Evaluation of modified surgical technique outcomes in single-suture and complex craniosynostosis

Uvod: Kraniosinostoze su oboljenja koja se karakterišu patološkom prevremenom fuzijom jedne ili više kranijalnih sutura usled čega dolazi do nastanka abnormalnog oblika lobanje, intrakranijalne hipertenzije i poremećaja neurokognitivnog razvoja obolele dece. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata lečenja modifikovanim hirurškim tehnikama u tretmanu unisuturnih i kompleksnih kraniosinostoza, koja podrazumeva: 1. detaljan prikaz novih modifikovanih hirurških tehnika: trikvadratna proširena osteotomija (triple square extended osteotomies, TSEO), dinamička remodelacija sa plivajućim čelom (floating forehead dynamic remodeling, FFDR) i frontoorbitalna hiperkorektivna remodelacija (fronto-orbital hypercorrective remodeling, FOHR) 2. procenu estetskih rezultata hirurškog lečenja prema standardnim klasifikacijama 3. procenu morfološkog ishoda hirurškog lečenja 4. neurokognitivnu evaluaciju operisanih pacijenata Materijal i metode: Ukupno 187 pacijenata sa prevremenim srastanjem jedne ili više kranijalnih sutura hirurški su lečeni u Klinici za neurohirurgiju KCS u Beogradu od januara 1999. do januara 2014. godine. Kod svih pacijenata sprovedena je adekvatna preoperativna neuroradiološka evaluacija, koja je podrazumevala nativni kraniogram i kompjuterizovanu tomografiju glave; magnetna rezonanca nije rutinski rađena i bila je razmatrana isključivo za sindromske slučajeve. Klinički parametri dobijeni su iz istorija bolesti i služili su za formiranje detaljnog upitnika. Kraniometrijske referentne vrednosti od interesa: preoperativni i postoperativni kranijalni indeks (CI), endokranijalni bifrontalni ugao (EBA) i modifikovani indeks za procenu simetrije kranijuma (modified cranial vault asymmetry index - mCVAI) korišćene su za morfološku procenu uspešnosti lečenja. Estetski rezultat lečenja evaluiran je Whitakerovom i Sloanovom klasifikacijom. Prisutni neurokognitivni poremećaj, zaostajanje u psihomotornom razvoju, kao i intelektualnom funkcionisanju, procenjivan je korišćenjem Razvojnog testa Čuturić, REVISK skale i testa NEPSY-II...Introduction: The term craniosynostosis refers to premature fusion of one of more cranial sutures that can lead to severe craniofacial disfigurement, intracranial hypertension and abnormal neurocognitive development in affected children. Aim: The present thesis has the intention to evaluate results of modified surgical techniques used in the treatment of unisutural and complex craniosynostosis that comprises of: 1. Detailed presentation of the new modified surgical techniques: triple square extended osteotomies (TSEO), floating forehead dynamic remodeling (FFDR) and frontoorbital hypercorrective remodeling (FOHR) techniques 2. Estimation of the aesthetic results after surgical treatment according to standard classifications 3. Estimation of morphological outcome of surgical treatment 4. Neurocognitive evaluation of treated patients Material and method: A total of 187 consecutive patients with premature fusion of one or more cranial sutures were surgically treated in Clinic of Neurosurgery KCS in Belgrade from January 1999 to January 2014. All patients underwent preoperative neuroradiological evaluation with plain cranial radiography and computerized tomography; magnetic resonance was not routinely performed and was considered strictly for syndromes. Clinical data were extracted from patient's medical history and comprehensive patient interview. Craniometrical referent points of interest: preoperative and postoperative cranial index (CI), endocranial bifrontal angle (EBA) and modified cranial vault asymmetry index (mCVAI) changes were used to estimate morphological outcome of surgery. Aesthetic outcome was assessed using Whitaker and Sloan classification. Presence of neurocognitive impairment, delay in psychomotor development and intellectual functioning were assessed with Cuturic developmental test, REVISK scale and NEPSY-II test..

