REFERAT
ANEURISMA CEREBRI
Disusunoleh : ANDREW L (030,05,027) PENGUJ: !"#RN# $P#$
%EPANTERAAN %LN% L&U PEN'A%T $ARAF FA%ULT FA%ULTA$ A$ %ED%TERAN %ED%TER AN UNER$ U NER$TA TA$ $ TR$A%T TR $A%T R$PAU DR#E$NAW DR# E$NAWAN AN ANTAR%$ ANTAR%$A A JA%ARTA
BAB I PENDAHULUAN
Aneu"i Aneu"is*+ s*+ +!+l+h +!+l+h ele-+ ele-+"+n "+n +.+u +.+u *en//e *en//ele* le*-un -un/n /n++ !in!in !in!in/ / e*-ul e*-uluh uh !+"+h, +n/ !i!+s+"1+n +.+s hil+n/n+ !u+ l+is+n !in!in/ e*-uluh !+"+h, +i.u .uni1+ .uni1+ *e!i+ *e!i+ !+n .uni1+ .uni1+ in.i*+ in.i*+,, sehin/ sehin//+ /+ *ene *ene"u "u+i +i .onol .onol+n +n -+lon# -+lon# Din!in Din!in/ / e*-uluh !+"+h +!+ +neu"is*+ ini -i+s+n+ *en+!i le-ih .iis !+n *u!+h e4+h# $e-e $e-en+ n+"n "n + +neu +neu"i "is* s*++ !++ !++.. .e" .e"+! +!ii !i e*e*-ul uluh uh !+"+ !+"+h h *+n+ *+n+ s++ s++ !i .u-u .u-uh h 1i.+##A+-il+ +neu"is*+ ini .e"+!i +!+ e*-uluh !+"+h o.+1, /e+l+n+ !++. -e"u+ s+1i. 1e+l+ +n/ he-+., -e"si+. -e"!enu., !++. !ise".+i +.+u .i!+1 !ise".+i !en/+n *un. *un.+h +h## %o* %o*li li1+s 1+sii !+"i !+"i +neu +neu"i "is* s*++ !++ !++.. *en *ene-+ e-+-1 -1+n +n .e"+! .e"+!in in+ + e4+h e4+hn n++ e*-uluh !+"+h !i o.+1, +n/ +n/ u/+ !i1en+l !en/+n s."o1e# $++n/n+, $++n/n+, 1+sus ini -elu* -+n+1 !i1e.+hui !i n!onesi+ !+n !+.+ .en.+n/ en+1i. en+1i. ini *+sih s+n/+. se!i1i.# Pele-+"+n ini !++. ul+ *ene1+n !+n *en/i1is +"in/+n !i !e1+.n+# 6il+ +neu"i +neu"is*+ s*+ i.u -e"+!+ -e"+!+ !e1+. !e1+. .ul+n/ .ul+n/,, .ul+n/ .ul+n/ .e"se-u .e"se-u.. +1+n +1+n *enii *eniis# s# 6il+ 6il+ -e"!e1 -e"!e1+.+ +.+n n !en/+n .en//o"o1+n, *+1+ -+/i+n +1+n .e".e1+n !+n s+lu"+n n++s .e"su*-+.# Di !+l+* "on//+ +neu"is*+, *u!+h .e"-en.u1 /u*+l+n !+"+h +n/ !ise-u. ."o*-us# T"o*-us T"o*-us ini s+n/+. s +n/+. "+uh !+n *u!+h *ene"ih# $e"ih+n ini *eni*-ul1+n su*-+.+n e*-uluh !+"+h !i -e"-+/+i .e*+.# No"*+ln+,
e*-uluh
!+"+h
*e*un+i
.i/+
l+is+n
u.+*+
+i.u:
# L+i L+is+n s+n e".+ e".+*+ *+ !ise!ise-u. u. l+i l+is+n s+n in.i* in.i*++ +n/ +n/ .e"! .e"!i" i"ii !+"i !+"i s+.u s+.u l+i l+iss en!o en!o.e .el# l# 2# L+is+n 1e!u+ +!+l+h l+is+n *e!i+ +n/ .e"!i"i !+"i l+is+n o.o. +n/ el+s.is# 3# L+is+n 1e.i/+ +!+l+h l+is+n +!8en.isi+ +n/ .e"!i"i !+"i +"in/+n i1+. lon//+" !+n le*+1#
Del++n uluh li*+ s+*+i se*-il+n uluh e"sen +neu"is*+ -e"+s+l !+"i -+/i+n !e+n +.+u e*-uluh !+"+h 1+"o.is, !+n sis+n+ -e"+s+l !+"i -+/i+n -el+1+n/ +.+u e*-uluh 8e".e-"+lis# Aneu"is*+ !i1+.+1+n h+*i" .i!+1 e*+h *eni*-ul1+n /e+l+ 1e4u+li .e"+!i e*-es+"+n !+n *ene1+n s+l+h s+.u s+"+ o.+1 sehin//+ *e*-e"i1+n /e+l+ se-+/+i 1el+in+n s+"+ o.+1 +n/ .e".e1+n see".i +!+ ."i/e*in+l neu"+l/i+# Aneu"is*+ in."+1"+ni+l se"in/ !i.e*u1+n 1e.i1+ .e"+!i "u.u" +n/ !++. *ene-+-1+n e"!+"+h+n !+l+* o.+1 +.+u +!+ "u+n/ su-+"+hnoi!, sehin//+ *ene-+-1+n e"!+"+h+n su-+"+hnoi!# Pe"!