Search

(1) Background: A chronic subdural hematoma (CSDH) is considered an acute life-threatening event that is easily treated surgically, but little is known about the longer-term mortality of these patients. The objective of this study was to evaluate the association of social determinants of health (SDoH) and the long-term mortality of patients with a chronic subdural hematoma. (2) Methods: This retrospective cohort study included 121 (88 male and 33 female) patients with a surgically treated unilateral or bilateral CSDH. Mortality was evaluated at 1, 2, 6, and 12 months after treatment. (3) Results: Most of the patients were >65 and retired, N = 96 (79.3%); of them, the majority presented with a neurological deficit, N = 71 (73.9%). Patients who lived alone more often had a neurological deficit, N = 57 (75.0%), compared to those who lived in communities, N = 25 (55.5%). Mortality at 1, 2, 6, and 12 months after surgery was 10.7%, 17.4%, 19.0%, and 45.5%, respectively, and there was a significant difference in the median age between the survival and deceased groups at 1 month (p < 0.01), 2 months (p < 0.01), and 6 months (p < 0.01) of follow-up, but not in the long-term (12 months) follow-up (p = 0.200). Patients who lived alone had 3.7 times higher odds of dying at the 12-month follow-up (p < 0.01), compared to those who lived in the community. (4) Conclusions: Living alone is related to an increased case fatality risk after CSDH surgery in the Serbian context. Social determinants of health can be associated with CSDH presentation and survival, indicating that further studies should include SDoH to obtain a deeper understanding of the occurrence, presentation, and outcomes of SDoH and propose additional preventive measures.

BACKGROUND: Endovascular cerebral aneurysm surgery, also known as endovascular neurosurgery, represents a minimally invasive approach aimed at diagnosing and treating intracerebral aneurysms through the use of catheters, wires, and various specialized instruments. This innovative approach has emerged as a promising alternative to traditional open surgical methods for addressing cerebral aneurysms. However, it is essential to acknowledge that while endovascular procedures offer numerous advantages, such as reduced morbidity and mortality rates, they are not devoid of associated risks, some of which can have life-threatening consequences. This paper seeks to delve into the realm of intraoperative complications in patients undergoing endovascular treatment for aneurysms, shedding light on the challenges and complexities within this field. METHODS: For this retrospective investigation, we conducted a comprehensive analysis of medical records spanning a five-year period, from 2019 to 2023. These records were obtained from the Neurosurgical Clinic of Belgrade, located within the University Clinical Center of Serbia. The study cohort comprised 44 patients who encountered intraoperative complications during endovascular aneurysm treatment. Patient information, including age, gender, aneurysm size, location, specific segment, and details regarding the nature of the intraoperative complications, was meticulously collected. Subsequently, the gathered data underwent rigorous statistical analysis. RESULTS: Out of a total of 429 patients who underwent endovascular treatment for aneurysms, 44 experienced intraoperative complications. The average age of these individuals was 55.4 years, ranging from 13 to 83 years, with the majority being women (37 out of 44, or 84.1%). Thirteen patients (29.5%) presented with significant preoperative co-morbidities and had previously experienced subarachnoid hemorrhaging before undergoing treatment. The most prevalent location for aneurysms was the internal carotid artery (ICA), accounting for 40.9% of cases, with the C6 segment being the most frequently affected at 27.3%. Other notable locations included the anterior communicating artery (ACoA) at 34.1% and the middle cerebral artery (MCA) at 13.6%. Regarding intraoperative complications, technical issues were the most frequent, affecting 84.1% of patients, while biological mishaps impacted 7 out of 44 patients (15.9%). Coil failure occurred in 16 out of 44 patients (36.4%), and stent failure was observed in 14 out of 44 patients (31.8%). Catheter-related problems were noted in 5 patients (11.4%), as were thromboembolic events, also in 5 patients (11.4%). Contrast extravasation was observed in 3 patients (6.8%), and hematoma formation occurred in 1 patient (2.3%). Additionally, 12 out of 44 aneurysms were found to be ruptured (27.3%). In this retrospective study spanning five years, our investigation focused on intraoperative complications in 44 out of 429 patients who underwent endovascular aneurysmal surgery. Our findings underscored that the primary source of these complications was related to technical issues, aligning with observations from previously referenced studies. Notably, coil and stent failures emerged as prominent concerns, along with catheter-related problems and thromboembolic events. CONCLUSION: In conclusion, the endovascular approach to treating aneurysms, while offering a minimally invasive option, is not exempt from inherent risks and complications. Despite these challenges, endovascular neurosurgery continues to hold significant value as a crucial alternative for the treatment of intracerebral aneurysms.

