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TINJAUAN PUSTAKA

Indikasi Pembedahan pada Trauma Kapitis


Andika Surya Atmadja
Dokter Umum di Wilayah Pulomas, Jakarta Timur, Indonesia

ABSTRAK
5SBVNB NFSVQBLBO QFOZFCBC UFSCBOZBL LFNBUJBO QBEB VTJB EJ CBXBI  UBIVO EBO MFCJI EBSJ  NFSVQBLBO USBVNB LBQJUJT5SBVNB
LBQJUJT NFSVQBLBO TBMBI TBUV NBTBMBI LFTFIBUBO ZBOH EBQBU NFOZFCBCLBO HBOHHVBO GJTJL EBO NFOUBM ZBOH LPNQMFLT .FTLJQVO
EFNJLJBO  UJEBL TFNVB USBVNB LBQJUJT NFNFSMVLBO QFSBXBUBO EJ SVNBI TBLJU  QFODJUSBBO CT-scan  BUBVQVO UJOEBLBO QFNCFEBIBO 0MFI
LBSFOBJUV EJQFSMVLBOQFOHFUBIVBONFOHFOBJJOEJLBTJCFEBIQBEBUSBVNBLBQJUJT

Kata kunci:*OEJLBTJCFEBI LMBTJLBTJ USBVNBLBQJUJT

ABSTRACT
5SBVNBJT UIFNPTUDPNNPODBVTFPG EFBUIGPSUIPTFVOEFSZFBSTPME BOENPSFUIBOJTIFBEUSBVNB)FBEUSBVNBDBODBVTF
DPNQMFY QIZTJDBM BOE NFOUBM EJTUVSCBODFT  CVU OPU FWFSZ IFBE USBVNB OFFET IPTQJUBMJ[BUJPO  $5TDBO JNBHJOH OPS TVSHJDBM NBOBHFNFOU
5IFSFGPSF JUhTOFDFTTBSZUPLOPXUIFJOEJDBUJPOTGPSTVSHFSZJOIFBEJOKVSZAndika Surya Atmadja. Surgical Indications in Head Trauma.

