This was a retrospective study of 12 eye injuries concomitant with closed head injury, that were treated by the authors in Sanglah General Hospital, Bali during 2008. The purpose of this study was to evaluate the efficacy of lateral orbitotomy for nerve compression in eye injuries. Optic nerve compression at the optic canal can cause traumatic optic neuropathy; and nerve compression of 3rd, 4th and 6th nerves at the superior orbital fissure can cause traumatic ophthalmoplegia. Optic nerve decompression with steroids or surgical interventions or both have therefore been advocated to improve visual prognosis in traumatic optic neuropathy. To date it is not known whether lateral orbitotomy is beneficial in these traumatic injuries. There were 12 patients in this study, consisting of 11 males and 1 female with diagnosis of traumatic optic neuropathy in 10 patients and traumatic ophthalmoplegia in 2. Lateral orbitotomy procedures were done and all patients were also given high doses of steroids preoperatively. The mean visual improvement ratio was 43.3 ± 22.3. Ten patients improved (83.3 %) and 2 patients did not. There were no clinical deterioration and side effects from the operative procedure. This study suggests that lateral orbitotomy may possibly be beneficial as treatment for traumatic optic neuropathy and ophthalmoplegia.

Laminectomy with fusion and bilateral laminotomy as a fenestration method have been used to improve pain, neurogenic claudication and neurological impairment in lumbar stenosis. To date it is not known whether the two surgical procedures have the same effectiveness in this degenerative disease. This is a retrospective review of 105 consecutive patients with lumbar stenosis who underwent surgery at the Sanglah General Hospital, Bali between 2005 and 2008. The aim of this study was to compare the results of bilateral laminotomy and laminectomy with fusion for canal decompression in lumbar stenosis. The study consisted of 46 patients who underwent bilateral laminotomy and 59 patients treated by laminectomy with fusion. The follow up ranged from 3-36 months. The outcome was evaluated by the Visual Analog Scale (VAS), Neurogenic Claudication Outcome Score (NCOS), and the Oswestry Disability Index (ODI) scores. The means of postoperative VAS for both groups were 2.6 + 0.9, postoperative NCOS for both groups were 64.0 + 13.9 and postoperative ODI for both groups were 24.4 + 7.9. There was no clinical deterioration and side effect from the operative procedure. Our results show that bilateral laminotomy and laminectomy with fusion are equally effective over a short follow up. However, bilateral laminotomy is a less invasive procedure.

Surgical techniques for non-missile penetrating brain injuries (PBI) are challenging because they require good preoperative planning. Generally, extraction is performed ipsilaterally at the entry site. In certain cases, the extraction can be performed contralaterally through the inner end of the foreign body; however, this requires special consideration. We present a case report of a patient who had a stab wound on the head via a screwdriver and underwent surgery, during which extraction was performed contralaterally through the inner end of the screwdriver without inducing any neurological deficit. Careful preoperative planning and surgical technique modification are required to minimize morbidity and mortality in patients with PBIs.