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 (p<0.05), combined arterial supply from different basins (p<0.05) with a length <60 mm, venous dilatation present in the drainage vein (p<0.01), and the angle of casting sup-ply arteries in the nidus (p<0.01) carry a risk of repeated bleeding. In the group of patients who had initial hemorrhage, the mean value of the casting angle size was 130°, while in the group that did not have initial bleeding the mean value of the measured angle size was 103.81° with standard deviation of 17.21° (p<0.01). In conclusion, AVMs with deep venous drainage from the carotid and vertebrobasilar basin, the length of the feeding arteries <60 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 in brain blood vessels are expanding bags composed of a neck, body and fundus. Clear visibility of the neck, the position of the aneurysm and surrounding structures are necessary for a ...proper choice of methods for excluding the aneurysm from the circulation. The aim of this study was to evaluate the reliability of spatial reconstruction of blood vessels of the brain based on the original software for 3D reconstruction of the equipment manufacturer and a personal computer model developed earlier in the Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, compared to intraoperative identification of these aneurysms.
This study included 137 patients of both sexes. The presence of an aneurysm was verified by angiographic methods computed tomographic angiography (CTA), multislice computed tomography angiography (MSCTA), magnetic resonance imaging angiography (MRA), or digital subtraction angiography (DSA).
The quality score (0 to 5) for CTA was 3.180 +/- 0.961, MSCTA 4.062 +/- 0.928, and for DSA 4.588 +/- 0.758 (p < 0.01). The results of this study favorite conventional angiography as the gold standard for diagnostic of intracranial aneurysms.
The results of this study are consistent with current publications review and clearly recognize the advantages and disadvantages of diagnostic neuroradiological procedures, with DSA of brain blood vessels as a binding preoperative diagnostic procedure in cases in who it is not possible to clearly visualize the supporting blood vessel and neck of the aneurysm by using the findings of CTA, MRA and MSCTA.
Intraventricular hemorrhage occurs in almost one fifth of prematurely born children. Due to present complications, such as hydrocephalus and neurological deficit, it endangers the child's life, ...therefore there is the need for understanding and prevent risk factors as well as the need for finding most optimal methods of treatment.
The aim of the study was to point out the current therapeutic modalities of the treatment of posthemorrhagic hydrocephalus in prematurely born children.
The study included 60 patients divided into two groups of 30 patients treated at the University Children's Hospital of Belgrade in the period 2003-2008.
Treatment outcome of the control group of patients treated by standard methods was influenced by gestational age (p=0.024), head circumference on birth (p = 0.043), body mass on birth (p = 0.006), Apgar score on birth (p < 0.001), peripartum asphyxia (p < 0.001), cardiorespiratory arrest (p < 0.001), respiratory distress (p = 0.002) and intraventricular hemorrhagic grade (p < 0.001). As statistically significant predictors of the poor treatment outcome of the experimental group of patients treated by using Ommaya reservoir were identified: low body mass on birth (p < 0.05), low Apgar score (p < 0.05), prolonged number of days on assisted ventilation (p < 0.05), presence of peripartum asphyxia (p < 0.05) and cardiorespiratory arrest (p < 0.05).
No statistically significant difference was detected in the outcome between the patients treated by the standard method and those with installed Ommaya reservoir. However, the difference of 10% in mortality between the two groups may be clinically significant so that further studies of larger samples are necessary.
The Pilomyxoid is rare tumor in elderly population, in addition to the occurrence of an isolated lesion in spinal cord is extremely rare in non‐pediatric population. Taking biopsy and subtotal ...resection is the starting point in essential approach for the treatment. After defining the histopathological nature of the tumor and specified that is Pilomyxoid, the next step is the combination of reoperation and adjuvant therapy.
The Pilomyxoid is rare tumor in elderly population, in addition to the occurrence of an isolated lesion in spinal cord is extremely rare in non‐pediatric population. Taking biopsy and subtotal resection is the starting point in essential approach for the treatment. After defining the histopathological nature of the tumor and specified that is Pilomyxoid, the next step is the combination of reoperation and adjuvant therapy.