Keywords:)FBEUSBVNB TVSHJDBMJOEJDBUJPOT UZQFT

PENDAHULUAN %J MBJO QJIBL  UJEBL TFNVB USBVNB LFQBMB 4FCBHJBO CFTBS 
 QBTJFO USBVNB LBQJUJT
5SBVNB NFSVQBLBO QFOZFCBC UFSCBOZBL NFNFSMVLBO QFSBXBUBO EJ SVNBI TBLJU  NFNJMJLJ ($4   IBOZB TFLJUBS  ZBOH
LFNBUJBO QBEB VTJB EJ CBXBI  UBIVO QFODJUSBBO EFOHBO CT-scan BUBVQVO NFNJMJLJ ($4   4FLJUBS  QBTJFO DFEFSB
EBO MFCJI EBSJ  NFSVQBLBO USBVNB UJOEBLBO QFNCFEBIBO 5FSEBQBU JOEJLBTJ LFQBMB BLBO NFODBSJ QFSUPMPOHBO QFSUBNB
LBQJUJT 5SBVNB LFQBMB NFSVQBLBO TBMBI UFSUFOUV VOUVL EJMBLVLBO UJOEBLBOUJOEBLBO QBEB EPLUFS VNVN EBO IBOZB  QBTJFO
TBUV NBTBMBI LFTFIBUBO ZBOH EBQBU UFSTFCVU ZBOHNFNCVUVILBOJOUFSWFOTJCFEBITBSBG
NFOZFCBCLBO HBOHHVBO TJL EBO NFOUBM
ZBOH LPNQMFLT EFGJTJU LPHOJUJG  QTJLJT  Klasifikasi Trauma Kapitis )BTJM TUVEJ UFSCBSV NFOHFOBJ USBVNB LBQJUJT
JOUFMFLUVBM  EBO MBJOMBJO  ZBOH EBQBU CFSTJGBU 5SBVNB LBQJUJT USBVNB LFQBMB
 BEBMBI NFOVOKVLLBO CBIXB IJQPLTJB EBO IJQPUFOTJ
TFNFOUBSBBUBVQVONFOFUBQ USBVNB NFLBOJL UFSIBEBQ LFQBMB CBJL ZBOH UFSKBEJ TFTBBU TFUFMBI USBVNB EBQBU
TFDBSB MBOHTVOH NBVQVO UJEBL MBOHTVOH NFOHBLJCBULBO LFSVTBLBO PUBL TFLVOEFS
%J *OEPOFTJB  UJEBL UFSEBQBU EBUB OBTJPOBM ZBOH NFOZFCBCLBO HBOHHVBO GVOHTJ 6OUVL NFODFHBI IBM UFSTFCVU  TBOHBU EJ
NFOHFOBJ USBVNB LFQBMB 1BEB UBIVO   OFVSPMPHJT  ZBJUV HBOHHVBO TJL  LPHOJUJG  QFSMVLBOQFOBOHBOBOBXBMZBOHUFQBU
EJ 34$. UFSEBQBU  QBTJFO USBVNB LFQBMB GVOHTJ QTJLPTPTJBM CBJL UFNQPSFS NBVQVO
SJOHBO   QBTJFO USBVNB LFQBMB TFEBOH  QFSNBOFO 1BEB USBVNB LBQJUJT QFSMV Pemeriksaan Awal pada Trauma Kapitis
EBO  QBTJFO USBVNB LFQBMB CFSBU %J EJQFSIBUJLBO BEBOZB QFSVCBIBO LFTBEBSBO 5JEBL TFNVB USBVNB LBQJUJT QFSMV EJCBXB LF
3VNBI 4BLJU 4JMPBN QBEB UBIVO  UFS TFUFMBI USBVNB ,FTBEBSBO EBQBU EJOJMBJ SVNBI TBLJU VOUVL QFNFSJLTBBO MFCJI MBOKVU
EBQBU  LBTVT USBVNB LFQBMB %J 3VNBI NFOHHVOBLBO Glasgow Coma Scale ($4
 *OEJLBTJLFSVNBITBLJUBEBMBI
4BLJU "UNB +BZB QBEB UBIVO   KVNMBI 5BCFM 
 "UBT EBTBS OJMBJ UFSTFCVU  USBVNB  /JMBJ ($4  QBEB QFNFSJLTBBO BXBM 
QBTJFO USBVNB LFQBMB NFODBQBJ  PSBOH LBQJUJT EBQBU EJLMBTJLBTJLBO NFOKBEJ USBVNB KJLB EJEVHB LBSFOB BMLPIPM  PCTFSWBTJ
EBSJQBTJFOSBXBUJOBQCBHJBOTBSBG LBQJUJT NJOJNBM  SJOHBO  TFEBOH  EBO CFSBU TFMBNB  KBN EBO CBXB LF SVNBI TBLJU
5BCFM 
 ,MBTJLBTJ USBVNB LBQJUJT TFMBJO CJMBOJMBJ($4UFUBQ
4BMBI TBUV DBSB VOUVL NFOHVSBOHJ LFNBUJBO CFEBTBSLBO ($4  KVHB EBSJ HBNCBSBO LMJOJT  5FSEBQBUpost-traumatic seizure
BEBMBI UJOEBLBO CFEBI %J "NFSJLB  TFUJBQ EBOIBTJMCT - scan PUBL   5FSEBQBUUBOEBUBOEBEFTJUOFVSPMPHJ
UBIVOOZB UFSEBQBU  QBTJFO ZBOH  5FSEBQBU UBOEB GSBLUVS UFOHLPSBL BEBOZB
NFNFSMVLBO UJOEBLBO PQFSBTJ TFCBHBJ +JLB QBEB CT-scan PUBL UFSMJIBU BCOPSNBMJUBT DBJSBO TFSFCSPTQJOBM EBSJ IJEVOH BUBV
QFOBUBMBLTBOBBO post-traumatic intracranial CFSVQB QFSEBSBIBO JOUSBLSBOJBM  QFOEFSJUB UFMJOHB  IFNPUJNQBOJ  NFNBS EJ CFMBLBOH
hematoma  EJHPMPOHLBOEBMBNUSBVNBLBQJUJTCFSBU BVSJLVMB NFNBSEJQFSJPSCJUBM

