Search

Background: Primary central nervous system lymphoma(PCNSL) is an aggressive, rare form of Non-Hodgkin lymphoma, characterized by the absence of systemic disease. There are limited data and no strictly defined guidelines for management of PCNSL., Objective: The aim of this study was to report a 10 year experience of PCNSL treatment, to evaluate treatment outcomes and asses Progression Free and Overall Survival of these patients., Methods: Study was conducted on the Haematology Clinic, Clinical center University of Sarajevo, BH, in the period from January 2012.-December 2022. Total sample of 24 patients were enrolled. All have undergone diagnostic surgery. Patients were treated with regimens based on High dose Methotrexate, with/without whole brain radiotherapy as consolidation. Treatment response was captured by imaging techniques. Patients who have relapsed were evaluated with imaging techniques and treated according to Methotrexate-based treatment protocols., Results: We have captured equal gender distribution. The median age of patients was 59.5 years (range 20-79). Pathohistological analysis confirmed DLBCL diagnosis in 22 patients, T cell lymphoma and anaplastic large cell lymphoma, each in 1 patient. Chemotherapy, chemotherapy combined with WBRT and radiotherapy were given to 5, 18 and 1 patients, respectively. The overall complete response rate (CR) was 87,15%. Those receiving combined modality-treatment had higher CR than those receiving chemotherapy (94,4% versus 60%). Out of 24 patients, 11 of them relapsed. The median time to relapse was 29 months (from 1 to 105). After second line of the treatment, CR was 54,5%, while 45,45% of patients died during the treatment. 4 patients relapsed for the second time with median time to relapse of 9 months (from 2 to 77). 2 year OS rate was 67%, and the median OS rate was 45,9 months. 2 year PFS rate was 31%., Conclusion: The OS and PFS rates indicate the usage of new drugs and consolidation with autologous stem cell transplantation in patients with PCNSL in order to achieve better treatment outcomes., Competing Interests: None to declare., (© 2024 Ajla Nizic, Lejla Ibricevic-Balic, Timur Ceric, Ibrahim Omerhodzic, Lejla Burazerovic, Vasvija Saric, Emina Mameledzija, Berina Hasanefendic.)