Electric vehicle conversion: optimisation of parameters in the design process

Jedan od pravaca ka stvaranju čistijih i ekonomičnijih vozila jeste prihvatanje koncepta električnog vozila. Rad predstavlja suvremene koncepte konstrukcije električnih vozila širom svijeta, kao i načine snabdjevanja vozila energijom. Opisan je prepravak vozila kako bi ga se moglo pogoniti elektro-motorom. Prikazani su rezultati vučno-dinamičkog proračuna i simulacije stabilnosti prije i poslije prepravka. Analizirani su dobiveni rezultati i utjecajni čimbenici radi optimiziranja u cilju utjecaja na karakteristike prepravljenog vozila. Zaključeno je da je proces optimizacije neophodno provesti prije početka prepravka kako bi se izbjegle neželjene posljedice, tj. neželjene karakteristike prepravljenog vozila i visoki troškovi prepravka.One of the directions for making cleaner and more economic vehicles is to adopt electric vehicle concept. The paper shows current design concepts for electric vehicles worldwide, as well as current sources for supplying vehicles with electric energy. It describes a conversion of one vehicle so that it can be powered by electric motor. The results of tractive and dynamic characteristics calculation and vehicle stability simulation, before and after the conversion, are shown. Obtained results and influential factors are analysed so they can be optimised in order to influence the final characteristics of the converted vehicle. The conclusion is that the complete optimisation process should be performed before the beginning of vehicle conversion in order to avoid undesirable effects, i.e. undesirable characteristics of converted vehicle and high conversion costs

Evaluation of modified surgical technique outcomes in single-suture and complex craniosynostosis

Uvod: Kraniosinostoze su oboljenja koja se karakterišu patološkom prevremenom fuzijom jedne ili više kranijalnih sutura usled čega dolazi do nastanka abnormalnog oblika lobanje, intrakranijalne hipertenzije i poremećaja neurokognitivnog razvoja obolele dece. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata lečenja modifikovanim hirurškim tehnikama u tretmanu unisuturnih i kompleksnih kraniosinostoza, koja podrazumeva: 1. detaljan prikaz novih modifikovanih hirurških tehnika: trikvadratna proširena osteotomija (triple square extended osteotomies, TSEO), dinamička remodelacija sa plivajućim čelom (floating forehead dynamic remodeling, FFDR) i frontoorbitalna hiperkorektivna remodelacija (fronto-orbital hypercorrective remodeling, FOHR) 2. procenu estetskih rezultata hirurškog lečenja prema standardnim klasifikacijama 3. procenu morfološkog ishoda hirurškog lečenja 4. neurokognitivnu evaluaciju operisanih pacijenata Materijal i metode: Ukupno 187 pacijenata sa prevremenim srastanjem jedne ili više kranijalnih sutura hirurški su lečeni u Klinici za neurohirurgiju KCS u Beogradu od januara 1999. do januara 2014. godine. Kod svih pacijenata sprovedena je adekvatna preoperativna neuroradiološka evaluacija, koja je podrazumevala nativni kraniogram i kompjuterizovanu tomografiju glave; magnetna rezonanca nije rutinski rađena i bila je razmatrana isključivo za sindromske slučajeve. Klinički parametri dobijeni su iz istorija bolesti i služili su za formiranje detaljnog upitnika. Kraniometrijske referentne vrednosti od interesa: preoperativni i postoperativni kranijalni indeks (CI), endokranijalni bifrontalni ugao (EBA) i modifikovani indeks za procenu simetrije kranijuma (modified cranial vault asymmetry index - mCVAI) korišćene su za morfološku procenu uspešnosti lečenja. Estetski rezultat lečenja evaluiran je Whitakerovom i Sloanovom klasifikacijom. Prisutni neurokognitivni poremećaj, zaostajanje u psihomotornom razvoju, kao i intelektualnom funkcionisanju, procenjivan je korišćenjem Razvojnog testa Čuturić, REVISK skale i testa NEPSY-II...Introduction: The term craniosynostosis refers to premature fusion of one of more cranial sutures that can lead to severe craniofacial disfigurement, intracranial hypertension and abnormal neurocognitive development in affected children. Aim: The present thesis has the intention to evaluate results of modified surgical techniques used in the treatment of unisutural and complex craniosynostosis that comprises of: 1. Detailed presentation of the new modified surgical techniques: triple square extended osteotomies (TSEO), floating forehead dynamic remodeling (FFDR) and frontoorbital hypercorrective remodeling (FOHR) techniques 2. Estimation of the aesthetic results after surgical treatment according to standard classifications 3. Estimation of morphological outcome of surgical treatment 4. Neurocognitive evaluation of treated patients Material and method: A total of 187 consecutive patients with premature fusion of one or more cranial sutures were surgically treated in Clinic of Neurosurgery KCS in Belgrade from January 1999 to January 2014. All patients underwent preoperative neuroradiological evaluation with plain cranial radiography and computerized tomography; magnetic resonance was not routinely performed and was considered strictly for syndromes. Clinical data were extracted from patient's medical history and comprehensive patient interview. Craniometrical referent points of interest: preoperative and postoperative cranial index (CI), endocranial bifrontal angle (EBA) and modified cranial vault asymmetry index (mCVAI) changes were used to estimate morphological outcome of surgery. Aesthetic outcome was assessed using Whitaker and Sloan classification. Presence of neurocognitive impairment, delay in psychomotor development and intellectual functioning were assessed with Cuturic developmental test, REVISK scale and NEPSY-II test..