Alamat korespondensi email: f_andika_surya@yahoo.com

CDK-236/ vol. 43 no. 1, th. 2016 29


TINJAUAN PUSTAKA

Tabel 1.Glasgow Coma Scale UVMBOH UFOHLPSBL EBO EVSBNBUFS 4VNCFS


VUBNB QFSEBSBIBO IFNBUPNB FQJEVSBM
Fungsi Respons Skor
BEBMBI SVQUVSOZB BSUFSJ NFOJOHFB NFEJB
.BUB 
#VLBTQPOUBO  -PLBTJ QFSEBSBIBO FQJEVSBM ZBOH QBMJOH
#VLBKJLBEJQFSJOUBI  TFSJOH BEBMBI EBFSBI UFNQPSPQBSJFUBM EBO
#VLBEFOHBOSBOHTBOHOZFSJ  EBFSBI UFNQPSBM  QBEB  QBTJFO EBQBU
5JEBLBEBSFTQPOT  UFSKBEJ CJMBUFSBM 1VODBL JOTJEFOT BEBMBI
#JDBSB 
/PSNBM  BOUBSB VTJB  TBNQBJ  UBIVO  4FLJUBS 
#JOHVOH   QBTJFO EFOHBO IFNBUPNB FQJEVSBM
,BUBLBUBLBDBV 
EJCBXB LF SVNBI TBLJU EBMBN LFBEBBO UJEBL
TBEBS
4VBSBUJEBLNFOFOUV 
5JEBLBEBSFTQPOT 
(FKBMB LMJOJT IFNBUPNB FQJEVSBM TFCBHBJ
.PUPSJL 
%BQBUNFOHJLVUJQFSJOUBI 
CFSJLVU
%BQBUNFOVOKVLUFNQBUOZFSJ   Lucid interval
, BXBMOZB QBTJFO UJEBL
%BQBUNFOHIJOEBSJOZFSJ  TBEBS  LFNVEJBO TBEBS EBO LFNCBMJ UJEBL
%FLPSUJLBTJ  TBEBS
%FTFSFCSBTJ   ,FTBEBSBONBLJONFOVSVO
5JEBLBEBSFTQPOT   Late IFNJQBSFTJT
 1VQJMBOJTPLPS
Tabel 2.,MBTJLBTJUSBVNBLFQBMB  3FFLT#BCJOTLJ
TBUVTJTJ
 'SBLUVSEJEBFSBIUFNQPSBM
Kategori GCS Gambaran Klinik CT-scan Otak
 1BEB TBBU QBTJFO TBEBS  EBQBU EJUFNVL BO
.JOJNBM  1JOHTBO 
EFTJUOFVSPMPHJ 
/PSNBM
HFKBMB EFTJU GPLBM EFTFSFCSBTJ  LFKBOH 
3JOHBO  1JOHTBONFOJU EFTJUOFVSPMPHJ 
/PSNBM BGBTJB

4FEBOH  1JOHTBONFOJUmKBN EFTJUOFVSPMPHJ
"COPSNBM  /ZFSJLFQBMBQSPHSFTJG
#FSBU  1JOHTBOKBN EFTJUOFVSPMPHJ
"COPSNBM  4BBU QBTJFO LFNCBMJ UJEBL TBEBS  TFSJOH
UFSKBEJTQBTUJTJUBTUVOHLBJCJMBUFSBM
 1FOVSVOBOLFTBEBSBO  KBN TFUFMBI EJPCTFSWBTJ BUBVQVO   ,BEBOH EJUFNVLBO CSBEJLBSEJ 
 3BTBCBBMQBEBUVCVI KBNTFUFMBIUSBVNB YNFOJU
 LFOBJLBO UFLBOBO EBSBI
 /ZFSJLFQBMBCFSBUEBOQFSTJTUFO  5FSEBQBU GSBLUVS BUBV EFQSFTJ QBEB TJTUPMJL  
 .VOUBICFSVMBOH LBMJ
 EBTBS UFOHLPSBL BUBV USBVNB
 "EBOZB BNOFTJB QPTUUSBVNBUJL  QFOFUSBTJ )BTJM CT-scan PUBL QBEB QBTJFO IFNBUPNB
NFOJU
  5FSEBQBU QFOVSVOBO LFTBEBSBO BUBV FQJEVSBM BEBMBI HBNCBSBO IJQFSEFOT
 5FSEBQBUBNOFTJBSFUSPHBSE NFOJU
 UBOEBEFTJUOFVSPMPHJCBSV QFSEBSBIBO
 CJLPOWFLT EJ UVMBOH UFOHLPSBL
 .FLBOJTNF USBVNB ZBOH CFSJTJLP CFTBS   ,FTBEBSBO QFOVI ($4 
 UBOQB EBO EVSB  VNVNOZB EJ EBFSBI UFNQPSBM
TFQFSUJ LFDFMBLBBO MBMV MJOUBT  KBUVI EBSJ GSBLUVS  UFUBQJ OZFSJ LFQBMB CFSBU EBO (BNCBS

