• Nur Setiawan Suroto, MD

Neurosurgeon & Endovascular Neurosurgeon

• Comprehensive Stroke Center (CSC) National Hospital Surabaya

• Neurovascular & Neuroendovascular Therapy Center
Dept of Neurosurgery Airlangga University-Dr Sutomo Hospital
Surabaya- Indonesia

Education & Training

• 2005
Graduate form medical school (Airlangga University Faculty of Medicine) in Surabaya Indonesia
• 2006-2011
Neurosurgical residency program at Airlangga University Faculty of Medicine Dr Sutomo Hospital
Surabaya Indonesia
• 2012-2013
Clinical fellowship program on Surgical Management of Neurointervention at Seoul National
University-Bundang Hospital, South Korea
• March & Oct 2014
Pierre Lasjaunias Nerovascular Educational Team Course - PLANET Dongtan, South Korea
• August 2016
Flow Diverter Pipeline Stent Training at Gold Cost Hospital. Australia

Position
• Chief of Neuroendovascular Division. Dept of Neurosurgery Airlangga University-Dr Sutomo
Hospital
• Neurosurgeon at Comprehensive Stroke Center National Hospital, Surabaya
• International Member of American Asscociation of Neurological Surgeon
• Member of Indonesian Society Of Neurosurgical Surgeon
• Member of Indonesian Society of Medical Doctor

© 2016 Surabaya Neurosciecnce Institute

ENDOVASCULAR NEUROSURGERY
&
NEUROTOMY FOR SPASTICITY

Nur Setiawan Suroto, dr. SpBS

Comprehensive Stroke Center (CSC) National Hospital Surabaya

&
Neurovascular and Neuroendovascular Therapy Center
Department of Neurosurgery Airlangga University-Dr Sutomo
Hospital Surabaya- Indonesia
HOW
 INTRODUCTION

• Term
• Endovascular Neurosurgery / Neurointervensi (Bedah Saraf Endovaskular)
• Teknik minimal invasive yang digunakan untuk mendiagnosa dan melakukan terapi pada
kelainan pembuluh darah otak dan pembuluh darah spinal
• Diagnosa
• Terapi
• Suportif
• Definitif
• “Kateterisasi Otak”
 WHAT CAN WE DO ENDOVASCULARLY ?

• Diagnose Macam Penyakit

• Treatment • Vaskular
• Stroke, aneurisme, avm, dll
• Suportif
• Tumor
• Ex: Preoperative embolisasi tumor,
AVM, dll • Preoperative planning, preoperative embolisasi

• Definitif • Trauma
• Fistula Carotid Cavernous, pseudoaneurisma
• Stroke
• Anak2
• Aneurisme
• Malformasi Vaskular, malformasi Gallen, dll
• Stenosis
• Lain2
• dll
• Idiopathic Epistaxis
• dll
 STROKE
• Stroke penyumbatan (Ischemic Stroke) • Stroke Perdarahan (Hemorrhagic
Stroke)
• Cerebral Thrombosis
• Cerebral Embolism – Hipertensi,
– Aneurisme pecah
– Varises otak (AVM)
Kencing manis, kolesterol, hipertensi, – Fistula
– dll
dll
 STROKE
HEMORRHAGIC
(PERDARAHAN)
• Intracerebral Hemorhage • Faktor resiko dan pemicu
• Hipertensi
• Subarachnoid Hemorrhage
• Diabetes Mellitus
• Proses Degeneratif

• Subdural Hemorrhage

© 2015 Surabaya Neurosciecnce Institute

 PERDARAHAN Perdarahan
SUBARACHNOID
(SAH) Intraserebral (ICH)
????????

