A brief history of neurosurgery in Bosnia and Herzegovina: historical vignette.

The modern period of neurosurgery in Bosnia and Herzegovina began with the first neurosurgical procedure performed by Dr. Karl Bayer in 1891 on 3 patients with depressed skull fractures and epilepsy. In 1956 the Department of Surgery in Sarajevo designated several beds specifically for a neurosurgical unit. A significant milestone in the history of neurosurgery in Bosnia and Herzegovina was the establishment of the Division of Neurosurgery at the Clinical Center University of Sarajevo in 1970. The first neurosurgeon to complete his training in Bosnia and Herzegovina was Dr. Faruk Konjhodzic. The first female neurosurgeon was Dr. Nermina Iblizovic. Presently, there are 7 neurosurgical departments in the country, located in Sarajevo, Tuzla, Zenica, Mostar, Banja Luka, Bihac, and Foca. The Association of Neurosurgeons in Bosnia and Herzegovina, founded in 2003, is a member of the European Association of Neurosurgical Societies and the World Federation of Neurosurgical Societies. The aim of this historical paper is to provide a concise chronology of important events and mention key individuals who have contributed to the development of modern neurosurgery in Bosnia and Herzegovina.

Diagnosis and Treatment of Pediatric Brain Tumors.

OBJECTIVE: Tumors of the brain and spine make up about 20% of all childhood cancers; they are the second most common form of childhood cancer after leukemia. Brain tumors are the most common solid tumor in children. Symptoms depend on a variety of factors, including location of the tumor, age of child, and rate of tumor growth. The aim of study was to present our experience with the diagnosis and treatment of brain tumors in children. PATIENTS AND METHODS: The aim of this study is to analyze clinicopathological characteristics, treatments, complications, and outcomes in children with brain tumors. This study is a retrospective analysis of 27 consecutive patients younger than 16 years and hospitalized for surgical treatment of brain tumors. Intracranial hypertension, neurological status, radiological computerized tomography (CT) or magnetic resonance imaging (MRI) findings, tumor localization, type of resection, hydrocephalus treatment, histopathology, complications, and outcome were analyzed. RESULTS: Twenty-seven surgeries were performed in patients for brain tumors. There were 9 females and 18 males. The average patient age was 7.8 years. There were 11 (40%) children with astrocytoma; of these, there were 9 (82%) pilocytic astrocytomas and 2 (18%) ordinary histopathological subtypes of high-grade tumors. CONCLUSION: As with any cancer, prognosis and long-term survival vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a brain tumor.

Impact of timing on surgical outcome in patients with cauda equina syndrome caused by lumbar disc herniation.

Aim To analyze the relationship between timing of surgery and outcome in patients with cauda equina syndrome caused by lumbar disc herniation. Methods A retrospective, non-randomized clinical study included 25 consecutive patients with cauda equina syndrome (CES) caused by lumbar disc herniation. All patients were operated within 24 hours after hospitalization at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between January 2000 and December 2010. All patients were evaluated before surgery on the basis of complete history, neurological examination and neuroimaging evaluations using CT (computed tomography)and MRI (magnetic resonance imaging). Results Statistically significant difference between preoperative and postoperative bladder (p=0.05) and bowel (p=0.05) function was found. A significant number of patients had bladder and bowel recovery after surgery, nine (36%) and 11 (44%), respectively. Significant recovery of muscle strength was noted with complete recovery(5/5) in 12 (48%) and partial recovery in 13 (52%) patients. Complete sensory recovery was noted in 16 (64%), incomplete in four (16%), and in five (20%) patients there were no changes. Most commonly, patients with complete sensory recovery were operated within 48 hours of symptom onset. In most patients early surgery was associated with better outcome. Conclusion This research showed that early decompression correlated with better outcome. Patients with cauda equina syndrome must be cleared for surgery in optimal conditions and, if it possible within optimal timing for recovery (within 48 hours).

Impact of Comorbidity on Early Outcome of Patients with Subarachnoid Hemorrhage Caused by Cerebral Aneurysm Rupture.

BACKGROUND: One of the complications aneurysms subarachnoid hemorrhage is the development of vasospasm, which is the leading cause of disability and death from ruptured cerebral aneurysm. AIM: To evaluate the significance of previous comorbidities on early outcome of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm in the prevention of vasospasm. PATIENTS AND METHODS: The study had prospective character in which included 50 patients, whose diagnosed with SAH caused by the rupture of a brain aneurysm in the period from 2011to 2013. Two groups of patients were formed. Group I: patients in addition to the standard initial treatment and "3H therapy" administered nimodipine at a dose of 15-30 mg / kg bw / h (3-10 ml) for the duration of the initial treatment. Group II: patients in addition to the standard initial treatment and "3H therapy" administered with MgSO4 at a dose of 12 grams in 500 ml of 0.9% NaCl / 24 h during the initial treatment. RESULTS: Two-thirds of the patients (68%) from both groups had a good outcome measured with values according to GOS scales, GOS IV and V. The poorer outcome, GOS III had 20% patients, the GOS II was at 2% and GOS I within 10% of patients. If we analyze the impact of comorbidity on the outcome, it shows that there is a significant relationship between the presence of comorbidity and outcomes. The patients without comorbidity (83.30%) had a good outcome (GOS IV and V), the same outcome was observed (59.4%) with comorbidities, which has a statistically significant difference (p = 0.04). Patients without diabetes (32%) had a good outcome (GOS IV and V), while the percentage of patients with diabetes less frequent (2%) with a good outcome, a statistically significant difference (p = 0.009). CONCLUSION: The outcome of treatment 30 days after the subarachnoid hemorrhage analyzed values WFNS and GOS, is not dependent on the method of prevention and treatment of vasospasm. Most concomitant diseases in patients with SAH which, requiring additional treatment measures are arterial hypertension and diabetes mellitus. The best predictors in the initial treatment of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm has the presence of comorbidity, which has statistical significance.

