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Uvod: Meningiomi predstavljaju oko l5 % svih intrakranijalnih neoplazmi i po pravilu su benigni i ekstraaksijalni tumori, ali uprkos tome u preko 50% slučajeva praćeni su peritumorskim edemom što može uticati na težinu hirurške resekcije i prognozu lečenih pacijenata. Povećana ekspresija faktora angiogeneze, pre svega vaskularnog endotelijalnog faktora rasta (VEGF), značajno je povezana sa hipervaskularizacijom meningioma i peritumorskim edemom, što takođe može uticati na prognozu hirurški lečenih pacijenata. Cilj: Cilj naše prospektivne studije je bio da se ispita uticaj peritumorskog edema i angiogeneze (ekspresije VEGF), mikrovaskularne gustine, i proliferativnog ćelijskog potencijala na prognozu u smislu morbiditeta i postoperativnih komplikacija kod pacijenata operisanih od intrakranijalnih meningioma. Materijal i metode: Kod 78 pacijenata operisanih od intrakranijalnih meningioma supratentorijalne lokalizacije urađena je analiza kliničkih, neuroradioloških, i histopatoloških parametara sa periodom praćenja od najmanje godinu dana. Procena prisustva peritumorskog edema je izvršena na osnovu CT i/ili NMR pregleda i određena kvantitativno merenjem njegove širine izražene u milimetrima (u pravcu najšireg dijametra tumora). Angiogeneza je ispitivana imunohistohemijskom analizom VEGF (stepen imunoekspresije), mikrovaskularne gustine (markiranjem krvnih sudova na CD 34), i proliferativnog potencijala (sa Ki67 u tumorskom tkivu). Rezultati: Utvrđena je značajna korelacija veličine peritumorskog edema (PTE) sa ekspresijom VEGF, svi pacijenti sa velikim PTE (> 40 mm) imali su visok stepen ekspresije VEGF (> 50%). Ishod lečenja je bio značajno bolji kod pacijenata sa niskom ekspresijom VEGF (p<0.05). Sve zabeležene postoperativne komplikacije imale su veću učestalost u grupi sa PTE. Dužina lečenja u jedinici intenzivne nege u grupi sa PTE (prosečno: 6.85 dana) je bila značajno veća nego u grupi bez PTE (prosečno: 3.68 dana; p=0.03). U grupi pacijenata bez PTE ishod lečen, Introduction: Meningiomas represent about 15% of all intracranial neoplasms, and are generally extra-axial and benign, but in more than 50% are accompanied by PTE which can increase the difficulty of surgical resection and affect the prognosis after surgical treatment. Increased expression of vascular endothelial growth factor (VEGF) plays significant role in meningioma hypervascularity and PTE genesis that also influences the prognosis in surgically treated patients. Aim: The aim of our study was to investigate the influence of peritumoral edema and angiogenesis (VEGF expression), microvascular density, and proliferative cell potential on prognosis in aspect of morbidity and postoperative complications after intracranial meningioma surgery. Material and methods: The analysis of clinical, neuroradiological, and histological data, with follow-up period of at least one year, of 78 microsurgically treated patients with intracranial supratentorial meningioma was performed. Presence or absence of PTE was examined on preoperative CT scan or MRI, and width of PTE was measured in millimeters (in direction of maximal tumor diameter). Angiogenesis was evaluated by imunohistochemical analyses for detection of VEGF (level of imunoexpression), microvascular density (by marking blood vessels on CD34), and proliferative potential detection (with Ki-67 antigen in tumor tissue). Results: Severity of peritumoral edema (PTE) showed significant correlation with VEGF expression, and all patients with large PTE (> 40 mm) had high level of VEGF expression (> 50%). Treatment outcome was significantly better in patients with low VEGF expression (p<0.05). All of the monitored postoperative complications were more frequent in the group with PTE. Duration of intensive care treatment in the group with PTE (mean: 6.85 days) was significantly longer than in the group without PTE (mean: 3.68 days; p=0.03). In the group without PTE, treatment outcome was significantly better than in patients with P

