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Introduction. Nerve transfers are the only surgical option in reconstruction of directly irreparable injuries of the brachial plexus. In the recent years there has been a trend toward the increased use of nerve transfers with introduction of many new methods and novel indications. Patients with total brachial plexus palsy generally have a poor outcome because of a very limited number of donor nerves. On the contrary, patients with partial injuries involving the C5, C6 and sometimes C7 spinal nerves have a remarquable outcome in a large majority of cases. In both situations , restoration of elbow flexion and shoulder functions are the main priorities. It should be emphasized, that in the cases with upper brachial plexus palsy this could be a complete functional recovery. The intention of this review article is a detailed survey on basics of nerve transfers with the comments concerning their advantages, problems and controversies. Analysis is documented with reported outcomes in the literature dealing with the most common methods of nerve transfer.Methods. PubMed/Medline databases were searched for English language basic articles concernig nerve transfers and series of adult patients who had nerve transfers for functional restoration of the upper arm nerves, performed within one year after injury and with minimum follow-up of one year. Finally, we selected 70 articles . Furthermore, literature search for outcome analysis was limited to the articles published after 1990 that included 45 systematic reviews and meta-analyses of the most common nerve transfers ( intercostal, spinal accessory, fascicular and collateral branches of the brachial plexus ). Analysis of clinical outcomes was based on Medical Research Council (MRC) grading system for muscle strenght, and grades M3 or more were considered as useful functional recovery.Results. Generally, intraplexal nerve transfers resulted with higher rate and better quality of recovery, comparing to the extraspinal transfers. Grades M3 or more were obtained in 72% of the intercostal and 73% of the spinal accessory nerve transfers for restoration of elbow flexion, and in 56% vs. 98% of transfers for restoration of shoulder function. Among intraplexal nerve transfers , elbow flexion was restored in 84% to 91% of the medial pectoral, 100% of the thoracodorsal and 94% to 100% of the single or double fascicular nerve transfers. Shoulder function was restored in 81,8% of the medial pectoral, 86% to 93% of the thoracodorsal and 100% of the triceps branch nerve transfers. Dual nerve transfers, meanning simultaneous reinnervation of the suprascapular and axillary nerves, resulted with 100% rate of recovery.Conclusion. Double fascicular transfer for restoration of elbow flexion and dual nerve transfer for restoration of shoulder function resulted with significantly better results than the other transfers, especially regarding the quality of recovery, meanning representation of grades M4 and M5 among recoveries. Medial pectoral and thoracodorsal nerve transfers proved as a good alternative for restoration of both functions.

The term "Southeast Europe" was introduced by Austrian researcher Johann Georg von Hahn in the 19th century as a broader termthan the traditional "Balkans," designating the region settled by several different nations, mostly alike, but also richly diverse. The mostappropriate definition describes the inhabitants as the people geographically, demographically, and culture related to SoutheasternEurope (1).Contemporary neurosurgery in the Southeast Europe region has recently witnessed remarkable progress, guided by the "Think globally,act locally" concept as an essential driving force. This slogan has long been in use in environmental contexts and has been gainingincreased significance in various disciplines over the past decades. In international education, this slogan was first introduced in 1950and popularized by Stuart Grauer in 1989 (2). Neurosurgeons in Southeast Europe genuinely implement the concept of thinking globallyand acting locally, working together to expand the horizons to the benefit of our patients and our well-being and recognition in themodern world. This mini review aims to highlight the development and progress of the Southeast Europe neurosurgical society (SeENS)as a regional neurosurgical society dedicated to neurosurgical education, research, capacity building, and exchanging experienceswithin the Southeast region of Europe.

Globally, the discipline of neurosurgery has evolved remarkably fast. Despite being one of the latest medical specialties, which appeared only around hundred years ago, it has witnessed innovations in the aspects of diagnostics methods, macro and micro surgical techniques, and treatment modalities. Unfortunately, this development is not evenly distributed between developed and developing countries. The same is the case with neurosurgical education and training, which developed from only traditional apprentice programs in the past to more structured, competence-based programs with various teaching methods being utilized, in recent times. A similar gap can be observed between developed and developing counties when it comes to neurosurgical education. Fortunately, most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice. In context to this understanding, a symposium was organized during the World Federation of Neurological Surgeons (WFNS) Special World Congress Beijing 2019. This symposium was the brain child of Prof. Yoko Kato—one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons. Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries. This paper summarizes the outcome of these presentations, with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.