+"+h+n su-+"+hnoi! !+"i su+.u "u.u" +.+u +neu"is*+ o.+1 !++. *ene-+-1+n .e"+!in+ s."o1e he*o"+/i1, 1e"us+1+n !+n 1e*+.i+n o.+1# "+n/ +n/ *en!e"i.+ +neu"is*+ !i o.+1, .i!+1 !ie"-oleh1+n -e"ol+h"+/+ -e"+. see".i +n/1+. -esi# 6+h++ e"!+"+h+n o.+1 *u!+h .e"+!i !+n -is+ -e"+1i-+. +.+l# Aneu"is*+ se"in/ -+"u !i1e.+hui se.el+h !il+1u1+n o.o "on./en +n/io/"+i un.u1 1ee"lu+n l+in# Pene-+- +neu"is*+ ini -is+ 1+"en+ ine1si, +.e"os1le"osis, "u!++1s+, +.+u
1ele*+h+n
-+9++n
+!+
!in!in/
e*-uluh
!+"+h#
6+/+i*+n+ +.oisiolo/i !+n en+n/+n+n +neu"is*+ sel+nu.n+ +1+n !i-+h+s !+l+* "e"+. ini#
BAB II TINJAUAN KEPUSTAKAAN
2.1 DEFINISI
Aneu"is*+ +!+l+h ele-+"+n +.+u *en//ele*-un/n+ !in!in/ e*-uluh !+"+h, +n/ !i!+s+"1+n +.+s hil+n/n+ !u+ l+is+n !in!in/ e*-uluh !+"+h, +i.u .uni1+ *e!i+ !+n .uni1+ in.i*+, sehin//+ *ene"u+i .onol+n +.+u -+lon# Din!in/ e*-uluh !+"+h +!+ +neu"is*+ ini -i+s+n+ *en+!i le-ih .iis !+n *u!+h e4+h# Pen/e".i+n +neu"is*+ +n/ sesun//uhn+ +!+l+h !il+.+si +-no"*+l !+"i +".e"i# +l ini h+"us !i-e!+1+n !+"i ;+lse< +neu"is*+, !i*+n+ .e"+!i en/u*ul+n !+"+h !ise1i.+" !in!in/ e*-uluh !+"+h +1i-+. ."+u*+# Aneu"is*+ se"in/ .e"-en.u1 se4+"+ e"l+h+n sel+*+ -e".+hun=.+hun !+n se"in/ u/+ .+n+ /e+l+ .e.+i i1+ .el+h .e"+!i "u.u" *+1+ ini +!+l+h 1e/+9+.!+"u"+.+n -e!+h +n/ !++. *en/+n4+* n+9+ +sien#
2.2 EPIDEMIOLOGI
Di -+n+1 ne/+"+, "e8+lensi en+1i. ini .e"/olon/ .in//i# Di A*e"i1+ $e"i1+., *is+ln+, +neu"is*+ *en4++i "+.+="+.+ li*+ e" 00#000 1+sus, .e"/olon/ +lin/ .in//i !i-+n!in/1+n !en/+n /+n//u+n +.+u 1el+in+n o.+1 l+inn+# %+sus ini !i -+n+1 ne/+"+ !i.e*ui +!+ +sien -e"usi+ 3 = 50 .+hun# nsi!en !+"i +neu"is*+ -+i1 +n/ e4+h *+uun +n/ u.uh +!+ o.osi !i.e*u1+n se-es+" 5 > !+"i oul+si u*u*# nsi!en +!+ 9+ni.+ !i.e*u1+n le-ih -+n+1 !i-+n!in/1+n "i+, +i.u: 2 = 3 : , !+n +neu"is*+ *ul.ile +.+u le-ih !+"i s+.u !i!++.1+n +n.+"+ 5 = 3>
2.3 KLASIFIKASI
6e"!+s+"1+n ene-+-n+, +neu"is*+ !i-+/i +.+s: # %on/eni.+l (+neu"is*+ s+1ule") ?#@> 2# Aneu"is*+ *i1o.i1 (se.i1) 2,> 3# Aneu"is*+ +".e"ios1le"o.i1 ?# Aneu"is*+ ."+u*+.i1 5==7,B># L+o"+n o.osi insi!ensi +neu"is*+ 1on/eni.+l se-es+" ?#@>=20> +n/ .e"!i"i !+"i 5> *ul.ile !+n B5> soli.e"# Lo1+si +neu"is*+ 1on/eni.+l !il+o"1+n : B5= @0> +!+ -+/i+n !e+n si"1ulus WLL$C 30==?0> +!+ +".e"i 4+"o.is in.e"n+C 30=?0> !i +# 4e"e-"i +n.e"io"4o**uni4+ns +n.e"io"C 20=30> !i +# 4e"e-"i *e!i+C 0=5> !i +#8e".e-"o=-+sil+"is# 6e"!+s+"1+n -en.u1n+, +neu"is*+ !++. !i-e!+1+n: Aneu"is*+ .ie usio"* (5@>)# Pen!e"i.+ +neu"is*+ ini *en/+l+*i 1ele*+h+n !in!in/ *elin/1+"i e*-uluh !+"+h se.e*+. sehin//+ *ene"u+i -+!+n -o.ol# Aneu"is*+ .ie s+1ule" +.+u +neu"is*+ 1+n.on/ (@0@5>)# P+!+ +neu"is*+ ini, 1ele*+h+n h+n+ +!+ s+.u e"*u1++n e*-uluh !+"+h sehin//+ !++. -e"-en.u1 see".i 1+n.on/ !+n *e*un+i .+n/1+i +.+u lehe"# D+"i selu"uh +neu"is*+ !+s+" .en/1o"+1, 1u"+n/ le-ih @0> *e"u+1+n +neu"is*+ s+1ule"# 6e"!+s+"1+n !i+*e.e"n+ +neu"is*+ s+1ule" !++. !i-e!+1+n +.+s:
