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 Konjhodžić. The first female neurosurgeon was Dr. Nermina Iblizović. Presently, there are 7 neurosurgical departments in the country, located in Sarajevo, Tuzla, Zenica, Mostar, Banja Luka, Bihać, and Foča. 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.

Introduction: Meningiomas are the most common benign tumor of the central nervous system, accounting for 53.3% and 37.6% of all central nervous system tumors (1). The World Health Organization (WHO) Grade I meningiomas account for 80.5% of all meningiomas and are considered benign meningiomas; the WHO Grade II meningiomas account for 17.7% of all meningiomas and exhibit more aggressive behavior. Methods: In the period 2015-2022, a retrospective single-center study at the clinic of neurosurgery at the Clinical Center University of Sarajevo was conducted, which included patients with a pathohistological finding of WHO Grade I or II meningioma. Depending on the pathohistological grade of the tumor, patients were divided into two groups: Grade I and Grade II patients. Patients were examined clinically and radiologically. Clinical data collected included in the study: Gender, age, number of symptoms before surgery, whether patients were symptomatic or asymptomatic, pre-operative Eastern Cooperative Oncology Group,and Karnopsky performance scale. Pre-operative contrast magnetic resonance imaging of the head measured tumor volume, temporal muscle thickness (TMT), sagittal midline shift, and surrounding cerebral edema. Results: A total of 80 patients were enrolled in the study, 68 with WHO Grade I and 12 with WHO Grade II meningiomas. We found that patients with Grade I meningioma were younger and that the mean thickness of the temporal muscle was statistically thicker than in patients with Grade II. Increasing TMT was significantly and positively associated with Grade I tumors and negatively associated with Grade II tumors (p = 0.032). Conclusion: This study demonstrates that TMT can serve as a radiologic pre-operative indicator of meningioma grade and provide valuable guidance to neurosurgeons in surgical planning. Further studies are needed to validate these results.

Background: The organizational climate is defined as the perception of events within the work environment (relationships, values, actions) among organization members that are psychologically meaningful. It also includes the influence of the surroundings on employee motivation and behavior. This concept is studied within the field of industrial and organizational psychology, particularly focusing on healthcare institutions. Objective: The study aims to explain the concept, definition, and history of organizational climate, with a specific focus on healthcare institutions. It also aims to examine the factors influencing the work environment and the extent to which they can improve it. Methods: The research utilizes both quantitative and qualitative methods. The quantitative approach is presented through a non-standardized survey method. Qualitative research was conducted using case studies of healthcare institutions in Sarajevo Canton. The integration of these methods allowed for a comprehensive examination of the organizational climate. Results: The survey provided detailed insights into the organizational climate within healthcare institutions in Sarajevo Canton. It identified key factors that influence the work environment and highlighted areas for potential improvement. Discussion: The findings underscore the importance of strategic management of human resources and potential in creating a positive organizational climate. The study suggests that improving organizational climate is a long-term, multi-layered process involving doctors, managers, and all organizational members working towards common goals. Further research is needed to explore specific interventions that can enhance organizational climate in healthcare settings. Conclusion: This underscores the need for healthcare institutions to focus on fostering a supportive organizational climate and nurturing positive interpersonal interactions to enhance overall job satisfaction among employees.

Aim To investigate the serum value of brain derived neurotrophic factor (BDNF), proteins S-100, NSE, IL-6 in normal pressure patients (NPH) compared to control (healthy) group and also a possible correlation with radiological findings in NPH patients. Methods Study patients were included during the period of 2020- 2022. All NPH patients met the diagnostic criteria for probability of NPH. Control patients group included patients without known brain disorder, without clinical symptoms of NPH. Blood samples were taken before planned surgery for NPH. BDNF serum concentrations were assessed by a sensitive ELISA kit, and serum concentrations of S-100, NSE and IL-6 were assessed by using ECLIA technology for immunoassay detection. Results Among 15 patients who were included, seven NPH patients were compared to eight control patients. Non-significant decrease in BDNF serum concentrations, an increase of protein S-100 serum concentrations, a decrease of NSE serum concentrations, as well as an increase of IL-6 serum concentrations in NPH patients compared to healthy controls was found. Strong positive correlation between BNDF and Evans index was observed (p=0.0295). Conclusion We did not find a significant difference of BDNF, protein S-100, IL-6 and NSE between serum concentration in NPH and healthy patients. More future research is needed to find the role of BDNF in NPH patients.