The aim of this study was to analyze risk factors present in schizophrenic patients with depressive symptomatology. The sample comprised of 76 respondents diagnosed with schizophrenia. In the study, we used the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia. The prevalence of depression was estimated to be 30%. The mean scores on the negative subscale of the PANSS were significantly higher in patients with schizophrenia and depression compared to control group (U=3.64, p=0.00), and so were those on the General Psychopathology Scale (U=4.91, p=0.00). Socio-demographic factors were identified as important factors (p, Cilj ovoga rada bio je analizirati čimbenike rizika prisutne u shizofrenih bolesnika s depresivnom simptomatologijom. Uzorak se sastojao od 76 ispitanika s dijagnozom shizofrenije. U studiji smo koristili Ljestvicu za procjenu pozitivnog i negativnog sindroma kod shizofrenije (PANSS) i Kalgarijsku ljestvicu depresije. Procjenjuje se da je učestalost depresije 30%. Prosječni rezultati na negativnoj podljestvici PANSS-a bili su značajno veći u bolesnika sa shizofrenijom i depresijom u usporedbi s kontrolnom skupinom (U=3,64, p=0,00), kao i na općoj psihopatološkoj ljestvici (U=4,91, p=0,00). Socio-demografski čimbenici identificirani su kao važni čimbenici (p

Background/Aim. Interventional neuroradiology procedures expose patients to ionizing radiation. The aim of this study was to assess doses received by patients during interventional neuroradiology procedures and to establish dose range with an estimate of risk from adverse consequences of irradiation. Methods. Our study describes series of patients submitted to diagnostic and/or therapeutic procedures at the Department of Interventional Neuroradiology, Clinical Center Kragujevac, Serbia, from December 1, 2014 to December 1, 2016. The following variables were considered for this study: kerma-area product, air kerma and fluoroscopy exposure time; peak skin dose and effective dose calculated from the kerma-area product. Results. Median kerma-area product was 87.802 Gy?cm2, 78.567 Gy?cm2, 117.626 Gy?cm2; effective dose was 12.731 mSv, 11.392 mSv, 17.056 mSv; peak skin dose was 0.456 Gy, 0.409 Gy, 0.612 Gy, and estimated brain dose was 254.62 mGy, 227.84 mGy, 341.12 mGy, for diagnostic, therapeutic and combined procedures, respectively. Conclusion. Interventional neuroradiology procedures show significant variability in radiation dose, due to patient constitution, radiologist expertise and equipment factors. Knowing the doses can have a great benefit for patients and medical and paramedical stff in terms of prevention of possible deterministic and stochastic effects of the radiation.

Introduction. Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal aneurysms are rare, while aneurysms in mirror position are extremely rare. These aneurysms have high tendency for rupture (PHASES score is always > 4). In more than a half of the patients with the DACA aneurysm rupture, imaging reveals intracerebral hematoma which is a predictor of poor outcome. Case report. A 49- year-old female patient was treated endovascularly in other institution, due to middle cerebral artery aneurysm (MCA) rupture, when the two small bilateral aneurysms at the distal segments of anterior cerebral artery (ACA) were revealed, left one measuring 4.5 mm and the right one measuring 6 mm in size, with the aneurysmal neck width of 3 mm and 4 mm, respectively. The decision was made by the interventional neuroradiologist only to treat the bleeding MCA aneurysm immediately. The patient was referred to our department six months later, and it was decided to perform microsurgical occlusion of the remaining DACA aneurysms. Unilateral interhemispheric approach was chosen to reach the distal ACAs and aneurysms at pericallosal-callosomarginal junction were clipped and completely excluded from the circulation. Conclusion. Management of DACA aneurysms is a surgical chellenge, even for experienced neurosurgeons. It is controversial whether these should be surgically clipped or coiled endovascularly, especially in cases like this one when a same-stage, endovascular coiling might look like a perfect approach. Surgical treatment should be prompt due to their tendency to early rupture. Careful evaluation for multiplicity is mandatory.