Background: A common peroneal nerve (CPN) injury located at the knee level, occurring as a consequence of hip surgery is described in the literature. However, there are only a few papers concerning their surgical management, while there are no thoroughly analyzed cases following open reduction and internal fixation (ORIF) of the acetabular fracture. This paper aimed to describe a such case and discuss current trends in the surgical management of these patients. The case: A 32-year-old woman was admitted to our department due to left-sided CPN palsy. The patient was injured in a traffic accident eight months earlier, followed by left hip dislocation and acetabular fracture. Following the acetabular fracture ORIF, a CPN palsy developed. The electromyoneurography (EMNG) and ultrasound (US) indicated a nerve lesion at the knee level. The surgical treatment included external neurolysis, decompression, and complete nerve deliberation, with the preservation of all nerve branches. The patient reported immediate relief, while completely recovered 8 months following the surgery (Medical Research Council (MRC) grade = 5, Visual Analogous Scale (VAS) = 0). Conclusion: The cause of CPN palsy following hip surgery may not always be located in the hip region. A detailed anamnesis, physical examination, and diagnostic evaluation are necessary for the proper surgical management of these patients. In addition to the EMNG, the US should be essential in preoperative planning and choosing the most effective surgical strategy.

Anaplastic astrocytoma WHO (World Health Organization) grade 3 represents about 7% of all primary brain tumours in the adult population. The standard treatment protocol involves safe surgical resection, chemotherapy and radiotherapy. Advances in therapeutic protocols have been noted over the past few decades, but the prognoses are still poor with a median survival of 31 months. We present a case of a male patient who is alive 25 years after the initial diagnosis and treatment of anaplastic astrocytoma WHO grade 3. The patient was operated and reoperated two times due to local tumour recurrence in the first two years after the initial diagnosis. After the last operation, the patient abandoned medical therapy and started praying. The patient is still alive without any clinical or radiological signs of tumour recurrence.

Objectives: To assess the effect of oxygen-ozone therapy guided by percutaneous Computed Tomography (CT) compared to corticosteroids in individuals experiencing lower back pain (LBP) not attributed to underlying bone-related issues. Methods: A total of 321 patients (192 males and 129 females, mean age: 51.5 ± 15.1 years) with LBP were assigned to three treatment groups: group A) oxygen-ozone only, group B) corticosteroids only, group C) oxygen-ozone and corticosteroids. Treatment was administered via CT-guided injections to the intervertebral disc (i.e., intradiscal location). Clinical improvement of pain and functionality was assessed via self-reported pain scales and magnetic resonance (MR) and CT imaging. Results: At all follow-up times, the mean score of the numeric rating scale and the total global pain scale (GPS) of study groups receiving oxygen-ozone (groups A and C) were statistically significantly lower than the study group receiving corticosteroids only (group B), with p < 0.001. There was a statistically significant difference between groups A and C at 30 days for the numeric rating scale. Conclusions: The percutaneous application of oxygen-ozone in patients with LBP due to degeneration of the lumbosacral spine showed long-lasting significant pain reduction of up to two years post-treatment when compared to corticosteroids alone. Combination therapy of oxygen-ozone and corticosteroids can be useful as corticosteroids showed statistically significant improvement in LBP earlier than the oxygen-ozone-only treatment.

ObjectiveAlthough the studies have shown the beneficial effects of diet, nutrition, and supplementation as an independent treatment modality, their roles are underestimated in the treatment of peripheral nerve injuries. This is in great part due to the development of efficient nerve repair techniques, combined with physical treatment and stimulation. To achieve the best possible functional recovery diet, nutrition, and supplementation should be implemented within a multidisciplinary approach. The aim of the study is to provide insight into the potentially beneficial effects of diet, nutrients, and supplementation, in the limitation of nerve damage and augmentation of the functional recovery after surgery in a review of human and animal studies.MethodsThe data relating to the diet, nutrients, and supplementation effects on peripheral nerve injuries and their treatment was extracted from the previously published literature.ResultsGeneral balanced diet as well as obesity influence the initial nerve features prior to the injury. In the period following the injury, neuroprotective agents demonstrated beneficial effects prior to surgery, and immediately after the injury, while those potentiating nerve regeneration may be used after the surgical repair to complement the physical treatment and stimulation for improved functional recovery.ConclusionsStandardized diet, nutrition, and supplementation recommendations and protocols may be of great importance for better nerve regeneration and functional recovery as a part of the multidisciplinary approach to achieve the best possible results in surgically treated patients with peripheral nerve injuries in the future.