Evaluation of modified surgical technique outcomes in single-suture and complex craniosynostosis

Uvod: Kraniosinostoze su oboljenja koja se karakterišu patološkom prevremenom fuzijom jedne ili više kranijalnih sutura usled čega dolazi do nastanka abnormalnog oblika lobanje, intrakranijalne hipertenzije i poremećaja neurokognitivnog razvoja obolele dece. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata lečenja modifikovanim hirurškim tehnikama u tretmanu unisuturnih i kompleksnih kraniosinostoza, koja podrazumeva: 1. detaljan prikaz novih modifikovanih hirurških tehnika: trikvadratna proširena osteotomija (triple square extended osteotomies, TSEO), dinamička remodelacija sa plivajućim čelom (floating forehead dynamic remodeling, FFDR) i frontoorbitalna hiperkorektivna remodelacija (fronto-orbital hypercorrective remodeling, FOHR) 2. procenu estetskih rezultata hirurškog lečenja prema standardnim klasifikacijama 3. procenu morfološkog ishoda hirurškog lečenja 4. neurokognitivnu evaluaciju operisanih pacijenata Materijal i metode: Ukupno 187 pacijenata sa prevremenim srastanjem jedne ili više kranijalnih sutura hirurški su lečeni u Klinici za neurohirurgiju KCS u Beogradu od januara 1999. do januara 2014. godine. Kod svih pacijenata sprovedena je adekvatna preoperativna neuroradiološka evaluacija, koja je podrazumevala nativni kraniogram i kompjuterizovanu tomografiju glave; magnetna rezonanca nije rutinski rađena i bila je razmatrana isključivo za sindromske slučajeve. Klinički parametri dobijeni su iz istorija bolesti i služili su za formiranje detaljnog upitnika. Kraniometrijske referentne vrednosti od interesa: preoperativni i postoperativni kranijalni indeks (CI), endokranijalni bifrontalni ugao (EBA) i modifikovani indeks za procenu simetrije kranijuma (modified cranial vault asymmetry index - mCVAI) korišćene su za morfološku procenu uspešnosti lečenja. Estetski rezultat lečenja evaluiran je Whitakerovom i Sloanovom klasifikacijom. Prisutni neurokognitivni poremećaj, zaostajanje u psihomotornom razvoju, kao i intelektualnom funkcionisanju, procenjivan je korišćenjem Razvojnog testa Čuturić, REVISK skale i testa NEPSY-II...Introduction: The term craniosynostosis refers to premature fusion of one of more cranial sutures that can lead to severe craniofacial disfigurement, intracranial hypertension and abnormal neurocognitive development in affected children. Aim: The present thesis has the intention to evaluate results of modified surgical techniques used in the treatment of unisutural and complex craniosynostosis that comprises of: 1. Detailed presentation of the new modified surgical techniques: triple square extended osteotomies (TSEO), floating forehead dynamic remodeling (FFDR) and frontoorbital hypercorrective remodeling (FOHR) techniques 2. Estimation of the aesthetic results after surgical treatment according to standard classifications 3. Estimation of morphological outcome of surgical treatment 4. Neurocognitive evaluation of treated patients Material and method: A total of 187 consecutive patients with premature fusion of one or more cranial sutures were surgically treated in Clinic of Neurosurgery KCS in Belgrade from January 1999 to January 2014. All patients underwent preoperative neuroradiological evaluation with plain cranial radiography and computerized tomography; magnetic resonance was not routinely performed and was considered strictly for syndromes. Clinical data were extracted from patient's medical history and comprehensive patient interview. Craniometrical referent points of interest: preoperative and postoperative cranial index (CI), endocranial bifrontal angle (EBA) and modified cranial vault asymmetry index (mCVAI) changes were used to estimate morphological outcome of surgery. Aesthetic outcome was assessed using Whitaker and Sloan classification. Presence of neurocognitive impairment, delay in psychomotor development and intellectual functioning were assessed with Cuturic developmental test, REVISK scale and NEPSY-II test..