Background  Many recent studies show that exoscopes are safe and effective alternatives to operating microscopes (OM). Developments of robotics and automation are present in neurosurgery with the appearance of a newer device such as RoboticScope (RS) exoscope with a digital three-dimensional (3D) image and a head-mounted display. The body of the RS is connected to a six-axis robotic arm that contains two video cameras, and serves as stereovision. This robotic arm allows accurate 3D camera motions over the field of view, giving the user a great degree of freedom in viewpoint selection. The surgeons may specify the direction and speed of the robotic arm using simple head movements when the foot pedal is pressed. Since its development in 2020, the RS has occasionally been used in neurosurgery for a multitude of procedures. Methods  This study showcases vessel microanastomosis training on chicken legs using the RS. The aim of this study is to demonstrate the feasibility of the RS without a comparative analysis of the standard OM. The study was conducted in 2023 during a month-long trial period of the device at the Department of Neurosurgery of the Clinical Center of the University of Sarajevo. All procedures including RS-assisted anastomosis were performed by a neurosurgeon in anastomosis training (A.A.) supervised by a senior vascular neurosurgeon (E.B.). For the purpose of the study, we evaluated occlusion time in minutes, bypass patency with iodine, and overall satisfaction of the trainee in terms of light intensity, precision of automatic focus, mobility of the device, ergonomics, and convenience of the helmet. Results  Ten RS-assisted microanastomoses were performed by interrupted suturing technique with 10.0 nylon thread. Bypass training included seven "end-to-side," two "end-to-end," and one "side-to-side" microanastomoses. The smallest vessel diameter was 1 mm. Occlusion time improved by training from 50 to 24 minutes, with contrast patency of the anastomoses in all cases without notable leakage of the contrast, except one case. Complete satisfaction of the trainee was achieved in 7 out of 10 cases. During this period, we also performed different RS-assisted surgeries including a single indirect bypass, convexity brain tumor resection, and microdiscectomies. Conclusion  RS provides a new concept for microanastomosis training as an alternative or adjunct to the standard microscope. We found a full-time hands-on microsuturing without the need for manual readjustment of the device as an advantage as well as instant depth at automatic zooming and precise transposition of the focus via head movements. However, it takes time to adapt and get used to the digital image. With the evolution of the device helmet's shortcomings, the RS could represent a cutting-edge method in vessel microanastomosis in the future. Nevertheless, this article represents one of the first written reports on microanastomosis training on an animal model with the above-mentioned device., Competing Interests: Conflict of Interest None declared., (Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Introduction: Decompressive craniectomy (DC) can save brain tissue, but unfortunately it has many limitations and complications. Hinge craniotomy (HC), as less aggressive method seems to be adequate alternative not only to DC but also to conservative treatment., Research Question: Presentation of the results of modified surgical techniques of cranial decompression and comparing with more and less aggressive medical options., Material and Methods: A prospective clinical study was conducted during 86 months. Comatose patients who suffered refractory intracranial hypertension (RIH) were treated. Altogether, 137 patients have been evaluated. The final outcome of all patients in the study was evaluated after 6 months., Results: Both surgical options resulted in adequate control of intracranial pressure (ICP). HC method was shown to have the lowest probability of worsening from a prior state of relative stability., Discussion and Conclusion: There was no statistically significant difference between methods to treatment of DC or HC, meaning the final outcome of patients treated in any manner. There was similar rate of early and late complications., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Epilepsy is a brain disorder characterised by unpredictable and excessive nerve cell activity that causes epileptic seizures. Epileptic seizures are more common in children and adolescents than in elderly population. Electroencephalography (EEG) is a diagram of electrical activity of the brain and it is used as a method of choice for diagnosing epilepsy. Despite the accurate EEG tracing of electrical activity in the brain, the disadvantage of this type of analysing is the doctor's skill to read the EEG correctly., Objective: The aim of this study was ro represents further research presented in our pevious works with wavelet based EEG analysis after masuring a multiresolution as relation between time and frequency resolution., Methods: Signal database set consist of 51 patients: a) healthy patient; b) 50 patients with a diagnosis of epilepsy. Additional characteristics of the analysed data: a) 19 signals-channels of EEG, b) Duration - 20 s or 2688 samples and. Nowadays, we can find dozens of EEG signal analysis papers using mathematical approach and with a focus on identification of epilepsy., Results: This paper represents some results relating to the analysis of EEG in children using Wavelet Transform (WT). The signals was collected and analysed at the Department of neuropediatrics, Pediatric Clinic at the University Clinical Center, University of Sarajevo., Conclusion: Using this approach it is possible to clearly differentiate patients with a diagnosis of epilepsy from healthy ones., Competing Interests: None declared., (© 2021 Salko Zahirovic, Samir Avdakovic, Feriha Hadzagic-Catibusic, Nedis Dautbasic, Maja Muftic Dedovic, Enra Suljic, Haso Sefo, Ibrahim Omerhodzic.)