A 48-year-old female was admitted to the authors’ department due to hand weakness as a consequence of C8, T1 root injury. Eight months earlier, the patient had been treated by a pulmonary surgeon due to an expansive lesion near the apex of the right lung, which resulted in right lower brachial plexus palsy. Postoperative pathohistological findings indicated that the lesion was nerve schwannoma. The diagnostic process included physical examination, electromyoneurography, and MRI. A distal nerve transfer (pronator teres–anterior interosseus nerve [PT-AIN], supinator–posterior interosseus nerve [SUP-PIN]) was performed in order to restore hand function. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID22110

Even though neurosurgeons exercise these enormous and versatile skills, the COVID-19 pandemic has shaken the fabrics of the global neurosurgical family, jeopardizing human lives, and forcing the entire world to be locked down. We stand on the shoulders of the giants and will not forget their examples and their teachings. We will work to the best of our ability to honor their memory. Professor Harvey Cushing said: "When to take great risks; when to withdraw in the face of unexpected difficulties; whether to force an attempted enucleation of a pathologically favorable tumor to its completion with the prospect of an operative fatality, or to abandon the procedure short of completeness with the certainty that after months or years even greater risks may have to be faced at a subsequent session-all these require surgical judgment which is a matter of long experience." It is up to us, therefore, to keep on the noble path that we have decided to undertake, to accumulate the surgical experience that these icons have shown us, the fruit of sacrifice and obstinacy. Our tribute goes to them; we will always remember their excellent work and their brilliant careers that will continue to enlighten all of us.

Background In patients with only upper (C5, C6) brachial plexus palsy (BPP), the pooled international data strongly favor nerve transfers over nerve grafts. In patients with complete BPP, some authors favor nerve grafts for the restoration of priority functions whenever there is a viable proximal stump. Objective To evaluate functional recovery in cases of upper and complete BPP where only direct graft repair from viable proximal stumps was performed. Methods The study included 36 patients (24 with complete BPP and 12 with only upper BPP) operated on over a 15-yr period. In all cases, direct graft repair from C5 to the musculocutaneous and the axillary nerve was performed. In cases with complete BPP, additional procedures included either direct graft repair from C6 to the radial nerve and the medial pectoral nerve or the dorsal scapular nerve transfer to the branch for the long head of the triceps. Results The use of C5 proximal stump grafts (in both complete and upper BPP) resulted in satisfactory elbow flexion in 26 patients (72.2%) and satisfactory shoulder abduction in 22 patients (61.1%). The use of C6 proximal stump grafts in patients with complete BPP resulted in satisfactory elbow extension in 5 (50%) and satisfactory shoulder adduction in another 5 (50%) patients. Conclusion Although nerve transfers generally enable better restoration of priority functions, in cases of infraganglionary injuries, especially in shorter defects, it is also necessary to consider direct graft repair, or at least its combination with nerve transfers, as a potentially beneficial treatment modality.

Introduction. Subarachnoid haemorrhage (SAH) can be followed by cardiac abnormalities. We describe a patient with Takotsubo cardiomyopathy and neurogenic pulmonary edema (NPE) after aneurysmal SAH. Case report. A previously healthy, postmenopausal woman, suffered from aneurysmal SAH with consequent hydrocephalus. After external ventricular drainage, craniotomy and clipping of the posterior inferior cerebellar artery aneurysm, the patient developed acute heart failure and NPE. Transthoracic echocardiogram showed the left ventricular apical ballooning and hypercontractile basal segments. On chest radiography, bilateral pulmonary infiltrates were seen. Seventeen days after the SAH attack, the patient was discharged from hospital. Postponed coronary angiography revealed no signs of coronary artery disease. Conclusion. This case and review of the relevant literature suggest that Takotsubo cardiomyopathy and neurogenic pulmonary edema are not uncommon after aneurysmal SAH.

Introduction/Objective. Hair transplantation is one of the fastest evolving procedures in aesthetic surgery and is accompanied by continuous improvement of new techniques. Hairline planning is one of the most important steps in hair transplantation. The shape of the hair also varies depending on the variation of facial shape so it is very important when determining hair direction and making holes for future grafts. Methods. We used ordinary 18 gauge injection needles whose number was the same as the number of micrographs we planned for transplantation. Needles are administered in pile growth direction and angle, starting from the first row, and then proceeding to the second one and so on, until we insert all prepared needles. We insert them one in front of the other with a precision ease for future follicles. Results. In all 56 patients, we obtained natural hair growth. Inserting the needles reduced bleeding and the average time of the operation was three hours. The success of grafting was 95%. We only had one infection in one patient. Hair growth corresponded to the needle insertion. After a year of transplantation at the last control, the patient?s satisfaction was 100%. Conclusion. By using the same number of needles as the number of grafts we reduced operating time, we had a better determination of the direction of hair growth, we can prevent follicular extraction that can be caused by new needle insertion, and this technique achieved a good aesthetic result.