Abstract Background  The initial clinical status after aneurysm rupture, whether primary or secondary, determines the final outcome. The most common cause of patient deterioration is a high Hunt and Hess (HH) score, which correlates closely with a high mortality rate. Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is determined as an HH score 4 or 5. The aim of this study was to evaluate the clinical characteristics of poor graded aneurysmal SAH at our institution. Patients and Methods  During the 5-year period, 415 patients with intracranial aneurysm were admitted to our institution. Patients with poor-grade aneurysmal SAH accounted 31.08% ( n  = 132) of the total number of ruptured aneurysms. Interventional treatment was predominantly in the form of surgery, whereas conservative treatment included medication and external ventricular drainage. Final outcome was assessed with a modified Rankin score (mRs). Statistical analysis was performed using SPSS version 23.0 with a significance level set to 5% (α = 0.05). Results  The majority of patients (57.6%) were in the age range from 51 to 69 years. Twenty-five patients (18.9%) had an HH score of 4, whereas 107 patients (81.1%) had an HH score of 5. Depending on the location, the majority of patients ( n  = 43) had an aneurysm on the medial cerebral artery (MCA). The final aneurysm occlusion was performed in 71 patients, of whom 94.36% were treated surgically. A positive outcome (mRs 0–4) was found in 49.25% of patients who underwent primarily surgical, treatment with a mortality of 42.3%. Although the outcome was better in patients with an HH score 4, both groups benefited from surgical treatment. Conclusion  Poor-grade aneurismal SAH is a condition of the middle and older age, with most patients with an HH 5 score and deep comatose state. There was better outcome in patients with an HH score of 4 compared to an HH score of 5 and both groups benefited from surgical treatment, which resulted in a positive outcome in almost 50% of surgically treated patients.

BACKGROUND: Tumors of the central nervous system comprise a wide range of over 100 histological distinct subtypes with different descriptive epidemiology, clinical features, treatments, and outcomes. The presence of isocitrate dehydrogenase gene mutation 1 (IDH1) has become one of the most critical biomarkers for molecular classification and prognosis in adult diffuse gliomas. About 65–90% of patients with adult diffuse gliomas have seizures as their initial symptoms. AIM: The objective of this study was to determine the association between IDH1 mutations in adult diffuse gliomas with an incidence of symptomatic epilepsy. METHODS: The study was conducted as an observational, cross-sectional, and prospective clinically controlled study at the Clinic of Neurosurgery of the Clinical Center of the University of Sarajevo. The research included a total of 100 patients treated at the Clinic of Neurosurgery, with pathohistological confirmation of glioma Grades II–IV who were stratified by groups according to tumor grade. Data were collected on tumor localization and grade, the presence of IDH mutations, and the presence of epileptic seizures as the first symptom of the glioma. RESULTS: Out of a total of 100 patients, 39 had IDH 1 mutations, while 61 patients were without them: Of these, diffuse astrocytoma Grade II 30 cases (30%), Grade III 5 (5%), and Grade IV 7 (7%), and the number of patients with glioblastoma was 58 (58%). In the group of patients with IDH 1 mutations, epileptic seizures were present in 87.2% compared to the group of patients without IDH 1 mutations (wild type) in which epileptic seizures were present in 16.4% of cases. Statistical analysis showed that the positive mutated IDH-type carries an almost 70% increase in the likelihood of epileptic seizures (χ2 = 8.378; p = 0.0001). If we separate the group of diffuse astrocytomas in the IDH 1-positive subgroup, 34 patients (85.81%) had epileptic seizures, while in the IDH 1-negative subgroup, there were no patients with epileptic seizures, which carries a statistically significant difference in frequency in favor of IDH 1-positive tumors (p ≤ 0.001). CONCLUSION: There is a clear connection between the presence of IDH1 mutations and the occurrence of epileptic seizures in the clinical picture of patients with diffuse adult glioma.