Closed injuries to the peroneal nerve recover spontaneously in about a third of patients, but surgery may be needed in the remaining 2/3. The recovery after surgery is not always satisfactory and the patients may need an orthosis or a walking aid to cope with regular daily activities. This study aimed to evaluate the useful functional recovery and quality of life (QoL) in surgically treated patients with peroneal nerve (PN) injuries. The study involved 51 patients who have undergone surgical treatment due to PN injury in our department, within a 15-year period (2006–2020). Thirty patients (59%) were treated with neurolysis, 12 (23%) with nerve repair techniques, and 9 (18%) with tendon transfer (TT). Neurolysis is employed in the least extensive nerve injuries when nerve continuity is preserved and yields a motor recovery ratio of almost 80%. Nerve repairs were followed by 58.33% of patients achieving M3+ recovery, while 41.66% recovered to the useful functional state (M4 or M5) With the use of TTs, all patients recovered to the M3+, while 66.7% recovered to M4. All our results correspond to the results of previous studies. No statistically significant differences were found regarding the QoL of the groups. There is an apparent advantage of neurolysis, over nerve repair, over TT procedure, both in terms of useful functional recovery, and foot-drop-related QoL. However, when involving all aspects of QoL, these advantages diminish. The individual approach leads to optimal results in all groups of patients.

IntroductionRadial nerve lesions present a clinical entity that may lead to disability, psychological distress, and job loss, and thus requires great attention. Knowledge of the etiology and exact mechanism of the nerve impairment is of great importance for appropriate management of these patients, and there are only a few papers that focused on these features in patients with surgically treated radial nerve lesions. The lack of studies presenting the etiology and injury mechanisms of surgically treated radial nerve lesions may be due to a relatively small number of specialized referral centers, dispersion to low-flow centers, and a greater focus on the surgical treatment outcomes.AimThe aim of this study was to describe the etiological and epidemiological characteristics of patients with surgically treated radial nerve lesions of various origins.MethodsThis retrospective study evaluated 147 consecutive patients with radial nerve lesion, treated in the department during the last 20 years, from January 1, 2001, until December 31, 2020.ResultsThe majority of patients belonged to the working population, and 70.1% of them were male. Most commonly, the etiology of nerve lesion was trauma (63.3%) or iatrogenic injury (28.6%), while the less common origin was idiopathic (4.1%) or neoplastic (4.1%). The most frequent location of the lesion was in the upper arm, followed by the elbow and forearm. Fracture-related contusion was the most common mechanism (29.9%), followed by postoperative fibrosis (17.7%), lacerations (17.7%), and compression (15.6%).ConclusionBased on the fact that traumatic or iatrogenic injuries constitute the majority of cases, with their relevant mechanisms and upper arm predomination, it is crucial to raise awareness and understanding of the radial nerve injuries among orthopedic surgeons to decrease the numbers of these patients and properly preserve or treat them within the initial surgery.

Myxopapillary ependymomas (MPE) of the spinal cord are slow-growing benign tumors most frequently found in adults between 30 and 50 years of age. They arise from the ependyma of the filum terminale and are located in the area of the medullary conus and cauda. The recommended treatment option is gross total resection, while patients undergoing subtotal resection usually require radiotherapy. Complete resection without capsular violation can be curative and is often accomplished by simple resection of the filum above and below the tumor mass. Nevertheless, dissemination and distant treatment failure may occur in approximately 30% of the cases. In this paper, we propose an original MPE classification, which is based upon our personal series report concerned with tumor location and its correlation with the extent of resection. We also provide literature review, discussing surgical technique, tumor recurrence rate and dissemination, and adjuvant treatment. In conclusion, our findings suggest that MPE management based on the proposed 5-type tumor classification is favorable when total surgical resection is performed in carefully selected patients. Yet, further studies on a much broader model is obligatory to confirm this.

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.

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

Introduction: The phrase “think globally, act locally”, which has often been used to refer to conservation of the environment, highlights the importance of maintaining a holistic perspective and stipulates that each individual has a role to play in their community and larger world. Although peripheral nerve surgery has been largely unemphasized in global neurosurgical efforts, a wide disparity in peripheral nerve surgery is presumed to exist between high-income and low- and middle-income countries. Serbia is an upper middle-income country with a long history of peripheral nerve surgery. Research question: How can understanding the development of peripheral nerve surgery in Serbia advance global education and improve peripheral nerve surgery worldwide? Material and methods: An anecdotal and narrative review of recent advances in peripheral nerve surgery in Serbia was conducted. The World Federation of Neurosurgical Society (WFNS) Peripheral Nerve Surgery Committee discussions on improving peripheral nerve surgery education were summarized. Results: In this manuscript, we describe the application of “think globally, act locally” to peripheral nerve surgery by providing an account of the development of peripheral nerve surgery in Serbia. Then, we report measures taken by the WFNS Peripheral Nerve Surgery Committee to improve education on peripheral nerve surgery in LMICs. Discussion and conclusion: Viewing the development of peripheral nerve surgery in Serbia through the lens of “think globally, act locally” may guide the development of peripheral nerve surgery in LMICs.