LFUJOHHJBO QFSTJTUFO  UFSEBQBU TFUJEBLOZB  LBMJ
NVOUBI QBEB TFMBOH XBLUV ZBOH Hematoma Subdural
1FNFSJLTBBO QFOVOKBOH QBEB USBVNB CFSCFEB )FNBUPNB TVCEVSBM BEBMBI IFNBUPNB
LBQJUJTBOUBSBMBJO  "EB SJXBZBU HBOHHVBO QFNCFLVBO BLJCBU SPCFLOZB WFOB EJ BOUBSB EVSBNBUFS
 'PUP QPMPT LFQBMB 'PUP QPMPT LFQBMB EBSBI TFQFSUJ NFOHHVOBLBO PCBU EBO QBSFOLJN PUBL bridging vein
 )FNBUPNB
NFNJMJLJ TFOTJUJWJUBT EBO TQFTJTJUBT BOUJLPBHVMBO
 EBO QFOVSVOBO TVCEVSBM EBQBU BLVU UFSEJBHOPTJT 
SFOEBI EBMBN NFOEFUFLTJ QFSEBSBIBO LFTBEBSBO  BNOFTJB  EBO UBNQBL IBSJ TFUFMBI USBVNB
 EBO LSPOJL  IBSJ
JOUSBLSBOJBM PMFI LBSFOB JUV  TFKBL EJ HFKBMBEFTJUOFVSPMPHJ TFUFMBI USBVNB
 1BEB MBOKVU VTJB EBQBU
UFNVLBOOZB CT-scan  GPUP QPMPT LFQBMB  Magnetic resonance imaging .3*
 UJEBL CFSLBJUBOEFOHBOUSBVNBBUBVEFOHBO
TVEBINVMBJEJUJOHHBMLBO LFQBMB 5FLOJL QFODJUSBBO JOJ MFCJI USBVNB SJOHBO 4FLJUBS  QBTJFO
 CT-scan LFQBMB CT-scan LFQBMB NFSVQBLBO TFOTJUJG EJCBOEJOHLBO CT-scan  OBNVO IFNBUPNB TVCEVSBM NFNQVOZBJ OJMBJ ($4
TUBOEBS CBLV VOUVL NFOEFUFLTJ QFNFSJLTBBO .3* NFNCVUVILBO XBLUV 
QFSEBSBIBO JOUSBLSBOJBM 4FNVB QBTJFO MFCJIMBNBEJCBOEJOHLBOCT-scan
EFOHBO ($4  TFCBJLOZB NFOKBMBOJ (FKBMB LMJOJT IFNBUPNB TVCEVSBM BEBMBI OZFSJ
QFNFSJLTBBOCT-scan*OEJLBTJCT-scan  DIAGNOSIS YANG MEMERLUKAN LFQBMB  EBQBU UFSKBEJ QFOVSVOBO LFTBEBSBO
 .BUB IBOZB NFNCVLB CJMB BEB TINDAKAN BEDAH EBOEFTJUOFVSPMPHJT 
SBOHTBOHTBLJU OJMBJ($4
 Hematoma Epidural
 5FSEBQBU QFOVSVOBO LFTBEBSBO OJMBJ )FNBUPNB FQJEVSBM BEBMBI TVBUV %JBHOPTJT IFNBUPNB TVCEVSBM EJUFHBLLBO
($4 
 EBO UJEBL NFNCBJL EBMBN IFNBUPNB ZBOH UFSBLVNVMBTJ EJ BOUBSB EFOHBO CT-scan LFQBMB. )BTJM CT-scan BLBO