Primitive trigeminal artery associated with aterovenous malformation of cerebellum

Introduction. Persistence of fetal cerebral carotid basilar anastomoses is rare. When it occurs, it is often associated with other vascular malformations, and other pathological conditions. Trigeminal primitive artery persistence is the most often among them. Coincidence of primitive trigeminal artery with cerebellar arteriovenous malformation is extremely rare. Case report. We reported a case of a 31-year-old woman with subarachnoid hemorrhage and cerebellar hematoma admitted in serious condition. Angiography demonstrated cerebellar arteriovenous malformation, primitive trigeminal artery and other malformation of Willis circle. After a complete surgical removal of arteriovenous malformation the patient was discharged without neurological or any other deficit. Conclusion. We reported an extremely rare condition, which had been reported very few times in the literature. The importance of primitive artery persistence is in changed anatomical and physiological condition of cerebral circulation, that is especially important in surgical procedures

Collateral branches of the brachial plexus as donors in nerve transfers

Background/Aim. Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors. Methods. This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve. The results were analyzed according to the donor nerve, the age of the patient and the timing of surgery. Results. The total rate of recovery for elbow flexion was 94.1%, for shoulder abduction 89.3%, and for shoulder external rotation 64.3%. The corresponding rates of recovery using the thoracodorsal nerve were 100%, 93.7% and 68.7%, respectively. The rates of recovery with medial pectoral nerve transfers were 90.5%, 83.3% and 58.3%, respectively. Despite the obvious differences in the rates of recovery, statistical significance was found only between the rates and quality of recovery for the musculocutaneous and axillary nerve using the thoracodorsal nerve as donor. Conclusion. According to our findings, nerve transfers using collateral branches of the brachial plexus in cases with upper palsy offer several advantages and yield high rate and good quality of recovery

Iatrogenic Peripheral Nerve Injuries—Surgical Treatment and Outcome: 10 Years' Experience

Background Iatrogenic nerve injuries are nerve injuries caused by medical interventions or inflicted accidentally by a treating physician. Methods We describe and analyze iatrogenic nerve injuries in a total of 122 consecutive patients who received surgical treatment at our Institution during a period of 10 years, from January 1, 2003, to December 31, 2013. The final outcome evaluation was performed 2 years after surgical treatment. Results The most common causes of iatrogenic nerve injuries among patients in the study were the operations of bone fractures (23.9%), lymph node biopsy (19.7%), and carpal tunnel release (18%). The most affected nerves were median nerve (21.3%), accessory nerve (18%), radial nerve (15.6%), and peroneal nerve (11.5%). In 74 (60.7%) patients, surgery was performed 6 months after the injury, and in 48 (39.3%) surgery was performed within 6 months after the injury. In 80 (65.6%) patients, we found lesion in discontinuity, and in 42 (34.4%) patients lesion in continuity. The distribution of surgical procedures performed was as follows: autotransplantation (51.6%), neurolysis (23.8%), nerve transfer (13.9%), direct suture (8.2%), and resection of neuroma (2.5%). In total, we achieved satisfactory recovery in 91 (74.6%), whereas the result was dissatisfactory in 31 (25.4%) patients. Conclusions Patients with iatrogenic nerve injuries should be examined as soon as possible by experts with experience in traumatic nerve injuries, so that the correct diagnosis can be reached and the appropriate therapy planned. The timing of reconstructive surgery and the technique used are the crucial factors for functional recovery