Radial nerve injuries are often associated with humeral shaft fractures. The results of treatment of these injuries, by contemporary surgical approaches, remain diverse. In this paper we presented the outcomes and analyzed the patient, clinical, and surgical procedure related characteristics and factors that may influence the outcome overall, in 77 patients treated at Clinic for Neurosurgery, Clinical Center of Serbia during a 20 years period. The nerve injuries were verified by US and EMNG. The majority of patients were treated by neurolysis or sural nerve grafting, while only few were treated by direct suture. The final recovery was evaluated by muscle strength assessment and classified using MRC. We analyzed extension of the wrist, extension of the fingers including the thumb, and abduction of the thumb. There was a significant statistical difference in MRC grade following the treatment. The total rate of useful functional recovery was achieved in 69 (89.61%) out of all studied patients, out of whom 20 (28.99%) achieved excellent recovery, 26 (37.68%) achieved good recovery and 23 (33.33%) achieved fair recovery. Only 8 (10.39%) out of all studied patients achieved poor recovery. The injured nerves, that were preserved in continuity, acquired by a low-energy trauma, and treated earlier than the 6 months were associated with better functional outcome following the surgery. In addition, there was a trend of better functional improvement with aging, keeping in mind that the old were subjected to lower energy trauma. The expectant management followed by surgery of radial nerve injury associated with humeral shaft fracture should be around 3 months, and the surgical nerve repair should not be performed later than the 6 months after injury. The energy of trauma may be a factor predicting patient's final recovery following the treatment.

Missile injuries are among the most devastating injuries in general traumatology. Traumatic brachial plexus injuries are the most difficult injuries in peripheral nerve surgery, and most complicated to be surgically treated. Nevertheless, missile wounding is the second most common mechanism of brachial plexus injury. The aim was to evaluate functional recovery after surgical treatment of these injuries. Our series included 68 patients with 202 nerve lesions treated with 207 surgical procedures. Decision on the treatment modality (exploration, neurolysis, graft repair, or combination) was made upon intraoperative finding. Results were analyzed in 60 (88.2%) patients with 173 (85.6%) nerve lesions followed-up for two years. Functional recovery was evaluated according to functional priorities. Satisfactory functional recovery was achieved in 90.4% of cases with neurolysis and 85.7% of cases with nerve grafting. Insufficient functional recovery was verified in ulnar and radial nerve lesions after neurolysis, and in median and radial nerve lesions when graft repair was done. We conclude that the best time for surgery is between two and four months after injury, except for the gunshot wound associated with injury to the surrounding structures, which requires immediate surgical treatment. The results of neurolysis and nerve grafting were similar.

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.

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.

Microdiscectomy (MD) is accepted nowadays as the operative method of choice for lumbar disc herniation, but it is not rare for neurosurgeons to opt for standard discectomy (SD), which does not entail the use of operating microscope. In our study, differences in disc herniation recurrence and clinical outcome of surgical treatment of lumbar disc herniation with and without the use of operating microscope were assessed. Our study included 167 patients undergoing lumbar disc surgery during a three-year period (SD, n=111 and MD, n=56). Clinical outcome assessments were recorded by patients via questionnaire forms filled out by patients at three time points. Operation duration, length of hospital stay and revision surgeries were also recorded. According to study results, after one-year follow up there was no statistically significant difference between the SD and MD groups in functional outcome. However, we recorded a statistically significant difference in leg pain reduction in favor of the MD group. According to the frequency of reoperations with the mean follow up period of 33.4 months, there was a statistically significant difference in favor of the MD group (SD 6.3% vs. MD 3.2%). There appears to be no particular advantage of either technique in terms of functional outcome since both result in good overall outcome. However, we choose MD over SD because it includes significantly lower recurrent disc herniation rate and higher reduction of leg pain.