30 CDK-236/ vol. 43 no. 1, th. 2016


TINJAUAN PUSTAKA

NFNQFSMJIBULBO HBNCBSBO IJQFSEFOT TINDAKAN BEDAH CT-scanEFOHBO($4CFSBQBQVO


QFSEBSBIBO
 EJ BOUBSB EVSBNBUFS EBO 5FSBQJ QFNCFEBIBO QBEB USBVNB LBQJUJT  1BEB QBTJFO EFOHBO ($4   IBSVT
BSBLOPJE  UBNQBL TFQFSUJ CVMBO TBCJU NFNFSMVLBO CFCFSBQB QFSUJNCBOHBO EBO EJMBLVLBO FWBLVBTJ QFNCFEBIBO TF
(BNCBS
 CFSCFEBQBEBTFUJBQKFOJTUSBVNBLBQJUJT DFQBUOZB
 )FNBUPNBFQJEVSBMZBOHQSPHSFTJG 
Fraktur Kranial Terdepresi dan Fraktur 1BEB VNVNOZB  QFNCFEBIBO VOUVL
Basis Kranii FWBLVBTJ IFNBUPNB QFSMV EJQFSUJNCBOH #JMB WPMVNF IFNBUPNB  DN  LFUFCBMBO
1BEB LBTVT GSBLUVS LSBOJBM UFSEFQSFTJ  QFSMV LBO BQBCJMB EJUFNVLBO IFNBUPNB EFOHBO  NN  EBO midline shift  NN QBEB
UFSBQJ BHSFTJG NFOHJOHBU SJTJLP JOGFLTJ  LFKBOH  WPMVNF NFMFCJIJ  DN QBEB IBTJM CT-scan QBTJFO EFOHBO ($4  EBO UBOQB EFTJU
EBO EFGPSNJUBT LPTNFUJL 1FOFMJUJBO .FTLJQVO EFNJLJBO  JOEJLBTJ QFNCFEBIBO OFVSPMPHJ  EBQBU EJUFSBQJ LPOTFSWBUJG EF
QBEB  QBTJFO GSBLUVS LSBOJBM UFSCVLB QBEB DFEFSB LFQBMB UJEBL IBOZB CFSEBTBSLBO OHBO QFNFSJLTBBO CT-scan TFSJBM :BOH QFSMV
NFOEBQBULBO   LFKBEJBO JOGFLTJ IBTJM CT-scan TBKB  UFUBQJ KVHB BEBOZB EJQFSIBUJLBO BEBMBI SJTJLP QFNCFTBSBO MFTJ
JOUSBLSBOJBM *OGFLTJ NFOJOHLBULBO LFKBEJBO QFSCVSVLBOLMJOJTEBOMPLBTJMFTJ CT-scan VOUVL follow up QBEB QBTJFO ZBOH
EFTJU OFVSPMPHJ QFSTJTUFO  LFKBOH TBNQBJ UJEBL EJPQFSBTJ  IBSVT EJMBLVLBO EBMBN 
MFCJI EBSJ  NJOHHV TFUFMBI USBVNB TFSUB 4FNVB MVLB QFOFUSBTJUFNCVT NFSVQBLBO KBN  4FLJUBS  LBTVT IFNBUPNB FQJEVSBM
LFNBUJBO JOEJLBTJQFNCFEBIBO   NFOHBMBNJ QFNCFTBSBO  QBMJOH TFSJOH
EBMBN  KBN TFUFMBI USBVNB 1FNCFTBSBO
1BEB GSBLUVS CBTJT LSBOJJ  HFKBMB LMJOJT TFTVBJ Hematoma Epidural UJEBLUFSKBEJMBHJKBNTFUFMBIUSBVNB
EFOHBOMPLBTJOZB *OEJLBTJ CFEBI QBEB IFNBUPNB FQJEVSBM
BEBMBI )BTJM PQFSBTJ CJBTBOZB CBJL  LFDVBMJ QBEB
1BEB GSBLUVS CBHJBO BOUFSJPS  HFKBMB EBO  7PMVNF IFNBUPNB  DN QBEB IBTJM GSBLUVS ZBOH QBOKBOH EBO MBTFSBTJ TJOVT
UBOEBLMJOJTOZBBEBMBI WFOPTVT 1SFWBMFOTJ IFNBUPNB FQJEVSBM
 ,FMVBSOZB DBJSBO MJLVPS NFMBMVJ IJEVOH CJMBUFSBM BEBMBI  1BEB QBTJFO LPNB 
rhinorrhea CJBTBOZB UFSEBQBU SFFLT #BCJOTLJ CJMBUFSBM 
 1FSEBSBIBO  ecchymosis QFSJPSCJUBM TQBTUJTJUBT  SJHJEJUBT  NFOVOKVLLBO LPNQSFTJ
CJMBUFSBMraccoon eye NFTFOTFGBMPO  EBO QSPHOPTJTOZB CVSVL 1BEB
 "OPTNJB QBTJFO TFQFSUJ JOJ  QFNCFEBIBO UJEBL CPMFI
EJUVOEB 
1BEB GSBLUVS CBHJBO NFEJB  HFKBMB EBO UBOEB
LMJOJTOZBBEBMBI .PSUBMJUBT PQFSBTJ FWBLVBTJ IFNBUPNB
 ,FMVBSOZB DBJSBO MJLVPS NFMBMVJ UFMJOHB FQJEVSBM BEBMBI  %BUB QFSCBOEJOHBO
otorrhea BOUBSB UFSBQJ PQFSBUJG EBO OPOPQFSBUJG QBEB
 (BOHHVBO/7**EBO7*** FQJEVSBMIFNBUPNBCFMVNBEB

1BEB GSBLUVS CBHJBO QPTUFSJPS  HFKBMB EBO Hematoma Subdural


UBOEB LMJOJTOZB BEBMBI ecchymosis NBTUPJE *OEJLBTJ QFNCFEBIBO QBEB IFNBUPNB
CJMBUFSBMBattle sign TVCEVSBMBEBMBI
Gambar 1.CT-scan VOUVLNFMJIBUmidline shift.  1BEB IBTJM CT-scan EJUFNVLBO LFUFCBMBO
Hematoma Intraserebral ,FUKJLB#"EJEVHBUFSKBEJmidline shift IFNBUPNB  NN BUBV midline shift 
)FNBUPNB JOUSBTFSFCSBM BEBMBI QFSEBSBIBO
QBSFOLJN PUBL BLJCBU QFDBIOZB BSUFSJ
JOUSBTFSFCSBM  CJBTBOZB LBSFOB DFEFSB LFQBMB
CFSBU $JSJ LIBT IFNBUPNB JOUSBTFSFCSBM
BEBMBI IJMBOH LFTBEBSBO EBO OZFSJ LFQBMB
CFSBUKJLBQBTJFOTBEBSLFNCBMJ