Aneu"is*+ s+1ule" 1e4il !en/+n !i+*e.e" − 4*#
Aneu"is*+ s+1ule" -es+" !en/+n !i+*e.e" +n.+"+ = 2#5 4*#
Aneu"is*+ s+1ule" "+1s+s+ !en/+n !i+*e.e" 2#5 4*#
Aneu"is*+ .ie !ise1.in/ ( > )#
Aneu"is*+ -is+ *ul.ile ( 70=75> ) !+n -is+ ul+ soli.e" #
Gambar 1. a. Saccular aneurysm with narrow neck , b. Saccular aneurysm with broad neck, c.Fusiform aneurysm
&enu"u. -es+"n+ , *+1+ +neu"is*+ o.+1 !i-+/i *en+!i 5 -+/i+n : # -+- ( 2 **) 2# s*+ll (2= **) 3# *e!iu* (=5 **) ?# l+"/e (5=25 **) 5# /i+n. ( 25 **)#
2.4 ETIOLOGI
Aneu"is*+ !++. !ise-+-1+n oleh -e"-+/+i +1.o"#
&ele*+hn+ s."u1.u" !in!in/ e*-uluh !+"+h +".e"i# &e"u+1+n 1+sus +n/ +lin/ se"in/ .e"+!i# %ele*+h+n +!+ !in!in/ e*-uluh !+"+h ini *ene-+-1+n -+/i+n e*-uluh +n/ .iis .i!+1 *+*u *en+h+n .e1+n+n !+"+h +n/ "el+.i .in//i sehin//+ +1+n *en//ele*-un/#
ie".ensi (.e1+n+n !+"+h .in//i)
A.e"os1le"osis (enu*u1+n le*+1 +!+ !in!in/ e*-uluh !+"+h +".e"i) !++. u/+ *ene-+-1+n e".u*-uh+n !+n e4+hn+ +neu"is*+#
6e-e"++ ine1si !+l+* !+"+h
6e"si+. /ene.i1
&+lo"*+si +".e"io8enos+, +i.u 1el+in+n +n+.o*is !i !+l+* +".e"i +.+u 8en+ !i !+l+* +.+u !i se1i.+" o.+1# &+lo"*+si +".e"io8enos+ *e"u+1+n 1el+in+n -+9++n, .e.+i -+"u !i1e.+hui 1e-e"+!++nn+ i1+ .el+h *eni*-ul1+n /e+l+# Pe"!+"+h+n !+"i *+lo"*+si +".e"io8enos+ -is+ se4+"+ .i-+=.i-+ *ene-+-1+n in/s+n !+n 1e*+.i+n, !+n 4en!e"un/ *ene"+n/ "e*++ !+n !e9+s+ *u!+
Tabel 1 Faktor Resiko Aneurisma Intracranial
F+1.o" 1e.u"un+n
F+1.o" "esi1o l+in
Au.oso*+l !o*in+n. ol4s.i4 1i!ne
A/e o8e" 50 e+"s Fe*+le /en!e"
!ise+se Te Ehle"s=D+nlos sn!"o*e
Iu""en. 4i/+"e..e s*o1in/ Io4+ine use
Pseu!oH+n.ho*+ el+s.i4u* e"e!i.+"
ne4.ion o 8essel 9+ll e+! ."+u*+
e*o""h+/i4 .el+n/ie4.+si+
n."+4"+ni+l neol+s* o" neol+s.i4
Neu"oi-"o*+.osis .e Alh+=+n.i."sin e*-oli e".ensionK Al4oholK "+l !ei4ien4 Io+"4.+.ion o .he +o".+
4on."+4e.i8e ill useK
Fi-"o*us4ul+" !sl+si+
e"4holes.e"ole*i+K
Pheo4h"o*o4.o*+ %lineel.e"s sn!"o*e Tu-e"ous s4le"osis Noon+ns sn!"o*e Alh+=/lu4osi!+se !ei4ien4
2.5 PATOFISIOLOGI
No"*+ln+,
e*-uluh
!+"+h
*e*un+i
.i/+
l+is+n
u.+*+
+i.u:
# L+is+n e".+*+ !ise-u. l+is+n in.i*+ +n/ .e"!i"i !+"i s+.u l+is en!o.el# 2# L+is+n 1e!u+ +!+l+h l+is+n *e!i+ +n/ .e"!i"i !+"i l+is+n o.o. +n/ el+s.is# 3# L+is+n 1e.i/+ +!+l+h l+is+n +!8en.isi+ +n/ .e"!i"i !+"i +"in/+n i1+. lon//+" !+n le*+1#
P+!+ +neu"is*+ !i.e*u1+n su+.u 1el+in+n +!+ l+is+n e*-uluh !+"+h +n/ .e"!i"i !+"i .i/+ l+is+n, +i.u l+is+n .uni1+ in.i*+, *e!i+ !+n +!8en.i.i+# P+!+ +neu"is*+ .e"!++. eniis+n .uni1+ *e!i+ !+n .uni1+ in.i*+ *en+!i le-ih el+s.is h+l ini *en/+1i-+.1+n 1ele*+h+n +!+ e*-uluh !+"+h !i !+e"+h +neu"is*+ sehin//+ e*-uluh
!+"+h
*e*-en.u1
.onol+n
+1i-+.