Nocardia is a ubiquitous microorganism which can be the cause of local and disseminated infection in humans. Immunocompetent and immunocompromised patients both can be affected and Nocardia cyriacigeorgica was reported as a pathogen isolated in patients worldwide. In most cases, nocardiosis is present as pulmonary infection because inhalation is the primary way of bacterial exposure. Nocardial brain abscess occurs usually secondary to a septic focus elsewhere in the body. Considering the facts that the elderly population is growing, such as the number of immunocompromised patients together with high mortality rate in patients with nocardial infection of the central nervous system, we have to raise aware-ness of the possibility for this rare but potentially fatal condition. We present a case where nocardial ab-scesses of lung and brain were initially suspected as lung cancer with brain metastases. The patient was treated with a combination of surgical resection and antimicrobial therapy with good outcome., Nocardia je ubikvitaran mikroorganizam koji može biti uzročnik lokalnih i sistemskih infekcija kod čovjeka. No-cardia cyriacigeorgica je patogen koji je izoliran i prijavljen u svim dijelovima svijeta. I imunokompetentne i imu-nokompromitirane osobe mogu biti zahvaćene ovom infekcijom. U većini slučajeva prisutna je infekcija pluća bu-dući da je inhalacija primarni put unošenja uzročnika. Nokardijalni apscesi mozga se obično javljaju uslijed posto-janja žarišta infekcije u drugim dijelovima organizma. Imajući u vidu činjenicu da raste broj osoba starije životne dobi i broj imunokompromitiranih osoba u ukupnoj populaciji, uz visoku smrtnost bolesnika s nokardijalnom infek-cijom središnjega živčanog sustava, moramo biti svjesni mogućnosti za razvoj ovog rijetkog, ali potencijalno fatal-nog stanja. Prikazujemo slučaj bolesnika kod kojega su plućna nokardijalna infekcija i nokardijalni apsces mozga inicijalno shvaćeni kao karcinom pluća i metastatski tumor mozga. Bolesnik je liječen kombinacijom kirurškog liječenja i antimikrobne terapije s dobrim ishodom.

Background/Aim. Chronic subdural hematoma (CSDH) is one of the most frequent neurosurgical conditions with an overall incidence ranging from 1.72 to 20.6 per 100,000 persons per year. The surgical procedure for CSDH is relatively simple and usually performed in the supine position. Reported reoccurrence rates range from 11.7% to 28%. Postperative pneumocephalus was previously identified as a sole predictor of reoccurrence. The aim of this study was to assess the advantage of the procedure in the sitting position in patients with CSDH and a possible impact on the reoccurrence rate. Methods. The study included 31 patients who underwent awake craniostomy with closed system drainage for CSDH (16 in supine and 15 in sitting position) in our department from December 2016 to March 2018. Results. A total of 22 males and 9 females were included in the study. The overall reoccurrence rate was 19% (22% and 18% in females and males, respectively). The re-occurrence was noted in 5 patients who had undergone surgery in the supine position, and in one case in the sitting position. Our results revealed a lower reoccurrence rate in patients undergoing surgery in the sitting position, although not reaching statistical significance [odds ratio (OR): 0.18, 95% confidence interval: 0.01?1.42, p = 0.172]. Conclusion. Craniostomy in the sitting position under local anesthesia is a safe, simple, and reliable procedure for CSDH treatment. Besides being very comfortable for the patient, according to our initial results, it might also lead to a lower reoccurrence rate, probably due to the better management of the air inflow, and consequent pneumocephalus.

[No Abstract Available]

This paper aims to provide an overview of recent advances in the diagnosis and treatment of peripheral nerve tumors (PNTs) with regard to biological and technological nuances, and to highlight some recommendations for achieving better outcomes in the treatment of patients suffering from PNT. PNTs are probably the most challenging entity in the field of peripheral nervous system surgery. The goal of removing a nerve tumor while also preserving nerve function at the same time is often complicated, regardless of the surgeon’s experience. Still, in most cases, high-quality results can be achieved upon carefully planned surgery. Clinical presentation, diagnosis, and indications for a specific type of treatment of PNTs still remain a topic of debate. Recent technological advances have led to an exponential improvement in the field with utilization of intraoperative ultrasound, neurostimulation devices, and intraoperative electrophysiological monitoring, along with the development of modern surgical techniques, whereby a multidisciplinary and individually shaped approach is necessary.Conclusion. These advances, however, still remain limited, and recent research is focused on the development of biological therapy. Biologically targeted therapies will emerge when there is a better understanding of the genetic and molecular mechanisms driving the development and growth of PNTs.