Perdarahan Subaraknoid
1FSEBSBIBO EJ SVBOH TVCBSBLOPJE CJBTBOZB
EJTFSUBJ IJMBOHOZB LFTBEBSBO  OZFSJ LFQBMB
CFSBU  EBO QFSVCBIBO TUBUVT NFOUBM ZBOH
DFQBU (FKBMB LMJOJT QFSEBSBIBO TVCBSBLOPJE
BEBMBI LBLV LVEVL  OZFSJ LFQBMB  EBO CJTB
EJEBQBUJ HBOHHVBO LFTBEBSBO )BTJM CT-
scan BEBMBI BEBOZB HBNCBSBO QFSEBSBIBO
IJQFSEFOT
 EJ SVBOH TVCBSBLOPJE (BNCBS

Gambar 2.)FNBUPNBFQJEVSBM Gambar 3.)FNBUPNBTVCEVSBM

CDK-236/ vol. 43 no. 1, th. 2016 31


TINJAUAN PUSTAKA

NNEFOHBOOJMBJ($4CFSBQBQVO - Cushing reflex IJQFSUFOTJ  CSBEJLBSEJ 


 1BEB OJMBJ ($4   QFSMV monitoring UBOEBUBOEBHBOHHVBOOBQBT

UFLBOBO JOUSBLSBOJBM TFDBSB IBUJIBUJ #JMB  /JMBJ ($4  EFOHBO LPOUVTJP  DN
UFLBOBO JOUSBLSBOJBM NFMFCJIJ  NN)H EJ EBFSBI GSPOUBM BUBV UFNQPSBM EFOHBO
BUBV QVQJM BOJTPLPS BUBV UFSEJMBUBTJ midline shift  NN EBO VLVSBO MFTJ 
UFUBQ EJQFSMVLBOQFNCFEBIBO DN
 1BEBQBTJFOEFOHBOOJMBJ($4EFOHBO
LFUFCBMBO IFNBUPNB  NN EBO 1BTJFO EFOHBO MFTJ NBTTB QBSFOLJN UFUBQJ
midline shift  NN  IBSVT EJMBLVLBO UJEBL NFNQFSMJIBULBO UBOEBUBOEB EFTJU
QFNCFEBIBO FWBLVBTJ IFNBUPNB CJMB OFVSPMPHJT  UFLBOBO JOUSBLSBOJBM UFSLPOUSPM
OJMBJ ($4 UVSVO TFUJEBLOZB  OJMBJ EBSJ EBO UJEBL EJUFNVLBO LFMBJOBO QBEB CT-scan,
TBBU LFKBEJBO TBNQBJ UJCB EJ SVNBI EBQBU EJUFSBQJ TFDBSB OPOPQFSBUJG EBO
TBLJU EFOHBOmonitoringQFODJUSBBOTFSJBM 

