Prijeoperacijska brzina protoka femoralne vene u maksimalnoj fleksiji je prediktor za duboku vensku trombozu u bolesnika podvrgnutih totalnoj artroplastici kuka

The aim of the study was to investigate if preoperative blood flow velocity in femoral vein in different positions of the hip during total hip arthroplasty (THA) is a predictor of postoperative deep vein thrombosis (DVT). In patients undergoing THA, blood flow velocity and diameter of proximal femoral vein on THA side were measured preoperatively in four flexion positions of the hip. After THA, patients were followed up for 42 days for DVT occurrence, and clinical features of patients with and without postoperative DVT were compared. The mean blood flow velocity in maximal flexion (90º+) preoperatively was significantly lower in patients with postoperative DVT (19/103) compared to patients without it (8.4±2 cm/s vs. 10.6±2.3 cm/s; p<0.001). Using the receiver operating characteristic curve analysis, the cut-off value for blood flow velocity during maximal flexion was 8.24 cm/s. In addition, anesthesia duration, duration of surgical position of the patient, body mass index, amount of blood transfused after surgery, and clinical signs of DVT were markedly different between patients with and those without postoperative DVT. Blood flow velocity in femoral vein in maximal flexion of the hip (90º+) measured prior to THA is an independent predictor of postoperative DVT.Cilj ove studije bio je istražiti je li prijeoperacijska brzina protoka krvi u femoralnoj veni u različitim položajima kuka tijekom potpune artroplastike kuka (total hip arthroplasty, THA) prediktor poslijeoperacijske duboke venske tromboze (DVT). U bolesnika koji su podvrgnuti THA brzina protoka krvi i promjer proksimalne femoralne vene na strani THA bili su prijeoperacijski izmjereni u četiri položaja kuka. Nakon THA bolesnici su praćeni 42 dana radi provjere nastanka DVT i uspoređeni su klinički podaci bolesnika s poslijeoperacijskom DVT i onih bez DVT. Srednja brzina protoka krvi u maksimalnoj fleksiji kuka (90º+) prijeoperacijski je bila znatno niža u bolesnika s poslijeoperacijskom DVT (19/103) u usporedbi s bolesnicima bez DVT (8,4±2 cm/s prema 10,6±2,3 cm/s; p<0,001). Analizom ROC (receiver operating characteristic curve) dobivena je granična vrijednost brzine protoka krvi tijekom maksimalne fleksije od 8,24 cm/s. Uz to, trajanje anestezije, trajanje kirurškog položaja bolesnika, indeks tjelesne mase, količina transfundirane krvi nakon operacije i klinički znakovi DVT bili su značajno različiti između bolesnika s poslijeoperacijskom DVT i bolesnika bez DVT. Brzina protoka krvi u femoralnoj veni u maksimalnoj fleksiji kuka (90º+) izmjerena prije THA je nezavisni prediktor za poslijeoperacijsku DVT

Neurosurgical Options for Glioma

Glioma surgery has been the main component of glioma treatment for decades. The surgical approach changed over time, making it more complex and more challenging. With molecular knowledge and diagnostic improvement, this challenge became maximally safe resection of tumor, which resulted in prolonged overall survival, progression-free period, and a better quality of life. Today, the standard glioma treatment includes maximally safe resection, if feasible, administration of temozolomide, radiotherapy, and chemotherapy. Surgical resection is performed as subtotal resection, gross total resection, and supratotal resection. Subtotal resection is the resection where a part of tumor is left. Gross total resection is a complete removal of the magnetic resonance imaging (MRI) visible tumor tissue. Supratotal resection is performed as gross total resection with excising the MRI visible tumor tissue borders into the unaffected brain tissue. Before we make final decision on which type of resection should be performed, many factors have to be considered. The main question has to be answered: what the actual impact of resection on the progression of glioma is and what the functional risk of resection is

Clinical characteristics of poor-grade aneurysmal subarachnoid hemorrhage treatment