Background/Aim. Duchenne muscular dystrophy (DMD) and its allelic form Becker muscular dystrophy (BMD) are X-linked diseases that affect males, characterized by progressive muscle and cardiopulmonary weakness, especially in DMD as a severe form of the disease. They result from mutations in the dystrophin gene, and the most common changes are large intragenic deletions and duplications (80%). One third of patients have de novo mutation and 2/3 of the mothers are estimated as carriers. The aim of the study was to analyze the frequency of duplications versus deletions in the dystrophin gene in patients with dystrophinopathies, as well as to analyze the phenotypic effect of large mutations obtained and to determine the carrier status of female relatives in probands with duplications. Methods. We examined 22 DMD and 35 BMD unrelated patients and 6 female relatives of the probands where duplications were found. We used polymerase chain reaction (PCR) and multiplex ligation-dependent probe amplification (MLPA) methods, according to the protocol, to detect or confirm mutations in probands and female carriers. Results. In probands, there were 34 (59.6%) large deletions (mostly affected exons 44-60) and 6 (10.5%) large duplications in 4 DMD and 2 BMD patients. Also, duplications were found in 3 out of 4 (75%) tested mothers. The distribution of duplications was heterogeneous, affecting N-terminal and central rod domain, and included more exons, except for one DMD patient who had duplication of exon 2. An exception from the Monaco rule was present in 9.5% of DMD and 15.8% of BMD probands, i.e. in 12.5% of DMD/BMD cases. Conclusion. In 57 DMD/BMD probands, we found 59.6% of large deletions and 10.5% of large duplications. The most affected region of the DMD gene was the central rod domain. An exception to Monaco's rule was present in 12.5% of DMD/BMD cases. Three out of 4 examined proband's mothers were confirmed as carriers. Uvod/Cilj. Dišenova mišićna distrofija (DMD) i njegova alelna forma, Bekerova mišićna distrofija (BMD), su Xvezane nasledne bolesti od kojih obolevaju muškarci, a karakteriše ih progresivna mišićna i kardiopulmonalna slabost, posebno kod DMD kao težeg oblika bolesti. Ove bolesti nastaju kao posledica mutacija u genu za distrofin, a najčešće su prisutne intragenske delecije i duplikacije (80%). Novonastalu mutaciju ima1/3 bolesnika, a procenjeno je da su 2/3 majki nosioci. Cilj rada je bio da se analizira učestalost duplikacija u odnosu na delecije u genu za distrofin kod bolesnika sa distrofinopatijom, kao i da se ispita efekat dobijenih mutacija na fenotip kod probanda i utvrdimo status nosioca kod ženskih srodnika probanda sa duplikacijama. Metode. Studijom je bilo obuhvaćeno 22 DMD i 35 BMD nesrodnih bolesnika i šest ženskih srodnika probanda kod kojih su bile otkrivene duplikacije. Za otkrivanje ili potvrdu mutacije, kod probanda i ženskih nosioca, korišćene su metode: lančana reakcija polimerazom (PCR) i višestruko umnožavanje vezanih sondi (MLPA), prema datom protokolu. Rezultati. Kod probanda je nađeno 34 (59,6%) velikih delecija (najčešće su bili zahvaćeni egzoni 44-60) i 6 velikih duplikacija (10,5%) kod 4 DMD i 2 BMD bolesnika. Takođe, duplikacije su nađene kod 3 od 4 (75%) testirane majke. Distribucija duplikacija je bila heterogena, obuhvatala je N-terminalni i štapićasti region i uključivala je veći broj egzona, osim kod jednog DMD bolesnika koji je imao duplikaciju egzona 2. Odstupanje od Monakovog pravila je bilo prisutno kod 9,5% DMD probanda, odnosno kod 15,8% BMD probanda, to jest kod 12,5% slučajeva. Zaključak. Kod 57 DMD/BMD probanda nađeno je 59,6% velikih delecija i 10,5% velikih duplikacija. Najčešće je bio zahvaćen štapićasti domen u DMD genu. Odstupanje od Monakovog pravila je bilo prisutno u 12,5% DMD/BMD slučajeva. Tri od četiri ispitane majke probanda su bile potvrđene kao nosioci.