.PSUBMJUBT QBTJFO IFNBUPNB TVCEVSBM 4BMBI TBUV JOEJLBTJ VUBNB QFNCFEBIBO


ZBOH NFNFSMVLBO UJOEBLBO QFNCFEBIBO QBEB IFNBUPNB JOUSBTFSFCSBM BEBMBI
BEBMBI  .PSUBMJUBT QBTJFO LPNB VOUVL NFOVSVOLBO UFLBOBO JOUSBLSBOJBM
ZBOH EJPQFSBTJ BEBMBI  5JOHHJOZB 8BMBVQVO CFMVN BEB EBUB QFSCBOEJOHBO
NPSUBMJUBT JOJ LBSFOB TFCBHJBO CFTBS LBTVT NPSUBMJUBT BOUBSB QBTJFO ZBOH EJPQFSBTJ EBO
IFNBUPNB TVCEVSBM CFSLBJUBO EFOHBO UJEBL  CFCFSBQB QFOFMJUJBO NFOVOKVLLBO
DFEFSB KBSJOHBO JOUSBLSBOJBM BUBVQVO QFOVSVOBO UFLBOBO JOUSBLSBOJBM ZBOH
FLTUSBLSBOJBM ,FMBJOBO JOUSBLSBOJBM ZBOH QB TJHOJLBO QBTDBPQFSBTJ 0QFSBTJ QBEB 
MJOH TFSJOH EJUFNVJ BEBMBI LPOUVTJP TFSFCSJ KBN QFSUBNB KVHB NFOVOKVLLBO QFSCFEBBO
EBO IFNBUPNB JOUSBTFSFCSBM ,FMBJOBO IBTJM ZBOH TJHOJLBO EJCBOEJOHLBO EFOHBO
FLTUSBLSBOJBM ZBOH QBMJOH TFSJOH BEBMBI PQFSBTJ ZBOH EJMBLVLBO MFCJI EBSJ  KBN
GSBLUVS GBTJBM  FLTUSFNJUBT  EBEB  EBO USBVNB TFUFMBI USBVNB )BTJM MFCJI CVSVL EJEBQBULBO
BCEPNFO 1FSCBOEJOHBO BOHLB NPSUBMJUBT   LBMJ MFCJI CBOZBL QBEB QBTJFO ZBOH
QBTJFO ZBOH EJPQFSBTJ EFOHBO ZBOH UJEBL Gambar 4.'SBLUVSLSBOJBMUFSEFQSFTJ IBOZB NFOEBQBULBO UFSBQJ PCBUPCBUBO
NBTJI CFMVN UFSTFEJB LBSFOB LFCBOZBLBO EJCBOEJOHLBOEFOHBOZBOHEJPQFSBTJ
QBTJFO BLIJSOZB NFNFSMVLBO UJOEBLBO BLBO NFOJOHLBULBO JOTJEFOT JOGFLTJ TFCFTBS
PQFSBTJ   Perdarahan Subaraknoid
1FSEBSBIBO TVCBSBLOPJE OPOUSBVNBUJL
Faktur Kranial Terdepresi Hematoma Intraserebral TFSJOH UFSKBEJ QBEB NBMGPSNBTJ BSUFSJWFOB
'SBLUVS LSBOJBM UFSEFQSFTJ UFSCVLB ZBOH *OEJLBTJ PQFSBTJ QBEB MFTJ QBSFOLJN PUBL /BNVO  QFSEBSBIBO TVCBSBLOPJE USBVNBUJL
NFMFCJIJ LFUFCBMBO LSBOJVN IBSVT EJPQFSBTJ BLJCBUUSBVNBBEBMBI UFSKBEJ QBEB TFLJUBS  QBTJFO EFOHBO
VOUVL NFODFHBI JOGFLTJ 4FUJBQ UJOEBLBO  5FSEBQBU EFTJU OFVSPMPHJT ZBOH DFEFSB LFQBMB 1FSEBSBIBO USBVNBUJL
VOUVL NFOHBUBTJ GSBLUVS LSBOJBM UFSEFQSFTJ QSPHSFTJG TVCBSBLOPJE USBVNBUJL CJBTBOZB UFSKBEJ CFS
UFSCVLB IBSVT EJCFSJ BOUJCJPUJL 'SBLUVS  5FSEBQBU QFOJOHLBUBO UFLBOBO JOUSB TBNBBO EFOHBO QFSEBSBIBO JOUSBLSBOJBM
LSBOJBM UFSEFQSFTJ UFSCVLB NBTJI EBQBU LSBOJBMZBOHSFGSBLUFS MBJOOZB TFQFSUJ IFNBUPNB FQJEVSBM 
EJUFSBQJ UBOQB PQFSBTJ CJMB CBJL LMJOJT
NBVQVO SBEJPMPHJ UJEBL NFOVOKVLLBO
BEBOZB QFOFUSBTJ EVSBNBUFS  IFNBUPNB
JOUSBLSBOJBM  LFUFSMJCBUBO TJOVT GSPOUBMJT  EBO
MVLBJOGFLTJ

'SBLUVS LSBOJBM UFSEFQSFTJ UFSUVUVQ UJEBL


NFNFSMVLBOUJOEBLBOPQFSBTJ

4FKVNMBI   LFKBEJBO JOGFLTJ CFS


IVCVOHBO EFOHBO EFTJU OFVSPMPHJ ZBOH
MFCJI CBOZBL EBO QFSTJTUFO  UFSKBEJOZB late
epilepsy LFKBOH UFSKBEJ  NJOHHV TFUFMBI
USBVNB
 EBO LFNBUJBO 5JOEBLBO PQFSBUJG
VOUVL EFCSJEFNFO NFOVSVOLBO LFKBEJBO
JOGFLTJ TFCFTBS   5JOEBLBO PQFSBTJ ZBOH
EJUVOEB MFCJI EBSJ  KBN TFUFMBI USBVNB Gambar 5.1FSEBSBIBOJOUSBTFSFCSBM Gambar 6.1FSEBSBIBOTVCBSBLOPJE