.e1+n+n
e*-uluh
!+"+h#
&e1+nis*e e*-en.u1+n +neu"is*+ !+n .e"+!in+ e"!+"+h+n +!+ +neu"is*+ *+sih 1on."o8e"si+l# Lesi ini !ie"1i"+1+n +1i-+. 1ele*+h+n 1on/eni.+l .uni1+ *us1ul+"is +".e"i se"e-"+l +n/ *ene-+-1+n .uni1+ in.i*+ *e*-onol !+n +1hi"n+ *e"o-e1 *e*-"+n+ el+s.i1 Te*+. +n/ -i+s+n+ .i*-ul +neu"is*+ +!+l+h +!+ !+e"+h : # $i"1ul+si +n.e"io" : e*-uluh !+"+h +".e"i 1o*uni1+ns +n.e"io" !+n +".e"i 4e"e-"i *e!i+ 2# $i"1ul+si os.e"io" : e*-uluh !+"+h +".e"i 1o*uni1+ns os.e"io" !+n e"4+-+n/+n +".e"i -+sil+"is (-+sil+" .i +neu"is*)
Gambar 2. Sr!"#"$ %##$
Gambar 3. Lokasi tersering dari aneurisma intrakranial
Aneu"is*+ s+1ul+" -e"1e*-+n/ !+"i !ee1 l+is+n o.o. (.uni1+ *us1ul+"is) +!+ +".e"i# Pe"u-+h+n el+s.isi.+s *e*-"+n !+l+* (l+*in+ el+s.i1+ in.e"n+) +!+ +".e"i 4e"e-"i !ie"4++i *ele*+h1+n !in!in/ e*-uluh !+"+h !+n *en/u"+n/i 1e"en.+n+n *e"e1+ un.u1 -e"u-+h +!+ .e1+n+n in."+lu*in+l# Pe"u-+h+n ini -+n+1 .e"+!i +!+ e".e*u+n e*-uluh !+"+h, !i*+n+ +li"+n !+"+h .u"-ulen !+n .+h+n+n +li"+n !+"+h +!+ !in!in/ +".e"i +lin/ -es+"# Aneu"is*+ s+1ul+" -i+s+n+ -e"-en.u1 ;i"s. +n! se4on! o"!e" +".e"ies<, -e"+s+l !+"i si1lus +".e"i se"e-"+l (si1lus 9illisi) +!+ !+s+" o.+1# Aneu"is*+ *ul.iel -e1e*-+n/ +!+ 30> +sien# Aneu"is*+ usio"*is -e"1e*-+n/ !+"i +".e"i se"e-"i +n/ e1.+.i1 !+n -e"li1u=li1u +n/ -i+s+n+ -e"+s+l !+"i sis.e* 8e".e-"+ -+sile" !+n -is+ s+*+i -e-e"++ sen.i*e.e" +!+ !i+*e.e"n+# P+sien +neu"is*e usio"*is -e"1+"+1.e" !en/+n /e+l+ 1o*"esi sel in!u1 o.+1 +.+u ne"8us 1"+ni+lis .+i /e+l+ .i!+1 sel+lu !ise".+i !en/+n e"!+"+h+n su-+"+1hnoi!#
2.& GEJALA KLINIS
Aneu"is*+ +n/ -elu* e4+h !++. !i1e.+hui ++-il+ .i*-ul /e+l+=/e+l+ /+n//u+n s+"+ (.e.+i +!+ u/+ +n/ .i!+1 *eni*-ul1+n /e+l+)# Ge+l+ ++ +n/ .i*-ul .e"/+n.un/ !+"i lo1+si !+n u1u"+n +neu"is*+ .e"se-u.# 6e-e"++ /e+l+ +n/ !++. .i*-ul +!+l+h s+1i. 1e+l+, en/lih+.+n 1+-u" /+n!+, *u+l, 1+1u lehe" !+n 1esuli.+n -e"+l+n# Te.+i -e-e"++ /e+l+ !++. *en+!i e"in/+.+n (9+"nin/ si/n) +!+n+ +neu"is*+, +i.u: 1elu*uh+n se-el+h +n//o.+ /e"+1 1+1i !+n .+n/+n, /+n//u+n en/lih+.+n, 1elo+1 *+.+ .i!+1 -is+ *e*-u1+ se4+"+ .i-+=.i-+, ne"i +!+ !+e"+h 9++h, ne"i 1e+l+ se-el+h +.+uun /e+l+ *ene"u+i /e+l+ s."o1e# G+*-+"+n 1lini1 e4+hn+ +neu"is*+ !i-+/i !+l+* 5 .in/1+. i+l+h: Tin/1+.
: $e+l/i+ "in/+n !+n se!i1i. .+n!+ e"+n/s+n/+n sel+u. o.+1 +.+u .+n+ /e+l+#
Tin/1+.
: $e+l/i+ +/+1 he-+. +.+u !i.+*-+h 1elu*uh+n s+"+ o.+1#
Tin/1+.
: %es+!+"+n so*nolen., -in/un/ +.+u +!+n+ 1el+in+n neu"olo/i1 o1+l
Tin/1+.
se!i1i.# : $.uo", he*i+"ese s+*+i -e"+., *un/1in +!+n+ e"*ul++n !ese"e-"+si !+n /+n//u+n sis.i* s+"+ o.ono*#
Tin/1+.
