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CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(03): 636-645
DOI: 10.1055/s-0045-1809143
Case Report

Navigating Limitations and Clinical Challenges in Indonesian Tertiary Trauma Center for Penetrating Brain Injury: A Case Report and Literature Review

Tedy Apriawan
1   Department of Neurosurgery, Dr. Soetomo General Hospital, Airlangga University, Surabaya, Jawa Timur, Indonesia
,
Asra Al Fauzi
1   Department of Neurosurgery, Dr. Soetomo General Hospital, Airlangga University, Surabaya, Jawa Timur, Indonesia
,
Nur Setiawan Suroto
1   Department of Neurosurgery, Dr. Soetomo General Hospital, Airlangga University, Surabaya, Jawa Timur, Indonesia
,
Alivery Raihanada Armando 
1   Department of Neurosurgery, Dr. Soetomo General Hospital, Airlangga University, Surabaya, Jawa Timur, Indonesia
,
Mohammad Rizky Pratama
1   Department of Neurosurgery, Dr. Soetomo General Hospital, Airlangga University, Surabaya, Jawa Timur, Indonesia
› Institutsangaben
Funding None.
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Abstract

Penetrating brain injury (PBI) accompanied by vascular injury is a severe trauma, often resulting in high mortality, particularly in low- and middle-income countries where many aspects of health care facilities are limited. Effective management of PBI requires efficient prehospital management, followed with advanced neurosurgical equipment, and continuous neurocritical monitoring. Delays in treatment due to inadequate transport infrastructure, scarce facilities, lack of specialized personnel, and inadequate transport infrastructure significantly elevate mortality rates. Neurointensive monitoring with radiological modalities plays significant role in detecting secondary processes in PBI, nevertheless facing significant limitations due to restricted access and resource allocation under national health insurance limit in clinical practice. Furthermore, undetected vascular complications could contribute to the high mortality observed in these environments. This case highlights the dilemmas in the neurocritical care of PBI as well as the need for improved health care policies for better health care.

Keywords

case report - penetrating brain injury - intraventricular hemorrhage - mortality rate - intensive care unit - health insurance

Authors' Contributions

T.A. was responsible for patient care, designing and formulating the paper, supervising the manuscript writing and editing process, and revising the paper. A.A.-F. performed the evacuation of the foreign object, contributed to the conceptual framework of the paper, supervised the writing and editing, provided critical feedback, and revised the manuscript. N.S.S. contributed to the conceptual framework, led the paper discussions, supervised manuscript preparation, provided critical feedback, and participated in revising the manuscript. A.R.A. and M.R.P. were involved in data collection, expanding the conceptual framework into a case report, writing the report, and revising the paper.


Ethical Approval

This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Institutional Review Board (IRB) approval was obtained from Soetomo General Hospital Ethics Board, ensuring that all protocols met the necessary ethical standards for research involving human participants. Informed consent was obtained from the participant and family involved.




Publikationsverlauf

Artikel online veröffentlicht:
19. Mai 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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