Intracranial meningeoma--ten-year evaluation.

The aim of the study was to analyze the prevalence, occurrence by gender, age, place of residence, location and pathohistological type, focusing on peculiarities of the surgically removed meningiomas in the first post-war decade in Bosnia and Herzegovina. The study was conducted in the region comprising more than 600.000 inhabitants. During the post-war decade 162 patients were surgically treated. Females accounted for 65.4%, convexity meningioma accounted for 43.8%. WHO grade I meningiomas occurred in majority of patients, 60.5%, grade II in 23.5%, and grade III in 16.0% patients. The prevalence of malignant menigeomas was significantly higher in males, 26.8%. Meningiomas were more common during the sixth (33.9%) and seventh (35.2%) decade of life. The somewhat higher prevalence of atypical and malignant meningiomas especially in males requires further analysis that would clarify this phenomenon.

Impact of clinical symptoms on CT ordering policy in minor head injuries.

INTRODUCTION: The aim of our study was to determine the impact of clinical signs and symptoms on CT ordering policy in minor head injuries. PATIENTS AND METHODS: The study encompassed 1830 patients that have sustained minor or mild head injury, as assessed by clinical criteria. Basic clinical variables were recorded and a subset of patients meeting either Canadian or New Orleans criteria were subjected to CT. Outcome in terms of "positive" CT scans and number of patients requiring surgery was recorded. RESULTS: The mean age was 30.4 years (ranging from 10 days to 80 years). 176 patients were subjected to CT scan (based on clinical criteria). CT scan revealed intracranial pathology in 29 patients (16.5% of patients subjected to CT scan) and 19 patients were subsequently subjected to surgery (accounting for 10.8% of patients subjected to CT scan and 1.0% of all patients with mild or minor head injuries). Brain contusions were detected in 10 (5.7%) patients, followed by epidural hematomas (10 patients or 5.7% were found to harbor an epidural hematoma) and subdural hematomas, that were found in 7 patients or 4.0% of patients subjected to CT scan. DISCUSSION: Despite numerous studies that have analyzed the importance of clinical signs and CT in the diagnosis and treatment of minor head injuries, there is still much controversy about the mode of treatment of these patients. Canadian protocol really reduces the need for CT of the brain in relation to the New Orleans protocol, which suggests more observation in hospital patients with minor or mild head injury. CONCLUSION: The authors conclude that minor or mild head injuries should prompt a CT as recommended by Canadian or New Orleans guidelines and that the strongest scientific evidence available at this time would suggest that a CT strategy is a safe way to triage patients for admission.

Intraparenchimal mesencephalic cyst: an unusual location.

OBJECTIVE: Intraparenchimal mesencephalic cyst which occurs in lateral part of the mesencephalon is very unusual. In addition to describe this case, the authors also review other brainstem cysts described in literature and briefly discus concept of their origin. METHODS: We report a patients with cyst in right part of the mesencephalon of a 10-years old girl presenting symptoms of increased intracranial pressure and local compression. We discuss the clinical presentation, radiological investignation, pathological features and surgical treatment options for this lesion. DISCUSSION: First surgical intervention was fenestration cysts, second ventricular-peritoneal shunt and third stereotactic navigation cysto-cysternostomo mesencephalic cyst with ponotocerebelar subarachnoidal space. Biochemical examination showed fluid in cyst and patohistological examination showed fibrilar connective tissue without epithelial cell of the wall cysts. CONCLUSION: Eight years later she is in good condition. Surgical resection or total extirpation cyst like that is not recommended.

[Narrowing of lateral recesus in lumbal column (surgical treatment)]. / Suienje lateralnoga receusa lumbalne kraljesnice (operacijsko lijecenje).

INTRODUCTION: In this study was analyzed 49 persons with lumbar lateral recess stenosis who were treated by operation. Resection articular facets was main principe for decompression root of nerve in lateral recess region. After operation we noticed sings of recovory during next sixth mounts. Many study were wrote results of treatment lumbar spinal stenosis. Results of treatment central, lateral, lateral recess or foramina stenos is, were not announced. In this study we were analyzed intensity recovery neurological sings sixth mounts after operation lumbar lateral recess stenosis. METHODS: Diagnosis was establish after neurological examines, functional X-ray and CT of lumbar spine et electromyography lower extremities. We analyzed, also, and patients opinion about them condition and treatments. RESULTS: It was noticed good recovery of neurogenic claudication, paresthesic and pain in leg. Local pain in lumbar spine and damages sensibilities were significant presents after therapy. It was registered opinion of good recovery in high grade stenosis and stenois associated with disc protrusion. CONCLUSION: Nerve root decompression in stenotic lateral recess of lumbar spine could achieved removing part of hypertrophy artricular facets. Good recovery was achieved after operation and rehabilitations treatment. Some grade disability could stayed because damages snezibilitics and local pain in lumbar spine.