© 2015 Surabaya Neurosciecnce Institute

 PERDARAHAN SUBARACHNOID (SAH)
EC. ANEURISME OTAK (BRAIN ANEURYSM)
Treatment :
FACTS :

• Insiden aneurime non rupture di

negara maju adalah 1 diantara 50
orang.
• Aneurisme pecah (ruptured
aneurysm) adalah 3-5 % dari
seluruh angka kejadian stroke

Clipping Surgery Aneurisme Coiling

• 15% dari pasien dengan SAH
meninggal sebelum mencapai
rumah sakit.

© 2015 Surabaya Neurosciecnce Institute

 Coiling Aneurisme

Clipping Surgery

© 2015 Surabaya Neurosciecnce Institute

 ISCHEMIC STROKE
• Stroke Thrombus
Sumber stroke berasal dari deposit
plaque yang ada di pembuluh darah otak

• Stroke Emboli
Sumber stroke berasal dari deposit
plaque yang ada di luar otak
Contoh : Jantung, percabangan arteri
karotis leher

© 2015 Surabaya Neurosciecnce Institute

 CT SCAN DAN MRI DI JAM AWAL
SERANGAN

CT Scan MRI (Diffusion)

CT scan di periode awal serangan tidak memberikan Justru menjadi dasar untuk pemberian terapi
gambaran abnormal thrombolysis (r-TPA)
© 2015 Surabaya Neurosciecnce Institute
 ACUTE ISCHEMIC STROKE
TREATMENT
• Intra Venous Thrombolysis
• R TPA : Recombinant Tissue Plasminogen
Activator
• ( < 4,5 jam )j
• Yang harus diupayakan
• “Primary Stroke Center”

Before After
 THEN, WE CAN DO THIS ALSO ….

Jika Intra vena belum optimal  bisa

dilakukan :
• Mechanical Thrombectomy – Stent
Retriever (Solitaire)

Comprehensive Stroke Center ( CSC )

National Hospital :
- Neurosurgeon
- Neurologist
- Neuroradiologist
- Neurorehabilitation
- Cardiologist
- Neuroanesthesiologist
 MENGETAHUI ETIOLOGI
ADALAH PENATALAKSANAAN
YANG UTAMA

• Hipertensi
Risk Factor
• DM - Berdiri sendiri
atau
• Kolesterol - Faktor pemicu
• ???

“It is important to treat Stroke but it is

more important to find the etiology”
 EX CASE : STROKE
RISK FACTOR : HYPERTENSION + CAROTID
STENOSIS

• Goal : Prevent another stroke

• Tx :
• Carotid Endartercetomy (CEA)
• Carotid Artery Stenting (CAS)
 ARTERIOVENOUS MALFORMATION (AVM)

• “Varises pada otak” • Insidens 0,14%

 1 : 700 (US)
• Suatu pintasan atau "shunting" • Mulai muncul pd saat periode
antara arteri dengan vena. fetal atau segera setelah lahir

• Gejala
• Nyeri kepala
• Kejang
• Perdarahan --> stroke
 PEMERIKSAAN RADIOLOGI (
IMAGING)
DSA
CT Angiografi
CT Scan

© 2015 Surabaya Neurosciecnce Institute

PENANGANAN

Surgical exicion

Embolisasi melaui
kateterisasi

Radioterapi Stereotaktik

© 2015 Surabaya Neurosciecnce Institute

 POST TRAUMATIC CAROTID CAVERNOUS
FISTULA (CCF)

Suatu kondisi dimana setelah

benturan hebat fraktur basis
cranii timbul saluran (fistula)
dari arteri karotis interna
dengan sinus cavernosus

Before After
 SPONTANEOUS DURAL ARTERY VENOUS
FISTULA (DAVF)

Patofisiologi mirip dengan

CCF, tetapi penyebab bisa
dikarenakan infeksi,
thrombus vena dll.
(Indirect type)

Before
After
MOYA MOYA DISEASE
(STROKE PADA ANAK)

• Mengetahui etiologi

• Moya-moya disease
• Penebalan dinding pembuluh darah di
distal arteri karotis
• By pass surgery
SPASTISITAS POST
STROKE Neurotomi Surgery
TERIMA KASIH