: %o*+ !+l+*, .+n!+ "i/i!i.+s !ese-"+si !+n .+n!+ s.+!iu* +"+lisis 4e"e-"+l 8+so*o.o"#
Aneu"is*+ !i !+l+* o.+1 *e"u+1+n ene-+- !+"i e"!+"+h+n in."+1"+ni+l, +n/ -is+ *ene-+-1+n s."o1e he*o"+/i1 (s."o1e 1+"en+ e"!+"+h+n)# A. Perdarahan ntraserebral
Pe"!+"+h+n in."+se"e-"+l *e"u+1+n s+l+h s+.u enis s."o1e, +n/ !ise-+-1+n oleh +!+n+ e"!+"+h+n 1e !+l+* +"in/+n o.+1# Pe"!+"+h+n in."+se"e-"+l .e"+!i se4+"+ .i-+=.i-+, !i*ul+i !en/+n s+1i. 1e+l+, +n/ !ii1u.i oleh .+n!+=.+n!+ 1el+in+n neu"olo/is (*is+ln+ 1ele*+h+n, 1elu*uh+n, *+.i "+s+, /+n//u+n -e"-i4+"+, /+n//u+n en/lih+.+n !+n 1e-in/un/+n)# $e"in/ .e"+!i *u+l, *un.+h, 1e+n/ !+n enu"un+n 1es+!+"+n, +n/ -is+ .i*-ul !+l+* 9+1.u -e-e"++ *eni.# Pe"!+"+h+n in."+se"e-"+l ini *eni*-ul1+n -e"-+/+i /e+l+ .e"/+n.un/ -+n+1n+ !+n lo1+si e"!+"+h+n#
!. Perdarahan subaraknoid
Pe"!+"+h+n su-+"+1noi! +!+l+h e"!+"+h+n .i-+=.i-+ 1e !+l+* "on//+ !i+n.+"+ o.+1 !+n sel+u. o.+1 ("on//+ su-+"+1noi!)# $u*-e" !+"i e"!+"+h+n +!+l+h e4+hn+ !in!in/ e*-uluh !+"+h +n/ le*+h (++1+h su+.u *+lo"*+si +".e"io8enos+ +.+uun su+.u +neu"is*+) se4+"+ .i-+=.i-+# %+!+n/ +.e"os1le"osis +.+u ine1si *ene-+-1+n 1e"us+1+n +!+ e*-uluh !+"+h sehin//+ e*-uluh !+"+h e4+h# Pe4+hn+ e*-uluh !+"+h -is+ .e"+!i +!+ usi+ -e"++ s++, .e.+i +lin/ se"in/ *ene"+n/ usi+ 25=50 .+hun# Pe"!+"+h+n su-+"+1noi! 1+"en+ +neu"is*+ -i+s+n+ .i!+1 *eni*-ul1+n /e+l+# %+!+n/ +neu"is*+ *ene1+n s+"+ +.+u *en/+l+*i 1e-o4o"+n 1e4il se-elu* e4+h, sehin//+ *eni*-ul1+n e".+n!+ +9+l, see".i s+1i. 1e+l+, ne"i 9++h, en/lih+.+n /+n!+ +.+u /+n//u+n en/lih+.+n l+inn+#
Pe".+n!+ +9+l -is+ .e"+!i !+l+* -e-e"++ *eni. s+*+i -e-e"++ *in//u se-elu* +neu"is*+ e4+h# Ji1+ .i*-ul /e+l+=/e+l+ .e"se-u. h+"us se/e"+ !i-+9+ 1e !o1.e" +/+" -is+ !i+*-il .in!+1+n un.u1 *en4e/+h e"!+"+h+n +n/ he-+.# Pe4+hn+ +neu"is*+ -i+s+n+ *ene-+-1+n s+1i. 1e+l+ *en!+!+1 +n/ he-+., +n/ se"in/1+li !ii1u.i oleh enu"un+n 1es+!+"+n ses++.# 6e-e"++ en!e"i.+ *en/+l+*i 1o*+, .e.+i se-+/i+n -es+" .e"-+n/un 1e*-+li, !en/+n e"+s++n -in/un/ !+n *en/+n.u1# D+"+h !+n 4+i"+n se"e-"osin+l !i se1i.+" o.+1 +1+n *en/i"i.+si sel+u. o.+1 (*enin/en), !+n *ene-+-1+n s+1i. 1e+l+, *un.+h !+n usin/# Denu. +n.un/ !+n l+u e"n++s+n se"in/ n+i1 .u"un, 1+!+n/ !ise".+i !en/+n 1e+n/# D+l+* -e-e"++ +* -+h1+n !+l+* -e-e"++ *eni., en!e"i.+ 1e*-+li *en/+n.u1 !+n lin/lun/# $e1i.+" 25> en!e"i.+ *e*ili1i 1el+in+n neu"olo/is, +n/ -i+s+n+ -e"u+ 1elu*uh+n +!+ s+.u sisi -+!+n# Ge+l+ l+inn+ +!+l+h: 1e1+1u+n lehe", 1e+n/, +!+ 1+sus +n/ .e"/olon/ -e"+., !++. .e"+!i 1o*+ +.+u 1e*+.i+n# Pe"!+"+h+n su-+"+1noi! ini 1e*u!i+n !++. -e"l+nu. *en+!i 1on!isi 8+sos+s*e, +i.u ene*i.+n e*-uluh !+"+h +".e"i !i o.+1, +n/ !++. *ene-+-1+n s."o1e +.+u 1e"us+1+n s+"+ +n/ l+in# Pe"!+"+h+n +1i-+. e4+hn+ +neu"is*+ o.+1 u/+ !++. *ene-+" 1e !+l+* o.+1 (e"!+"+h+n in."+se"e-"+l) 9+l+uun le-ih +"+n/ !i-+n!in/1+n ene-+"+n 1e " u+n/ su-+"+1noi!# %e-+n+1+n +neu"is*+ in."+1"+ni+l +!+l+h +si*.o*+.i1 !+n i1+ *ene.+, .i!+1 .e"!e.e1si s+*+i .e"+!i "u.u"# Pe"!+"+h+n su-+"+hnoi! *e"u+1+n su+.u 1e+!++n !+"u"+. *e!is +n/ +lin/ se"in/ *eni*-ul1+n *+nies.+si 1linis# A!+n+ se"+n/+n s+1i. 1e+l+ +n/ -e"+. !+n +.ii1+l *e"u+1+n /e+l+ 1h+s !+"i e"!+"+h+n su-+"+hnoi!# s+1i. 1e+l+ -oleh +.+u .i!+1 -oleh !ihu-un/1+n !en/+n hil+n/n+ 1es+!+"+n, *u+l !+n *un.+h, !eisi. neu"olo/is o1+l, +.+u *enin/is*us#
Tabel 2 Gejala aneurisma unruptur pada 111 orang pasien
J"m#a) P'*+'r,a
G'(a#a Akut
Ne"i 1e+l+ he-+.
