Tarlov cyst-a rare lesion in children: case report.

Perineural cysts, also known as Tarlov cysts, are benign lesions increasingly found in patients undergoing neuroimaging studies. These cysts can very rarely be identified in children and even then, they are not so likely to be responsible for some neurological deficit. It seems to be of scientific and clinical importance to present a pediatric case with Tarlov cyst. We report a case of a patient, a 7-year-old boy, previously treated for nocturnal enuresis (bedwetting), who later developed signs and symptoms of classic urinary incontinence. Magnetic resonance imaging (MRI) showed a relatively large extradural cyst at the level of S2. The cyst was approached by laminectomy of L5 to S2, excised, and completely removed from the belonging nerve root. The patient has established normal sphincter control without even a single episode of involuntary discharge of urine. A surgery is a powerful, safe, and efficacious option for treatment in pediatric patients with sacral Tarlov cysts.

[Development of new intracranial saccular aneurysms].

Newly formed aneurysms developing from a cerebral vessel which had appeared to be normal in a previous angiographic study are very rare. Four cases of angiographically documented newly developed saccular aneurysms are described in this report. In all four patients, the new aneurysms were symptomatic, causing subarachnoid hemorrhage (SAH). Repeat angiography, performed after the second SAH, revealed new aneurysms that were not demonstrated on initial angiograms after the first SAH. They were clipped with good postoperative course. Our observations and literature data suggest that some patients with SAH need further neuroradiological followup. The presence of the risk factors and age of the patient should be taken into consideration.

[Cerebral vasospasm after subarachnoid hemorrhage].

Cerebral vasospasm causes permanent neurolological deficit or death occurance in 13% of clinical cases. Peak frequency is from 8-10th day after SAH. The purpose of this study is factor analysis that may have influence on vasospasm development , as well as predictor determination. The study is prospective and analysis 192 patients treated in Institute of Neurosurgery, Clinical Centre of Serbia, Belgrade. The majority of patients were admitted in hospital in first four days after SAH, and 184 had GCS over 7. Univariate methods of factor analysis were used, and for significance of predictors influence testing multivariante regression analysis was used. Vasospasm occurred in 22,40% of all cases. No relationships have been found between sex, age, previous hypertension, timing of surgery, appearance of hydrocephalus and intracerebral hematoma, hypertermia or mean arterial blood pressure, with occurrence of cerebral vasospasm. Factors with significantly associated with the occurance of vasospasm were: hearth disease, hypernatriemia, Hct, clinical grade on admission as well as preoperative clinical grade and Fisher CT scan grade. In the first four days after SAH, Fisher scan grade, preoperative clinical grade and Hct, appeared as predictors. After four days, clinical grade on admission and hypernatiemia, showed as poredictors.

[Therapeutic approach to pain syndromes after peripheral nerve injuries]. / Terapijski pristup bolnim sindromima posle povreda perifernih nerava.

There are a variety of reasons that pain might persist beyond the period of normal healing, and usually these reasons are complex and multifactorial. The acute phase of denervation of muscles, especially that of large ones, can be quite painful. Also, during the early months of regenerative process patient may experience associated paresthesias or dysesthesias. Such a pain pattern is selflimited, just as is the regenerative process. Neuropathy is a condition in which pain impulses are generated and perpetuated by injured, malfunctioning nervous tissue itself. Causalgia nad reflex sympathetic dystrophy are terms reserved to describe a very characteristic burning pain, accompanied by hyperesthesia and autonomic disturbances. In this study we analysed a series of 727 patients operated on Institute of neurosurgery with injury of one or more peripheral nerves, and 170 patients with brachial plexus injury.

[Transplantation in peripheral nerve injuries]. / Transplantacija kod povreda perifernih nerava.

Autologous nerve grafting is the most commocommnlynly used operative technique in delayed primary, or secondary nerve repair after the peripheral nerve injuries. The aim of this procedure is to overcome nerve gaps that results from the injury itself, fibrous and elastic retraction forces, resection of the damaged parts of the nerve, position of the articulations and mobilisation of the nerve. In this study we analyse the results of operated patients with transections and lacerations of the peripheral nerves from 1979 to 2000 year. Gunshot injuries have not been analyzed in this study. The majority of the injuries were in the upper extremity (more than 87% of cases). Donor for nerve transplantation had usually been sural nerve, and only occasionally medial cutaneous nerve of the forearm was used. In about 93% of cases we used interfascicular nerve grafting, and cable nerve grafting was performed in the rest of them. Most of the grafts were 1 do 5 cm long (70% of cases). Functional recovery was achieved in more than 86% of cases, which is similar to the results of the other authors. Follow up period was minimum 2 years. We analyzed the influence of different factors on nerve recovery after the operation: patient's age, location and the extent (total or partial) of nerve injury, the length of the nerve graft, type of the nerve, timing of surgery, presence of multiple nerve injuries and associated osseal and soft tissue injuries of the upper and lower extremities.

[Surgical treatment of compressive neuropathies]. / Hirursko lecenje kompresivnih neuropatija.

Nerve entrapment syndromes are, by definition, states of disproportion between the volume of the peripheral nerve and the space through which a nerve in extremities passes. In the Institute of Neurosurgery, Clinical Center of Serbia carpal tunnel syndrome and cubital tunnel syndrome are the most frequent compressive neuropathies, and their frequency in our series is 91%. This study represents comparative analysis of parameters which can influence on surgical treatment of carpal and cubital tunnel syndrome. Analysis was performed on 169 patients operated on because of carpal tunnel syndrome, and 83 patients operated on because of cubital tunnel syndrome by microsurgical procedures such as decompression, transposition, epineurectomy or interfascicular neurolysis, during the period from 1979. up to 2000. Through the comparative and descriptive analysis it was investigated corelation between clinical and electrodiagnostical findings, as well as between results of the surgical treatment with intention of checking of indication for surgical treatment.