Patients with brain arteriovenous malformation (AVM) have a certain risk to bleed, and the goal of this study was to examine the effect of radiological and clinical predictive characteristics of AVM hemorrhage using multidetector computed tomographic (MDCT) angiography. The study included a series of 57 patients, mean age 35.46 years, who were diagnosed during their hospitalization at Clinical Department of Neurosurgery, Clinical Center of Serbia, in the period from January 2008 to March 2016. In all patients, the diagnosis was made using MDCT angiography. Two groups of patients were observed. The first group included patients who did not initially present with hemorrhage, while the second group initially presented with hemorrhage. Both groups were treated with medical therapy or a combination of medical therapy with embolization/surgery/radiotherapy. Deep venous drainage (p60 mm, venous dilatation present in the drainage vein (p60 mm, the angle of the casting feeding arteries in the nidus ≥130° and dilatation and/or venous aneurysm of drainage vessel are predictive for clinical presenting by hemorrhage.

Aneurysms of blood vessels at the base of the brain are pathological focal outpouchings, usually found at the branching points of the arteries. Aneurysm can remain silent for life. Clinical presentation is due to rupture and bleeding. In only 1.3% of cases it results in subdural hematoma, which is associated with direct interaction of the aneurysm with the basal arachnoid membrane. Multiple aneurysms are present in 15% to 33% of cases with subarachnoid hemorrhage. Assessment of these patients is more complicated, as there are no specific signs to pinpoint/detect the aneurysm that has ruptured. This report presents a 44-year-old female patient suffering from multiple cerebral aneurysm disease, who was urgently treated after rupture by both endovascular (for multiple aneurysms) and surgical (for acute subdural hematoma) approach in the same act under general anesthesia, which resulted in complete recovery of the patient.

The aim of this study was to evaluate and compare the outcomes of intraoperative aneurysmal rupture in patients with subarachnoid hemorrhage undergoing open surgical or endovascular treatment. This retrospective study included 742 patients with aneurysmal subarachnoid hemorrhage treated at the Clinical Department of Neurosurgery, Clinical Center of Serbia, during a three-year period. Among them, 167 (31.15%) were treated by clipping and 33 (16.01%) by coiling in the early phase (≤72 hours). The overall outcome and pretreatment variables were analyzed for each group, including between-group difference according to the occurrence of intraoperative aneurysmal rupture. Intraoperative aneurysmal rupture occurred in 14.7% of microsurgical and 2.4% of endovascular procedures. It was more frequent in early procedures as compared with delayed procedures (27.5% and 9.7% vs. 2.2% and 1.1%, respectively). On the contrary, mortality rates were lower in the surgical group (11.4%) than in the endovascular one (60.0%).On the basis of the results obtained, it is concluded that intraoperative aneurysmal rupture is more frequent after open than after endovascular treatment, but clinical outcome is more favorable in the former group.

The verified presence of a glioblastoma multiforme (GBM ) tumor in the motor area of the brain, in a patient lacking preoperative neurological deficit, offers no certainty that the tumor can be radically removed without the possibility of causing postoperative motor deficit. We present a series of 60 patients hospitalized at the Clinical Department of Neurosurgery, Clinical Center of Serbia in Belgrade between October 2011 and February 2015, harboring tumors located within and in the vicinity of the motor zone of the brain. By using Karnofsky‘s index (KI), the pre- and postoperative conditions of the patients were evaluated. Regarding electrical stimulation of the motor cortex, significantly lower values of the electrical current intensity, frequency, and pulse wave duration (p

The aim of this study was to investigate the mechanisms and etiologic factors of forearm nerve injuries. This retrospective survey included all patients treated surgically in Clinical Department of Neurosurgery, Clinical Center of Serbia, from January 1, 2000 to December 31, 2010. All relevant data were collected from medical records. Statistical procedures were done using the PASW 18 statistical package. Our study included 104 patients that underwent surgery after forearm nerve injury. The majority of admitted patients were male (n=84; 80.8%) and only 20 (19.2%) were female. Ulnar nerve injury predominated with 70 cases, followed by median nerve with 54 (51.9%) cases and radial nerve with only 5 cases. Transection was the dominant mechanism of injury and it occurred in 84.6% of cases. Injury by a sharp object was the most frequent etiologic factor and it occurred in 62 (59.6%) patients, while traffic accident and gunshot injuries were the least common etiologic factor of forearm nerve injury, occurring in 7 (6.7%) and 6 (5.8%) cases, respectively. Associated injuries of muscles and tendons, bones and blood vessels occurred in 20 (19.2%), 16 (15.4%) and 15 (14.4%) patients, respectively. The etiology and mechanism of peripheral nerve injury are of great importance when choosing the right course of treatment in each individual patient because timing and type of treatment are closely related to these factors.