Background: The initial clinical status after aneurysm rupture, whether primary or secondary, determines the final outcome. The most common cause of patient deterioration is a high Hunt and Hess (HH) score, which correlates closely with a high mortality rate. Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is determined as an HH score 4 or 5. The aim of this study was to evaluate the clinical characteristics of poor graded aneurysmal SAH at our institution. Patients and Methods  During the 5-year period, 415 patients with intracranial aneurysm were admitted to our institution. Patients with poor-grade aneurysmal SAH accounted 31.08% ( n  = 132) of the total number of ruptured aneurysms. Interventional treatment was predominantly in the form of surgery, whereas conservative treatment included medication and external ventricular drainage. Final outcome was assessed with a modified Rankin score (mRs). Statistical analysis was performed using SPSS version 23.0 with a significance level set to 5% (α = 0.05). Results  The majority of patients (57.6%) were in the age range from 51 to 69 years. Twenty-five patients (18.9%) had an HH score of 4, whereas 107 patients (81.1%) had an HH score of 5. Depending on the location, the majority of patients ( n  = 43) had an aneurysm on the medial cerebral artery (MCA). The final aneurysm occlusion was performed in 71 patients, of whom 94.36% were treated surgically. A positive outcome (mRs 0-4) was found in 49.25% of patients who underwent primarily surgical, treatment with a mortality of 42.3%. Although the outcome was better in patients with an HH score 4, both groups benefited from surgical treatment. Conclusion  Poor-grade aneurismal SAH is a condition of the middle and older age, with most patients with an HH 5 score and deep comatose state. There was better outcome in patients with an HH score of 4 compared to an HH score of 5 and both groups benefited from surgical treatment, which resulted in a positive outcome in almost 50% of surgically treated patients

Clinical and radiologic features in patients with the WHO grade I and II meningiomas

Introduction: Meningiomas are the most common benign tumor of the central nervous system, accounting for 53.3% and 37.6% of all central nervous system tumors (1). The World Health Organization (WHO) Grade I meningiomas account for 80.5% of all meningiomas and are considered benign meningiomas; the WHO Grade II meningiomas account for 17.7% of all meningiomas and exhibit more aggressive behavior. Methods: In the period 2015-2022, a retrospective single-center study at the clinic of neurosurgery at the Clinical Center University of Sarajevo was conducted, which included patients with a pathohistological finding of WHO Grade I or II meningioma. Depending on the pathohistological grade of the tumor, patients were divided into two groups: Grade I and Grade II patients. Patients were examined clinically and radiologically. Clinical data collected included in the study: Gender, age, number of symptoms before surgery, whether patients were symptomatic or asymptomatic, pre-operative Eastern Cooperative Oncology Group,and Karnopsky performance scale. Pre-operative contrast magnetic resonance imaging of the head measured tumor volume, temporal muscle thickness (TMT), sagittal midline shift, and surrounding cerebral edema. Results: A total of 80 patients were enrolled in the study, 68 with WHO Grade I and 12 with WHO Grade II meningiomas. We found that patients with Grade I meningioma were younger and that the mean thickness of the temporal muscle was statistically thicker than in patients with Grade II. Increasing TMT was significantly and positively associated with Grade I tumors and negatively associated with Grade II tumors (p = 0.032). Conclusion: This study demonstrates that TMT can serve as a radiologic pre-operative indicator of meningioma grade and provide valuable guidance to neurosurgeons in surgical planning. Further studies are needed to validate these results

Primarni epiteloidni hemangioendoteliom u malom mozgu: prikaz slučaja uz osvrt na drastičnu promjenu u klasifikaciji SZO