Background: Arteriovenous malformation (bAVM) presents maldevelopment of the brain's vessels with a direct connection between cerebral arteries and veins. By current data, patients from Spetzler Ponce A (SP) are found to benefit from the treatment. Considering the outcome, most of SP C and some of the SP B are the most debatable., Objective: Arteriovenous malformation presents maldevelopment of the brain's vessels with a consequent direct connection between cerebral arteries and veins. The annual risk of hemorrhage in adults is reported for 2-3 %. They usually present with unilateral headaches seizures and intracranial hemorrhage. By current data, patients from Spetzler Ponce A (SP) are found to benefit from the treatment. Considering the outcome, most of SP C and some of the SP B are the most debatable., Methods: The study included a cohort of bAVM patients referred to Fujita Health University Bantane Hotokukai Hospital, Nagoya, Aichi, Japan where the main author (AA) has completed an international cerebrovascular fellowship under the mentorship of Professor Yoko Kato. Japanese Stroke Guidelines (JSG) were used for the treatment decision. Patients were graded according to the Spetzler Ponce (SP) system. Considering American Heart Association criteria (AHA), embolization was used as a part of multimodal treatment. Intraoperative microscopic video tools included Indocyanine green ICG, FLOW 800 and dual image video angiography DIVA. Clinical outcomes were measured using Modified Ranking Score (mRs)., Results: A total of eleven patients with brain bAVM were studied with a median age of 32 years [IQR = 22-52]. There were ten patients presented with supratentorial and a single patient with infratentorial AVM. Patients were graded according to the Spetzler Ponce (SP) system. There were eight patients in SP A (72,7%), one in group B (9 %) while the rest of them were in C (18 %). Two patients had associated aneurysms that required treatment. The median size of the AVM nidus was 3,50 cm [IQR= 2-5]. Deep venous drainage was found in six patients while three were located in eloquent zones. Clinical outcomes were considered good by mRs <2 in eight patients, seven from the surgically treated group (72,7 % respectively). Surgery median length time was 427, 5 minutes; [IQR =320 - 463] with complete AVM resection in all patients and no mortality recorded in this cohort with the median follow up of 39,5 months [IQR = 19-59]., Conclusion: Ideal management of bAVM is still controversial. Those complex vascular lesions require multimodal treatment in a majority of cases in highly specialized centers. In SP A patients, surgery provides the best results with a positive outcome and a small number of complications. With the improvement of endovascular feeder occlusion SP B patients become prone to a more positive outcome. Nowadays, intraoperative microscopic tools such as FLOW 800, ICG and DIVA are irreplaceable while improving safety to deal with bAVM. For SP C patients, a combination of endovascular and stereotactic radiosurgery was found to be a good option in the present time., Competing Interests: The authors declare no conflict of interests., (© 2021 Adi Ahmetspahic,, Eldin Burazerovic, Edin Hajdarpasic, Almir Dzurlic,, Ibrahim Omerhodzic, Haso Sefo, Yoko Kato.)

Purpose: Secondary brain ischaemia (SBI) usually develops after aneurysmal subarachnoid haemorrhage (SAH) and severe traumatic brain injury (TBI). Current approaches to managing these conditions are based either on intracranial pressure-targeted therapy (ICP-targeted) with cerebral microdialysis (CM) monitoring according to the modified Lund concept or cerebral perfusion pressure-targeted therapy (CPP-targeted). We present a prospective, randomised controlled study comparing relative effectiveness of the two management strategies., Methods: Sixty comatose operated patients with SBI following aneurysmal SAH and severe TBI were randomised into ICP-targeted therapy with CM monitoring and CPP-targeted therapy groups. Mortality rates in both groups were calculated and tissue biochemical signs of cerebral ischaemia were analysed using CM. Measured CM data were related to outcome (Glasgow Outcome Scale [GOS] score 1, 2 and 3 for poor outcome or GOS score 4 and 5 for good outcome)., Results: Patients treated with ICP-targeted therapy with CM monitoring had significantly lower mortality rate as compared with those treated with CPP-targeted therapy (P=0.03). Patients monitored with CM who had poor outcome had lower mean values of glucose and higher mean values of glycerol and lactate/pyruvate ratio as compared with those who had good outcome (glucose: P=0.003; glycerol: P=0.02; lactate/pyruvate ratio: P=0.01). There was no difference in the mortality outcome between aneurysmal SAH and severe TBI in the two groups (P=0.28 for ICP-targeted therapy with CM monitoring, P=0.36 for CPP-targeted therapy). Also, there were no differences in the CM values between patients with aneurysmal SAH and severe TBI who underwent ICP-targeted therapy (glucose: P=0.23; glycerol: P=0.41; lactate/pyruvate ratio: P=0.40)., Conclusion: The modified Lund concept, directed at bedside real-time monitoring of brain biochemistry by CM showed better results compared to CPP-targeted therapy in the treatment of comatose patients sustaining SBI after aneurysmal SAH and severe TBI., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Aim: In this paper we discuss the Neurosurgical Training Programme (NTP) in some European countries., Material and Methods: Although there is no official data on how many neurosurgeons are certified in Europe, our calculation shows that this number is somewhat lower than in the United States of America and even 3 times lower than in Japan (per 100.000 population). It is also evident that there is no consensus in the Programme duration or in the official NTP content, despite the recommendations of the EANS (The European Association of Neurosurgical Societies). Trainees from outside the European Union (EU) are under-represented in the EANS training courses. We believe that in the eastern part of Europe there is the most space for improvement in neurosurgical training. Solving of all these problems requires first and foremost their recognition and consideration - then devising a solution., Conclusion: The purpose of this paper is to compare and contrast several NTP's in Europe in order to promote a more coherent medical education. Some remarks and suggestions from the perspective of young neurosurgeons are given.