Uvod. Cilj ovog istraživanja je da se identifikuje najsvrsishodniji način hirurškog lečenja hidrocefalusa kod prevremeno rođene dece koji je uzrokovan spontanom intraventrikularnom hemoragijom i identifikuju prediktorni faktori lošeg perioperativnog ishoda. Metodologija. Prikazujemo seriju od 60 pacijenata sa spontanom intraventrikularnom hemoragijom (IVH) i hidrocefalusom, kojima je plasiran ventrikuloperitonealni (VP) šant ili subkutani (Omaya) rezervoar, u Univerzitetskoj Dečijoj klinici u Beogradu u periodu od marta 2006 godine do marta 2011 godine . Rezultati. Prediktori lošeg ishoda lečenja pri plasiranju VP šanta su : gestacijska starost (t=2,323; p=0,024), obim glave na rođenju(t=2,072; p=0,043), porođajna telesna masa (t=2,832; p=0,006), APGAR skor na rođenju(t=5,026; p<0,01), broj dana na asistiranoj ventilaciji (Z=6,203; p<0,001), peripartalna asfiksija (χ2=17,376; p<0,01), respiratorni distres (χ2 =9,176; p=0,002). Prediktori lošeg ishoda lečenja pri plasiranju Omaya rezervoara su: niska porođajna telesna masa (t=2,560; p=0,016), nizak apgar skor (t=3,059; p =0,005), produžen broj dana na asistiranoj ventilaciji (Z=4,404; p<0,001), prisustvo peripartalne asfiksije (χ2=9,977; p=0,002) i kardio-respiratorni arest (χ2=12,804; p<0,001). Zaključak. Ishod lečenja hidrocefalusa uzrokovanog spontanom intraventrikularnom hemoragijom kod prevremeno rođene dece je najlošiji u perinatologiji. Nema konsenzusa u dijagnostici i lečenju postehmoragičkog hidrocefalusa, naši rezultati ukazuju da je glavni prediktorni faktor preoperativno stanje deteta i da su VP šant i Omaya razervoar komplementarne metode hirurškog lečenja., Object. The aim of this study was to identify the most appropriate method of surgical treatment of hydrocephalus in preterm infants that is caused by spontaneous intraventricular hemorrhage, and to identify predictive factors of poor perioperative outcomes. Methods. We present a series of 60 patients with spontaneous intraventricular hemorrhage (IVH) and hydrocephalus, to whom a VP shunt was placed, or subcutaneous (Omaya) reservoir, at the University Children's Hospital in Belgrade during the period from March 2006 to March 2011. Results. Predictors of poor outcome with VP shunt placement were: gestational age (t=2.323, p=0.024), head circumference at birth (t=2.072, p=0.043), birth weight (t=2.832, p=0.006), APGAR score at birth (t=5.026, p<0.01), number of days on assisted ventilation (Z=6.203, p <0.001), peripartal asphyxia (χ2 =17.376, p<0.01), respiratory distress (χ2=9.176 p=0.002). Predictors of poor outcome in getting Omaya reservoir are: low birth weight (t=2.560, p=0.016), low Apgar scores (t=3.059, p=0.005), an extended number of days on assisted ventilation (Z=4.404, p<0.001), presence of peripartal asphyxia (χ2=9.977, p=0.002) and cardio-respiratory arrest (χ2=12.804, p<0.001). Conclusions. The outcome of treatment of hydrocephalus caused by spontaneous intraventricular hemorrhage in premature born children is the worst in perinatology. There is no consensus in the diagnosis and treatment of posthemorrhagic hydrocephalus, our results suggest that the main predictive factor is preoperative condition of the child and that the VP shunt and Omaya reservoir are complementary methods of surgical treatment.