7
T"+nsien. is4he*i+
7
%e+n/
3
P+"+lisis N, enu"un+n 8isus
2 "ronik
Ne"i 1e+l+ non4+.+s."ohi4 +n/ -e"-e!+ 1+"+1.e"n+ !en/+n ne"i 1e+l+ se-elu*n+
B
Penu"un+n en/lih+.+n 1"oni1
0
Neu"o+.h o.i4 unil+.e"+l
7
%ele*+h+n *o.o"i1 n+*un .i!+1 *en/en+i !+e"+h se1i.+" *+.++
?
Ne"i +!+ 9++h
3
Tabel 3. Ringkasan hasil operasi dari penelitian internasional aneurisma intracranial unruptur Lama $','#a) -'ra$
30 h+"i
.+hun
R%a/a, S"b+"ra# )'ma,-m
T*0!a, K'ma,a* T*0!a, !'aa,a*
'es
0
3#7
No
2#3
5#3
'es
2#
No
3#B
2
2. PEMERIKSAAN PENUNJANG
Di ne/+"+ *+u, +neu"is*+ +!+ s.+!iu* !ini le-ih -+n+1 !i.e*u1+n# +l ini 1+"en+ -+n+1 o"+n/ +n/ *en+l+ni e*e"i1s++n magnetic resonance imaging (&R) sehin//+ +neu"is*+ +!+ .in/1+. +9+l !++. .e"lih+. el+s# %+!+n/=1+!+n/ +neu"is*+ .i!+1 sen/++ !i.e*u1+n s++. check up !en/+n *en//un+1+n +l+. 4+n//ih see".i IT s4+n, &R +.+u +n/io/"+*# Di+/nosis +s.i +neu"is*+ e*-uluh !+"+h o.+1, -ese".+ lo1+si
!+n
u1u"+n
+neu"is*+
!++.
!i.e.+1+n
!en/+n
*en//un+1+n
e*e"i1s++n+n/io/"+*# 6i+s+n+ !il+1u1+n e*e"i1s++n IT s4+n !+n &R un.u1 *e*-e!+1+n s."o1e is1e*i1 !en/+n s."o1e e"!+"+h+n# Pe*e"i1s++n .e"se-u. u/+ -is+ *enunu11+n lu+sn+ 1e"us+1+n o.+1 !+n enin/1+.+n .e1+n+n !i !+l+* o.+1# Pun/si lu*-+l -i+s+n+ .i!+1 e"lu !il+1u1+n, 1e4u+li i1+ !i!u/+ .e"!++. *enin/i.is +.+u ine1si l+inn+# Ji1+ !ie"lu1+n, -is+ !il+1u1+n un/si lu*-+l un.u1 *elih+. +!+n+ !+"+h !i !+l+* 4+i"+n se"e-"osin+l# An/io/"+i !il+1u1+n un.u1 *e*e"1u+. !i+/nosis !+n se-+/+i +n!u+n i1+ !il+1u1+n e*-e!+h+n# %e*un/1in+n u/+ -is+ .e"+!i leu1osi.osis +n/ .i!+1 .e"l+lu -e"+".i#
Tabel 4 ensiti!itas dan spesi"isitas dari modalitas imaging untuk mendeteksi aneurisma intrakranial M-+a#,a$
S'*$,6,a$
S'$6$,a$
&+/ne.i4 "eson+n4e +n/io/"+h
@ .o 00
75 .o 00
Io*u.e! .o*o/"+hi4 +n/io/"+h
B5 .o @5
Ti!+1 !il+o"1+n
T"+ns4"+ni+l Dole" ul."+sono/"+h
50 .o @
B7#5
Gambar #. $% scan menun&ukkan aneurisma '(anah besar) dan (erdarahan 'Panah kecil* daerah terang)
Gambar +. Arteriogram %am(ak lateral menun&ukkan aneurisma arteri communikan
Gambar -. Arteriogrammenun&ukkan aneurysm dari arteri kommunikan (osterior
Gambar /. Arteriogram showing cli( (laced across the neck of the aneurysm. %he aneurysm no longer fills with blood.