The perioperative management of a deeply comatose patient (Glasgow Coma Score, GCS 5) following a spontaneous subarachnoid hemorrhage is presented. Six intracranial aneurysms of the anterior circulation were discovered at operation, contrary to angiographic findings. These were successfully clipped by the author (KD). Postoperatively, the patient's cerebral energy metabolism was monitored by bedside cerebral microdialysis in real time. The ICP (volume)-targeted therapy (Lund concept) was utilised in accordance with findings of intrinsic brain biochemistry. Three-month follow-up showed excellent outcome (Glasgow Outcome Score, GOS 5).

Trauma is number one cause of death in young population in Bosnia & Herzegovina. Department of Neurosurgery, Clinical Center Unversity of Sarajevo (CCUS), as a representative of Bosnia & Herzegovina, participated in the International Research-Treat-Traumatic brain injury project over a span of three years with the main objective to save the lives of patients sustained the traumatic brain injury (TBI) and to improve the quality of life of survivors through research in factors determining the outcome and through changing current clinical practices to provide better care. The scores used to measure the compliance to TBI guidelines at individual patient were developed and tested. The scores were successfully tested on all the patients entered into the database. The patients satisfying the selection criteria were only included into this study. The criteria of severe TBI were used according to the National Traumatic Coma Database established in the US: Glasgow Coma Scale (GCS) score of 8 or less following resuscitation, which may include endotracheal intubation; or GCS score deteriorating to 8 or less within 48 hours of injury. The implementation of Scientific Evidence Based Medicine procedures is followed by a research in efficacy of changed medical practice. This was facilitated by developing a guidelines compliance measurement tool, which evaluates how closely the guidelines are followed in the treatment of individual case. When evaluating the compliance and when discussing the guidelines implementation one of the major problems surfaced is lack of financial support. In the future, we should tend to establish the scientifically basis for dissemination of the Scientific Evidence Based knowledge to all Hospitals in Bosnia& Herzegovina which deal with severe TBI patients. The financial obstacles and misunderstanding could be overcome through creation of public awareness campaign. Reducing mortality of TBI patients, who are youngest and most active part of population, must be priority for our whole community.

Distance learning or learning from the distance represents the educative technique with occupies all more significant place in the actual medical education of the healthcare workers at the international plan, specuale in the domains of the postgraduated and continuous medical education. It represents the educative technique of the significant effectivness, wich has to have at the disposal both adequate technological infrastructure as well as the previous education of the lecturer and users, adapted teaching plans and evaluation mechanisms of knowledge. By use of the rich choice of technological models, in relation to the traditional method of learning, enables the simultaneous education to the great number of students of the various profiles, the approach to all the relevant data basis as well as the mechanism of the evaluation knowledge institutions and the lectures.