nausea,
• Clots > 15 mm thickness vomiting.
• Brain stem herniation • Clot in frontal, parietal,
• Clot volume >30 cc occipital
• Midline shift w/ uncal • Small posterior fossa
herniation lesion
• Underlying surgical
lesion
 Subdural Hematomas

Non-surgical/
Surgical Indications
Observation
• Focal neurologic • Neurologically intact
deficit, drowsy • Clot in
• Clots > 10 mm interhemispheric,
thickness tentorial, posterior
• Large Midline shift fossa (thin)
• Underlying surgical • No or limited MLS
lesion
• Hemisferic or large
brain swelling
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