2.7 PENATALAKSANAAN
Un.u1 +neu"is*+ +n/ -elu* e4+h, .e"+i !i.uu1+n un.u1 *en4e/+h +/+" +neu"is*+ .i!+1 e4+h, !+n u/+ +/+" .i!+1 .e"+!i en//ele*-un/+n le-ih l+nu. !+"i +neu"is*+ .e"se-u.# $e!+n/1+n un.u1 +neu"is*+ +n/ su!+h e4+h, .uu+n .e"+i +!+l+h un.u1 *en4e/+h e"!+"+h+n le-ih l+nu. !+n un.u1 *en4e/+h +.+u *e*-+.+si .e"+!in+ 8+sos+s*e (1on."+1si e*-uluh !+"+h +n/ *ene-+-1+n ene*i.+n !i+*e.e" e*-uluh !+"+h)# Aneu"is*+ -i+s+n+ !i+.+si !en/+n oe"+si, +n/
!il+1u1+n !en/+n *e*-e!+h o.+1, *e*+s+n/ 1li lo/+* 1e4il !i !+s+" +neu"is*+, sehin//+ -+/i+n !+"i e*-uluh !+"+h +n/ *en//ele*-un/ i.u .e".u.u !+n .i!+1 -is+ !il+lui oleh !+"+h# Den/+n oe"+si ini !ih+"+1+n 1e*un/1in+n +neu"is*+ .e"se-u. un.u1 e4+h +uh -e"1u"+n/# Te"+i l+in +!+l+h !en/+n *e*+su11+n 1+.e.e" !+"i e*-uluh !+"+h +".e"i !i 1+1i, !i*+su11+n .e"us s+*+i 1e e*-uluh !+"+h !i o.+1 +n/ .e"1en+ +neu"is*+, !+n !en/+n -+n.u+n sin+" M, !i+s+n/ 1oil lo/+* !i .e*+. +neu"is*+ e*-uluh !+"+h o.+1 .e"se-u.# $e.el+h i.u !i+li"1+n +"us lis."i1 1e 1oil lo/+* .e"se-u., !+n !ih+"+1+n !+"+h !i .e*+. +neu"is*+ i.u +1+n *e*-e1u !+n *enu.ui selu"uh +neu"is*+ .e"se-u.# Pe*-uluh +n/ *en//ele*-un/ !++. !ioe"+si !en/+n .in/1+. 1e-e"h+sil+n @@,@ e"sen# 6il+ .el+h e4+h !+n 1o*+, 1e-e"h+sil+n .in//+l 50 : 50# Pen!e"i.+ se/e"+ !i"+9+. !+n .i!+1 -oleh *el+1u1+n +1.i8i.+s -e"+.# -+. e"e!+ ne"i !i-e"i1+n un.u1 *en/+.+si s+1i. 1e+l+ he-+.# %+!+n/ !i+s+n/ sel+n/ !"+in+se !i !+l+* o.+1 un.u1 *en/u"+n/i .e1+n+n# Pe*-e!+h+n -is+ *e*e"+n+n/
h+"++n
hi!u
en!e"i.+,
*es1iun
*enin//+l1+n
1el+in+n
neu"olo/is +n/ -e"+.# Tuu+n e*-e!+h+n +!+l+h un.u1 *e*-u+n/ !+"+h +n/ .el+h .e"1u*ul !i !+l+* o.+1 !+n un.u1 *en/u"+n/i .e1+n+n !i !+l+* .en/1o"+1# Pe*-e!+h+n un.u1 *enu*-+. +.+u *e*e"1u+. !in!in/ +".e"i +n/ le*+h, -is+ *en/u"+n/i
"esi1o
e"!+"+h+n
+.+l
!i
1e*u!i+n
h+"i#
Pe*-e!+h+n ini suli. !+n +n/1+ 1e*+.i+nn+ s+n/+. .in//i, .e"u.+*+ +!+ en!e"i.+ +n/ *en/+l+*i 1o*+ +.+u s.uo"# $e-+/i+n -es+" +hli -e!+h *en/+nu"1+n un.u1 *el+1u1+n e*-e!+h+n !+l+* 9+1.u 3 h+"i se.el+h .i*-uln+ /e+l+# &enun!+ e*-e!+h+n s+*+i 0 h+"i +.+u le-ih *e*+n/ *en/u"+n/i "esi1o e*-e!+h+n .e.+i *enin/1+.1+n 1e*un/1in+n .e"+!in+ e"!+"+h+n 1e*-+li# P+sien +n/ !i4u"i/+i +.+u !+.+n/ !en/+n /e+l+ +s*.o*+.i4 +.+u si*.o*+.i1 +neu"is*+ in."+1"ni+l h+"us
!il+1u1+n .in!+1+n -e!+h# Du+ ilih+n un.u1 .e"+i in8+si +!+l+h 1"+nio.o*i .e"-u1+ !+n .e"+i en!o8+s1ul+"#
2.8 KOMPLIKASI
Aneu"is*+ +n/ e4+h !++. *en/+1i-+.1+n : # Pe"!+"+h+n su-+"+4hnoi! s++# 2# Pe"!+"+h+n su-+"+4hnoi! !+n e"!+"+h+n in."+ se"e-"+l (0>)# 3# n+"1 se"e-"i (50>)# ?# Pe"!+"+h+n su-+"+4hnoi! !+n su-!u"+l# 5# Pe"!+"+h+n su-+"+4hnoi! !+n hi!"oseh+lus +n/ se-+/i+n 1e4il *en+!i hi!"oseh+lus no"*o.ensi (30>)# # Aneu"is*+ +# 4+"o.is in.e"n+ !++. *en+!i is.ul+ 4+"o.i4o4+8e"nosu*# 7# &+su1 1e sinus shenoi! -is+ .i*-ul eis.+1sis# B# Pe"!+"+h+n su-!u"+l s++# 6+h++ !+"i Aneu"is*+ +n/ .e"-en.u1, !++. *ene-+-1+n .e"+!in+ s."o1e +.+u 1e*+.i+n, 1+"en+ e4+hn+ Aneu"is*+ .e"se-u.#