32 CDK-236/ vol. 43 no. 1, th. 2016


TINJAUAN PUSTAKA

IFNBUPNB TVCEVSBM  BUBVQVO IFNBUPNB MFCJI CVSVL KJLB EJTFSUBJ EFOHBO QFSEBSBIBO Glasgow Coma Scale VOUVL NFOFOUVLBO
JOUSBTFSFCSBM )BM JOJ NFOZFCBCLBO JOEJLBTJ TVCBSBLOPJE QFOBUBMBLTBOBBOOZB 5JEBL TFNVB QBTJFO
PQFSBTJ QBEB QFSEBSBIBO TVCBSBLOPJE USBVNB LBQJUJT QFSMV EJSBXBU JOBQ EJ SVNBI
USBVNBUJL NFOHJLVUJ JOEJLBTJ PQFSBTJ QBEB SIMPULAN TBLJU  EJMBLVLBO QFNFSJLTBBO CT-scan  BUBV
QFSEBSBIBO JOUSBLSBOJBM MBJOOZB ZBOH UFSKBEJ 5SBVNB NFSVQBLBO QFOZFCBC UFSUJOHHJ QVO EJPQFSBTJ 5FSEBQBU LSJUFSJB UFSUFOUV
)BOZBTBKB QSPHOPTJTQFSEBSBIBOJOUSBLSBOJBM LFNBUJBO QBEB VTJB EJ CBXBI  UBIVO EBO VOUVL UJOEBLBO PQFSBTJ NBTJOHNBTJOH
MBJOOZB TFQFSUJ IFNBUPNB FQJEVSBM  MFCJI EBSJ  USBVNB NFSVQBLBO USBVNB KFOJT USBVNB LBQJUJT *OEJLBTJ QFNCFEBIBO
IFNBUPNB TVCEVSBM  EBO IFNBUPNB LBQJUJT 5SBVNB LBQJUJT EJLMBTJLBTJLBO NFO EJUFOUVLBO CFSEBTBSLBO QFNFSJLTBBO LMJOJT
JOUSBTFSFCSBM BLBO NFNQVOZBJ IBTJM ZBOH KBEJ SJOHBO  TFEBOH  EBO CFSBU CFSEBTBSLBO EBOSBEJPMPHJ

DAFTAR PUSTAKA
 3PQQFS") 4BNVFMT.""EBNTBOE7JDUPST1SJODJQMFTPGOFVSPMPHZUIFE64".D(SBX)JMM$P *OD
 4DPUUJTI*OUFSDPMMFHJBUF(VJEFMJOFT/FUXPSL&BSMZNBOBHFNFOUPGQBUJFOUTXJUIBIFBE*OKVSZ&EJOCVSHI
 %FXBOUP(4VXPOP8+3JZBOUP#5VSBOB:%JBHOPTJTEBOUBUBMBLTBOBQFOZBLJUTBSBG+BLBSUB1FOFSCJUCVLVLFEPLUFSBO&($
 *OESBXBO) %FXJ %FXBOUP( 4FUJBXBO'1FSCBOEJOHBOHMBTHPXDPNBTDBMFEBOSFWJTFEUSBVNBTDPSFEBMBNNFNQSFEJLTJEJTBCJMJUBTQBTJFOUSBVNBLFQBMBEJ3VNBI4BLJU"UNB+BZB
.BKBMBI,FEPLUFSBO*OEPOFTJB 

 #VMMPDL3. $IFTOVU3 (IBKBS+ (PSEPO% )BSUM3 /FXFMM%8 FUBM4VSHFSZHVJEFMJOF4VSHJDBM.BOBHFNFOUPG5#*"VUIPS(SPVQ/FVSPTVSHFSZ 

 1FSEPTTJ,POTFOTVTOBTJPOBMQFOBOHBOBOUSBVNBLBQJUJTEBOUSBVNBTQJOBM
 4FSWBEFJ' $PNQBHOPOF$ 4BIVRVJMMP+5IFSPMFPGTVSHFSZJOUSBVNBUJDCSBJOJOKVSZ-JQQJODPUU8JMMJBNT8JMLJOT
 4IJNB, "SVHB5 0OVNB5 4IJHFNPSJ.+4/5(VJEFMJOFTGPSUIFNBOBHFNFOUPGTFWFSFIFBEJOKVSZ "CSJEHFE&EJUJPO
"TJBO+/FVSPTVSH 

 4VMMJWBO51 +BSWJL+( $PIFO8"'PMMPXVQPGDPOTFSWBUJWFMZNBOBHFEFQJEVSBMIFNBUPNBT*NQMJDBUJPOTGPSUJNJOHPGSFQFBU$5"N+/FVSPSBEJPM

CDK-236/ vol. 43 no. 1, th. 2016 33