Made available in DSpace on 2021-06-25T11:47:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-01 Ege Univ, Dept Neurosurg, 1416 Sok 7 Kahramanlar, Izmir, Turkey Liaquat Natl Hosp & Med Coll, Karachi, Pakistan Humanitas Univ, Dept Neurosurg, Milan, Italy Univ Mumbai, LTM Med Coll, Dept Neurosurg, Mumbai, Maharashtra, India Capital Med Univ, Xuanwu Hosp, Dept Neurosurg, Beijing, Peoples R China Rush Univ, Dept Neurosurg, Med Ctr, Chicago, IL 60612 USA Korea Univ, Ansan Hosp, Dept Neurosurg, Med Ctr, Ansan, South Korea Osaka Med Coll, Dept Neurosurg, Takatsuki, Osaka, Japan Tsukazaki Hosp, Dept Neurosurg, Himeji, Hyogo, Japan Neurochirurg CMCO Cote dOpale St Martin, Boulogne, France President Continental Assoc African Neurosurg Soc, Nairobi, Kenya Burdenko Inst, Dept Neurosurg, Moscow, Russia Sao Paulo State Univ, Dept Neurosurg, Sao Paulo, Brazil El Bosque Univ, Dept Neurosurg, Bogota, Colombia ABC Med Ctr, Dept Neurosurg, Mexico City, DF, Mexico Airlangga Univ, Dept Neurosurg, Surabaya, Indonesia Kovai Med Ctr, Dept Neurosurg, Coimbatore, Tamil Nadu, India Univ Philippines, St Lukes Med Ctr, Bonifacio Global City, Philippines Hosp Lusiadas, Dept Neurosurg, Porto, Portugal Univ Saarland, Dept Neurosurg, Homburg, Germany Univ Belgrade, Clin Ctr Serbia, Dept Neurosurg, Belgrade, Serbia Leiden Univ, Dept Neurosurg, Med Ctr, Leiden, Netherlands Kathmandu Univ, Nepal Med Coll & Teaching Hosp, Dept Neurosurg, Kathmandu, Nepal Cairo Univ, Dept Neurosurg, Cairo, Egypt Usmanu Danfodiyo Univ Teaching Hosp, Sokoto, Nigeria Univ Bamenda, Fac Hlth Sci, Neurosurg Div, Bambili, Cameroon Bangabandhu Shiek Mujib Med Univ, Dept Neurosurg, Dhka, Bangladesh Med Univ Varna, Multiprofile Hosp St Anna Varna, Varna, Bulgaria Hirslanden Klin St Anna Lucerne, Dept Neurosurg, Luzern, Switzerland Mem Hosp, Istanbul, Turkey Med Univ Varna, Varna, Bulgaria Sao Paulo State Univ, Dept Neurosurg, Sao Paulo, Brazil