Epithelioid hemangioendothelioma is a rare vascular brain tumor. It develops from endothelial cells, usually in the liver, lung, bone and soft tissue. Primary localization of this tumor in the intracranial space is very uncommon; only 47 cases have been described in the literature. This tumor was initially classified as grade I (benign) in the World Health Organization (WHO) 2007 classification. In 2016, this tumor was re-classified as grade III (malignant). Herein, the first case report of epithelioid hemangioendothelioma in the cerebellum of a male patient is presented. Complete surgical excision was done. No adjuvant therapy was administered. Magnetic resonance imaging performed 2 years after the surgery continued to show no recurrence of the tumor. To our knowledge, this is the first report of cerebellar location of this rare tumor. In addition, the authors report drastic re-classification of the epithelioid hemangioendothelioma from the benign tumor (WHO 2007) to a malignant one (2016), which significantly changes postoperative management and follow up of this brain neoplasm.Epiteloidni hemangioendoteliom je rijedak vaskularni tumor mozga. Nastaje iz endotelnih stanica, obično u jetri, plućima, kosti i mekom tkivu. Primarna lokalizacija ovoga tumora u intrakranijskom prostoru je veoma rijetka; samo je 47 slučajeva opisano u literaturi. Ovaj tumor je isprva bio klasificiran kao gradus I (dobroćudan) u klasifikaciji Svjetske zdravstvene organizacije (SZO) iz 2007. godine. U 2016. godini ovaj tumor je klasificiran kao gradus III (zloćudan). Autori opisuju prvi slučaj epiteloidnog hemangioendotelioma u malom mozgu kod muškog bolesnika. Izvršena je potpuna kirurška ekscizija. Adjuvantna terapija nije ordinirana. Nalaz magnetske rezonance 2 godine nakon operacije pokazao je da nema povratka tumorske mase. Prema našem saznanju, ovo je prvi prikaz lokalizacije ovoga rijetkog tumora u malom mozgu. Također, autori upućuju na drastičnu promjenu u klasifikaciji epiteloidnog hemangioendotelioma od dobroćudnog tumora (SZO, 2007.) do zloćudnog (2016.), koja zasigurno mijenja poslijeoperacijski pristup i praćenje ove neoplazme mozga

Primary Epithelioid Hemangioendothelioma in the Cerebellum: Case Report with Reference to Drastic Change in the WHO Classification

Epithelioid hemangioendothelioma is a rare vascular brain tumor. It develops from endothelial cells, usually in the liver, lung, bone and soft tissue. Primary localization of this tumor in the intracranial space is very uncommon; only 47 cases have been described in the literature. This tumor was initially classified as grade I (benign) in the World Health Organization (WHO) 2007 classification. In 2016, this tumor was re-classified as grade III (malignant). Herein, the first case report of epithelioid hemangioendothelioma in the cerebellum of a male patient is presented. Complete surgical excision was done. No adjuvant therapy was administered. Magnetic resonance imaging performed 2 years after the surgery continued to show no recurrence of the tumor. To our knowledge, this is the first report of cerebellar location of this rare tumor. In addition, the authors report drastic re-classification of the epithelioid hemangioendothelioma from the benign tumor (WHO 2007) to a malignant one (2016), which significantly changes postoperative management and follow up of this brain neoplasm

Comparison of outcomes and recurrence rates in patients undergoing single or double burr hole surgery for the treatment of chronic subdural hematoma in Bosnia and Herzegovina

Introduction: Chronic subdural hematoma (CSDH) is a prevalent condition commonly seen in elderly individuals, often requiring neurosurgical intervention. Research question: This study investigates patient characteristics and recurrence rates in CSDH patients treated with single or double burr hole surgery in Bosnia and Herzegovina. Methods: A retrospective study was conducted on patients treated for CSDH between January 2018 and December 2022. The diagnosis of CSDH was confirmed through preoperative CT or MRI of the brain. Patients underwent either single or double burr hole surgery based on the neurosurgeon's decision. Preoperative and postoperative brain CT scans, along with clinical outcomes, were analyzed. Results: A total of 87 patients were included in the study, with 102 burr hole surgeries performed. Among these, 49 patients received single burr hole surgery, while 53 patients underwent double burr hole surgery. Recurrence of CSDH occurred in 8.8% of cases, with no significant difference observed between the groups. Notably, single burr hole surgery demonstrated comparable efficacy to double burr hole surgery in terms of subdural reduction and occurrence of pneumocephalus, while exhibiting fewer complications and shorter hospitalization. Discussion and conclusions: burr hole surgery, whether performed as a single or double procedure, is an effective treatment option for CSDH, as it leads to positive outcomes in both radiological and clinical assessments of patients following surgery. The population of Bosnia and Herzegovina receives good neurosurgical care for CSDH