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Introduction: High grade gliomas (HGG) are a group of tumors with infiltrative nature in general. Surgery is the first step in their treatment. It can be beneficial in two aspects: firstly, in establishing normal intracranial pressure and, secondly, in reducing the tumour volume. The choice of method depends on the location of the lesion, the expected grade of malignancy, and the general condition of the patient. Despite constant development of neuro-oncology and microsurgical techniques, the 5-year survival rate in patients with HGG remains less than 10% and the median survival is still less than 2 years. Aim: At present, there is no final therapeutic “segment” to provide a better outcome than the complex treatment of HGG. Moreover, the treatment’s relative efficacy and recurrence of these tumours carry an additional problem. The aim of this study was to estimate the overall survival of patients with HGG operated in our clinic and compare it with literature data. Materials and methods: One hundred twenty-one cranial operations for HGG were reviewed (conducted between 2014 and 2019). Summary characteristics of the various parameters were presented in respect to the radical nature of the operative intervention using Kaplan-Meier analysis and chi square tests. All patients were followed up at regular check-ups. Results: HGGs were 103 or 85.12% of all gliomas operated for the 2014-2019 period. The most common cases were in the 51 to 60 age group. The cases in men were twice as common. The most common localization of the neoplasm is in the temporal region (36.36%) and the rarest was found in the occipital region (3.30%). It was estimated that our operated patients with HGG had 12.23 months over-all survival. Gross total resected patients had a median survival (OS) of 14.53 months, while subtotal resected patients had a median survival (OS) of 10.44 months. It is estimated 7.97 months free tumor survival period (time to relapse - FTS) for our operated patients with HGG. Gross total resected patients had a median FTS of 10.88 months, while subtotal resected patients had median FTS of 5.70 months. We noticed permanent new neurological deficit (NND) in 20 patients (19.45%) operated with GTR, and in 5 patients (4.85%) operated with STR. Conclusions: Median survival - OS, free tumor survival period - FTS and new neurological deficit - NND were statistically significant (p

Summary Unsatisfactory results from lumbar disc herniation (LDH) conservative treatment suggest referral of patients for neurosurgical treatment. The time required for such a decision is considered to be about 4-6 weeks. In most cases, surgery quickly relieves pain symptoms, all along with the restoration of patient functions. The optimal surgical technique for LDH is theoretically controversial. We consider two discectomy methods as quite effective in our clinic: standard open discectomy (SD) and microdiscectomy (MD). Many retrospective studies have demonstrated the superiority of one of these techniques. Most studies describe microdiscectomy as a golden standard for surgical treatment of symptomatic disc herniation. We focused on the clinical aspects and correlations in the surgical treatment of LDH, as presented in the literature. The patients we present were divided by type of surgical procedure (SD or MD), and other parameters: sex, age, duration of symptoms, blood loss, duration of the operation, reoperation rate, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). We used chi-square tests (ANOVA analysis) and directional measures to determine statistically significant data. Five hundred eighty-nine single-level lumbar discectomies were performed for five years (2012-2017), and all the patients presented with classical signs of the condition, i.e., vertebral and radicular syndromes. SD was performed on 498 patients, and MD – on 91 patients. Analyses of the parameters mean VAS values of lumbar and leg pain postoperatively, and within one month after surgery demonstrated statistically significant differences between standard and microdiscectomy (p

Summary Juvenile pilocytic astrocytoma (JPA) is a low-grade glioma, a most common astrocytoma in young patients. It is a tumor with relatively well-defined margins. Pilocytic astrocytomas (PA) comprise approximately 5-6% of all gliomas. Gross total resection ensures a radical cure of patients and long-time survival. In the literature, the data on the survival rate of more than 20 years is scarce. A 5.5-year old boy with a history of 3-month complaints of headache, dizziness, and vomiting was diagnosed after CT to harbour a hypodense cerebellar tumor mass, situated in the midline-right hemisphere. The compression of the fourth ventricle resulted in rostral hydrocephalus with transependymal resorption. Within a week, a VP shunt was applied, followed by a radical Nafziger-Town operation. Gross total resection of the tumor was achieved. Profound clinical improvement was observed immediately after the operation. Postoperative CT scans, including the ones 22 years after the operation, remained practically normal. The patient is now 28-year old and is a perspective economist now. He leads a healthy working life. In general, the prognosis is excellent. If the tumor is completely removed by surgery, the chances of being “cured” are very high. Pilocytic astrocytoma has a five-year survival rate in over 96 percent in children and young adults, which is one of the highest survival rates of any brain tumor. However, there is even a small percent possibility for malignant transformation (1-4%).

Summary Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.

Summary The majority - over 80%, of arteriovenous malformations (AVMs) are supratentorial. The infratentorial AVM are uncommon and different from other intracranial AVMs in terms of history, diagnosis, treatment, prognosis, and follow up. The authors present a case of an intracranial hemorrhage, caused by rupture of an AVM in the posterior cranial fossa. Native (unenhanced) CT and computed tomography angiography (CTA) images of this rare location of AVM are presented.