Giant cavernomas (GC) are rare lesions, with less than 50 cases reported so far. Clinical presentation usually involves epileptic seizures and less typically focal neurological deficit, due to repeated hemorrhages and GC mass effect and consequentially increased intracranial pressure. Although individual cases have been reported, due to the rarity and variable imaging appearance, GCs are usually not considered in the differential diagnosis of large hemorrhagic lesions, especially when significant mass effect is present. A 17-year-old boy presented due to severe headache, right-sided weakness, and slurred speech. Symptoms started three days before with occasional headaches, which intensified gradually. Emergency computed tomography revealed a left frontal massive heterogeneous lesion. Soon after, right-sided hemiparesis and speech impairment progressed, and the patient became drowsy with the slightly dilated left pupil. Emergency surgery was performed, and the lobed grayish lesion was entirely removed. Based on the macroscopic appearance, the surgeon assumed it was a metastasis of melanoma. Histopathologic analysis result was cavernoma. GC should be considered as an option in hemorrhagic lesions, especially in the young age population. Emergency surgery for mass lesions is not uncommon in neurosurgery; however, bleeding cavernomas are usually planned for elective surgery due to the specific approach and complications., Divovski kavernomi (DK) su rijetke lezije s manje od 50 dosad opisanih slučajeva. Uobičajena simptomatologija su epileptični napadaji, a rjeđe se manifestiraju žarišnim neurološkim deficitom koji je uzrokovan ponavljanim hemoragijama i posljedičnim povećanjem intrakranijskog tlaka. Iako su objavljeni pojedini slučajevi, zbog rijetke pojavnosti i raznovrsne radiološke prezentacije DK se obično ne razmatraju u diferencijalnoj dijagnostici velikih hemoragičnih ekspanzivnih lezija, pogotovo kada je prisutan značajan kompresivni učinak. Sedamnaestogodišnji dječak se javio liječniku zbog jake glavobolje, blaže desnostrane slabosti i nerazgovijetnog govora. Simtpomi su se javili 3 dana ranije u vidu blagih glavobolja koje su se postupno pojačavale. Hitna kompjutorizirana tomografija je pokazala masivnu hemoragičnu leziju frontalno lijevo. Nedugo zatim desnostrana slabost i nerazgovijetan govor su se pogoršali i bolesnik je postao pospan s blago proširenom lijevom zjenicom. Učinjena je hitna operacija, kružna sivkasta lezija je u cijelosti uklonjena. Na osnovi makroskopskog izgleda kirurg je pomislio da se radi o metastazi melanoma. Histopatološka analiza je pokazala da se radi o kavernomu. DK bi trebalo razmatrati kao mogućnost kod hemoragičnih lezija, pogotovo kod mlađih bolesnika. Hitna operacija kod kompresivnih lezija nije rijetkost u neurokirurgiji, međutim, krvareći kavernomi se obično planiraju za elektivnu operaciju zbog specifičnog pristupa i mogućih komplikacija.

Introduction/Objective. Increasing incidence of spinal cord injuries presents a very important issue. These patients are usually very young, treatment is very tough, long, expensive and, in general, of little success rate. The aim of this study was to evaluate the angiogenic potential of the omental graft in spinal cord revascularization after the injury. Methods. The study included 19 patients, who underwent recurrent surgical procedure for pain syndrome or surgical complication, and one patient in whom angiography revealed no flow in distal part of omental graft. Results. Our study confirmed angiogenic capabilities of omental graft placed in the course of omentomyelopexy for the injured spinal cord revascularization, macroscopically and histopathologically. Study results are limited due to inclusion of patients, only when the postoperative period was complicated. Conclusion. Our study provides some insight into the angiogenic capabilities. Although, further (likely less invasive) studies are needed to provide more insight into omental angiogenesis and to include patients in whom the procedure went well.

The fact that this Special Issue of the Neurological Research journal is devoted to the current neurosurgical research conducted in Southeast Europe provides invaluable acknowledgement to the profe...

Developmental venous anomalies are cerebral vascular malformations that present normal venous drainage of cerebral tissue. With increased and accessible usage of modern diagnostic tools, they are now one of the most commonly diagnosed cerebral vascular malformations. Although developmental venous anomalies are considered to be benign lesions, association with arteriovenous malformation renders malignant potential to this combined pathology. In the case presented, these malformations were clinically silent and diagnosed accidentally, so they were not treated either with surgery, endovascular surgery or radiosurgery, considering the possible complications such as venous infarction of the brain, and because there was no obvious neurologic deficit related to this pathology. The patient presents for regular neurosurgical follow up examinations and has been free from symptoms that were present on admission.

The use of multidetector computed tomography (MDCT) is an integral part of contemporary diagnostics of Graves‘ orbitopathy. Th e aim of this study was to assess proptosis measurement by MDCT and to compare it to the current standard, Hertel exophthalmometry. A crosssectional study was conducted at the Clinical Centre of Serbia and included 91 patients (19 male and 72 female) with verified Graves‘ orbitopathy. Globe protrusion measured by MDCT (globe protrusion, GPR) was correlated to Hertel measured protrusion (HR). Th ere was no constant or any systematic bias between the two methods. GPR significantly correlated with the best-corrected visual acuity, while HR did not. Age, body mass index and duration of the disease did not influence proptosis measurement by either method. Proptosis was significantly larger in males. According to our results, GPR compared to HR provides better assessment of the protrusion in Graves‘ disease. GPR measurement is simple and should always be part of the radiological assessment of orbits in Graves‘ disease.