The use of multidetector computed tomography (MDCT) is an integral part of
contemporary diagnostics of Graves‘ orbitopathy. The aim of this study was to assess proptosis measurement
by MDCT and to ...compare it to the current standard, Hertel exophthalmometry. A cross-sectional
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). There 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.
In spite of the progress made in diagnostic procedures and development of the operating rooms technology, considerable neurological deficit after operation of tumors localised in the brain motor zone ...commits one to direct intraoperative identification of the motor zone. By introducing direct electrocortical stimulation into the routine intraoperative application the primary goal has been achieved -reaching the maximum degree of radicalness of surgical resection while preserving motor centres in the cerebral cortex.
We are hereby demonstrating a series of 60 patients operated for primary brain tumors localised in the area in the front and around the central sulcus. All operations have been performed under the general anesthetics. During the operations the method of direct electrostimulation (ES) was used for the purpose of identifying motor centres.
Intraoperatively a level of subtotal resection was achieved in 22 cases, while radical resection was possible in 38 cases. Significantly higher level of radicalness of surgical resection of the low grade glioma tumor was confirmed statistically in relation to the group of patients with glioblastoma multiforme by applying the ES cortex (p < 0.05). Patients with slow developing brain glioma have statistically considerably higher KI value in relation to the KI values in the group of patients with glioblastoma multiforme (p 0 < 0.01). Difference in the measured values of distance from the coronal suture based on the results of MRI measuring and finding obtained by ES, has shown a statistically considerably higher difference with a glioblastoma multiforme 8.26 +/- 4.288 mm when compared to slowly developing astrocitoma 5.88 +/- 3,080 (p < 0.05).
Electrostimulation of the brain cortex is a safe, simple and precise method for identification of the brain motor zone which enables prevention of additional postoperative deficit and higher level of surgical radicalness.
Introduction. Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal aneurysms are rare, while aneurysms in mirror position are extremely rare. These aneurysms have high ...tendency for rupture (PHASES score is always > 4). In more than a half of the patients with the DACA aneurysm rupture, imaging reveals intracerebral hematoma which is a predictor of poor outcome. Case report. A 49- year-old female patient was treated endovascularly in other institution, due to middle cerebral artery aneurysm (MCA) rupture, when the two small bilateral aneurysms at the distal segments of anterior cerebral artery (ACA) were revealed, left one measuring 4.5 mm and the right one measuring 6 mm in size, with the aneurysmal neck width of 3 mm and 4 mm, respectively. The decision was made by the interventional neuroradiologist only to treat the bleeding MCA aneurysm immediately. The patient was referred to our department six months later, and it was decided to perform microsurgical occlusion of the remaining DACA aneurysms. Unilateral interhemispheric approach was chosen to reach the distal ACAs and aneurysms at pericallosal-callosomarginal junction were clipped and completely excluded from the circulation. Conclusion. Management of DACA aneurysms is a surgical chellenge, even for experienced neurosurgeons. It is controversial whether these should be surgically clipped or coiled endovascularly, especially in cases like this one when a same-stage, endovascular coiling might look like a perfect approach. Surgical treatment should be prompt due to their tendency to early rupture. Careful evaluation for multiplicity is mandatory.
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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 < 0.01) were needed for triggering motor response in case of GBM tumor compared to a slowly growing tumor (low-grade). Patients with low-grade gliomas (LGG) had statistically significantly higher KI values pre- and postoperatively than patients with GBM (p < 0.01). Using electrical stimulation of the cortex, a higher grade of resection of LGG could be achieved as compared with the group presenting with GBM (χ² = 5.281; df = 1; p < 0.05). Our findings and review of the results reported by other authors underline the necessity of routine application of electrical stimulation of the cerebral cortex in order to identify the primary motor field (M1).
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