Skripsi

Masalah Tindakan Operasi Epilepsi Bedah Saraf: Sejak Diagnosis hingga Terlaksana Operasi di RSUPN. Dr. Cipto Mangunkusumo (RSCM) = Challenges in Neurosurgical Epilepsy Surgery: From Diagnosis to Operation at RSUPN Dr. Cipto Mangunkusumo (RSCM).

Latar Belakang Epilepsi resisten obat (DRE) merupakan masalah yang serius; pada sebagian pasien, pembedahan memberi peluang kendali kejang yang bermakna. Penelitian ini menggambarkan kriteria kandidat, hambatan sejak diagnosis hingga operasi, dan luaran pascaoperasi di RSCM Metode Desain deskriptif cross-sectional menggunakan telaah rekam medis total sampling terhadap 13 pasien yang menjalani evaluasi lengkap hingga operasi epilepsi di Poli Bedah Saraf RSCM (Februari 2018–Februari 2025). Variabel meliputi profil klinis, EEG (interiktal/iktal), neuroimaging, terapi OAE, jenis operasi, penurunan frekuensi kejang, dan klasifikasi Engel. Hasil Hampir seluruh pasien memenuhi DRE; 76,9% pasien menunjukkan aktivitas epileptiform pada EEG dan 100% lesional pada imaging, tersering mesial temporal sclerosis (61,5%). Konkordansi klinis–EEG–imaging penuh/parsial terdapat pada 92,3% pasien. Hambatan utama: keterlambatan diagnosis (30,8%), eskalasi ≥4 OAE (76,9%), dan fokus epileptogenik tidak resektabel (23,1%). Operasi didominasi reseksi temporal (ATL+AH 46,2%). Luaran: bebas kejang 46,2% dan penurunan ≥90% sebesar 30,8%; Engel I-II (61,5%), Engel III (23,1%), dan Engel IV (15,4%). Kesimpulan Kandidat pasien operasi epilepsi adalah DRE lesional dengan konkordansi multimodal yang memadai. Hambatan berpusat pada keterlambatan diagnosis, kebutuhan evaluasi kompleks, penyakit komorbid pasien, dan fokus epileptogenik yang tidak resektabel. Operasi epilepsi memberikan manfaat klinis bermakna: ~¾ pasien mencapai ≥90% penurunan kejang atau bebas kejang, menegaskan pentingnya seleksi dini dan rujukan cepat ke pusat bedah epilepsi.
Kata Kunci: Amigdalo-hipokampektomi; bedah epilepsi; lobektomi temporal anterior; mesial temporal sclerosis; outcome pascabedah; resistensi obat


Introduction Drug-resistant epilepsy (DRE) is a serious condition; in certain patients, surgery offers a significant opportunity for seizure control. This study describes the candidate criteria, barriers from diagnosis to surgery, and postoperative outcomes at RSCM. Method A descriptive cross-sectional design using total sampling of medical records from 13 patients who underwent complete evaluation through epilepsy surgery at the Neurosurgery Clinic, RSCM (February 2018–February 2025). Variables included clinical profile, EEG (interictal/ictal), neuroimaging, antiseizure medications (ASMs), type of surgery, reduction in seizure frequency, and Engel classification. Results Almost all patients met the criteria for DRE; 76.9% showed epileptiform activity on EEG and 100% had lesional findings on imaging, most commonly mesial temporal sclerosis (61.5%). Clinical–EEG–imaging concordance was full/partial in 92.3% of patients. The main barriers included diagnostic delay (30.8%), escalation to ≥4 antiseizure medications (76.9%), and unresectable epileptogenic focus (23.1%). Surgery was predominantly temporal resection (ATL + AH 46.2%). Outcomes showed seizure freedom in 46.2% and ≥90% reduction in 30.8%; Engel class I–II (61.5%), Engel III (23.1%), and Engel IV (15.4%). Conclusion Eligible candidates for epilepsy surgery are patients with lesional DRE and adequate multimodal concordance. The main barriers center on diagnostic delay, the need for complex evaluations, patient comorbidities, and unresectable epileptogenic foci. Epilepsy surgery provides significant clinical benefits: ~¾ of patients achieved ≥90% seizure reduction or complete seizure freedom, underscoring the importance of early selection and timely referral to epilepsy surgery centers.
Keywords: Amygdalo-hippocampectomy; anterior temporal lobectomy; drug resistance; epilepsy surgery; mesial temporal sclerosis; postoperative outcomes.