2.19 PROGNOSIS
P"o/nosis +!+ +neu"is*+ -e"/+n.un/ +!+ enis +neu"is*+ ("u.u"e +.+u un"u.u"), -en.u1 +neu"is*+, lo1+si, 9+1.u en+n/+n+n !+n 1on!isi +sien s++. !il+1u1+n en/o-+.+n (usi+, /e+l+ 1linis, 1es+!+"+n !+n +!+n+ en+1i. l+in)# P"insin+ se*+1in 4e+. !i.e*u1+n +neu"is*+ *e*un+i 1e*un/1in+n 1ese*-uh+n +n/ -+i1, oleh 1+"en+ i.u e*e"i1s++n *e!is "u.in s+n/+. !i+nu"1+n# Aneu"is*+ +# 4o**uni4+ns os.e"io", !en/+n li/+si +#4+"o.is 4o**unis 1e*+.i+n se-es+" 0>, se!+n/1+n !en/+n -e! "es. 1e*+.i+n se-es+" ?2># Aneu"is*+ +# 4e"e-"i *e!i+, !en/+n 4liin/ l+n/sun/ +!+ +neu"is*+n+ *o".+li.+s
>, se!+n/ !en/+n is.i"+h+. !i.e*+. .i!u" *o".+li.+s se-es+" 3># Aneu"is*+ +# 4o**uni4+ns +n.e"io" .in!+1+n -e!+h *+uun 1onse"8+.i +n/1+ 1e*+.i+n s+*+# Pe"!+"+h+n in."+se"e-"+l *e"u+1+n enis s."o1e +n/ +lin/ -e"-+h++# $."o1e -i+s+n+ lu+s, .e"u.+*+ +!+ en!e"i.+ .e1+n+n !+"+h .in//i *en+hun# Le-ih !+"i se+"uh en!e"i.+ +n/ *e*ili1i e"!+"+h+n +n/ lu+s, *enin//+l !+l+* -e-e"++ h+"i# Pen!e"i.+ +n/ sel+*+. -i+s+n+ 1e*-+li s+!+" !+n se-+/i+n un/si o.+1n+ 1e*-+li, 1+"en+ .u-uh +1+n *ene"+ sis+=sis+ !+"+h# P+!+ e"!+"+h+n su-+"+hnoi!, se1i.+" see".i/+ en!e"i.+ *enin//+l +!+ eiso!e e".+*+ 1+"en+ lu+sn+ 1e"us+1+n o.+1# 5> en!e"i.+ *enin//+l !+l+* -e-e"++ *in//u se.el+h .e"+!i e"!+"+h+n -e".u"u.=.u"u.# Pen!e"i.+ +neu"is*+ +n/ .i!+1 *en+l+ni e*-e!+h+n !+n -e".+h+n hi!u, se.el+h -ul+n *e*ili1i "esi1o se-+n+1 5> un.u1 .e"+!in+ e"!+"+h+n# 6+n+1 en!e"i.+ +n/ se-+/i+n +.+u selu"uh un/si *en.+l !+n isi1n+ 1e*-+li no"*+l, .e.+i 1el+in+n neu"olo/is 1+!+n/ .e.+ +!+#
DAFTAR PUSTAKA
# Ih+"les 8e/+, *#!#, e"e*i+h 8# %9oon, *#!#, +n! se+n !# L+8ine, *#!# Intracranial Aneur#sms$ %urrent &!idence and %linical 'ractice, Uni8e"si. o I+lio"ni+, "8ine, Iolle/e o &e!i4ine, "8ine, I+lio"ni+, A/us.us, 2002# 2# s*+il $e.o"+no.o, Pen!e1+.+n &!idence()ased *edicine +!+ &+n+e*en troke
Pe"!+"+h+n
n."+se"e-"+l,
6+/i+n Neu"olo/i
F+1ul.+s %e!o1.e"+n
Uni8e"si.+s G+!+h &+!+, 'o/+1+".+, n!onesi+#1.o-e"# 200B# 3# W+"!l+9 J&, Whi.e P&# The !e.e4.ion +n! *+n+/e*en. o un"u.u"e! in."+4"+ni+l +neu"s*s# )rain# 2000C23(. 2):2052# ?# Ron1+inen
A, e"nesnie*i
J, Pu"+nen
&, Nie*i.u1i+
L, +nninen
R,
Rn+nen &, e. +l# F+*ili+l in."+4"+ni+l +neu"s*s# +ancet # @@7C3?@:3B0?# 5# n4i $, $e.le" RF# n."+4"+ni+l +neu"s*s +n! +".e"i+l he".ension: + "e8ie9 +n! ho.hesis# urger# ,eurologi# 2000C53:530?0# # Un"u.u"e! in."+4"+ni+l +neu"s*sO"is1 o "u.u"e +n! "is1s o su"/i4+l in.e"8en.ion#
n.e"n+.ion+l
$.u!
o
Un"u.u"e!
n."+4"+ni+l
Aneu"s*s
n8es.i/+.o"s# , &ngl - *ed # @@BC33@:72533# 7# Le-l+n4 R, Wo"sle %J, &el+nson D, T+*ie"i D# An/io/"+hi4 s4"eenin/ +n! ele4.i8e
su"/e"
o
+*ili+l
4e"e-"+l
+neu"s*s:
+
!e4ision
+n+lsis#
,eurosurger## @@?C35:@B# B# $+*suhi!++.# R#, !e Jon/# W#, 6+- 22 J+n.un/, Pe*-uluh A".e"i, en+, !+n Li*e: Aneu"is*+ !+l+* )uku Ajar Ilmu )edah, e!# # J+1+".+, EGI, @@7# @# 999#nl*#nih#/o8*e!linelusen4+".i4le0022#h.*
0# h..:en#9i1ie!i+#o"/9i1i+neu"s*
