Introduction: Aim of this study is to analyze gender-related epidemiological characteristics of cauda equina syndrome (CES) in Zenica-Doboj Canton in 10 years period. Methods: The study was conducted in the Zenica-Doboj Canton, and data were obtained from the time period between 2012 to 2022. The study included a total sample of 1709 patients diagnosed with disc herniation who underwent surgical decompression. In total, 48 patients developed cauda equine syndrome (CES). Results: The analysis unveiled noteworthy gender disparities, with male predominance (79.2% vs. 20.8%, p<0.001) and varying employment distributions (males: 23.7% unemployed, 63.2% employed, 13.1% retired; females: 40.0% unemployed, 20.0% employed, 40.0% retired, p<0.001). The calculated OR for 2012-2022 was 2.969 (95% CI: 1.576-5.593, p=xxx), signifying a substantial gender-incidence relationship for CES. CES-I incidence ranged 0.80-1.60/100,000 and CES-R ranged 0.25-0.83/100,000. Highest CES incidence was 4.17/100,000 (2015); the lowest was in 2019 with no CES-R cases reported. Male incidence peaked at 2.64/100,000 (2018), and the lowest was 1.06/100,000 (2013, 2017). For females, the highest was 1.17/100,000 (2018, 2021), with no cases reported in certain years. The affected level demonstrated gender differences, with L4/L5 prevalence in males (47.4%) and L3/L4 in females (50%, p=0.165). Conclusion: This study revealed a higher incidence of CES in males compared to females in the Zenica-Doboj Canton. The heterogenicity of data regarding CES occurring due to the lumbar disc herniation is significant. This indicates a clear need for additional research and epidemiological studies that would highlight the population of patients that have higher risk of CES onset.

Lumbar disc herniation (LDH) often results in significant pain and disability, and histopathologic evaluation of intervertebral discs offers critical insights into treatment outcomes. This prospective observational study explores histopathologic (HP) changes in intervertebral discs (IVD) and their association with clinical outcomes following surgical treatment for lumbar disc herniation (LDH). A cohort of 141 patients undergoing magnetic resonance imaging (MRI)-confirmed LDH surgery underwent HP evaluation using a semi-quantitative Histopathologic Degeneration Score (HDS). Preoperatively and at a six-month follow-up, comprehensive clinical assessment included the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), with a minimal clinically important difference (MCID) calculated from ODI and VAS. Results indicated significant associations between higher HDS and adverse clinical outcomes, including persistent pain and greater disability post-surgery. Specifically, HDS ≥ 7 was predictive (OR = 6.25, 95%CI: 2.56-15.23) of disability outcomes measured with MCID-ODI (AUC: 0.692, 95%CI: 0.609-0.767, P < 0.001), and HDS ≥ 8 was predictive (OR = 1.72, 95%CI: 1.04-2.77) of persistent pain measured with MCID-VAS (AUC: 0.628, 95%CI: 0.598-0.737, P = 0.008), highlighting the diagnostic potential of HDS in assessing postoperative recovery. This study underscores the potential of HP evaluation using HDS to provide valuable insights into disease progression and outcomes in LDH patients, complementing conventional radiologic methods. The findings support the application of personalized treatment strategies based on HP findings while acknowledging challenges in interpretation and clinical implementation.

Simple Summary This study explores hypoxia-inducible factors (HIFs) in glioblastoma development, progression, and treatment. Reviewing 104 relevant studies, it highlights diverse global contributions, with China leading at 23.1%. The most productive year was 2019, contributing 11.5% of the studies. Key factors studied included HIF1α, HIF2α, osteopontin, and cavolin-1, involving pathways such as GLUT1, GLUT3, VEGF, PI3K-Akt-mTOR, and ROS. HIF expression correlates with glioblastoma progression, survival, neovascularization, glucose metabolism, migration, and invasion. Overcoming treatment resistance and the lack of biomarkers is crucial for integrating HIF-related therapies into glioblastoma treatment to improve patient outcomes. Abstract Background: The study aims to investigate the role of hypoxia-inducible factors (HIFs) in the development, progression, and therapeutic potential of glioblastomas. Methodology: The study, following PRISMA guidelines, systematically examined hypoxia and HIFs in glioblastoma using MEDLINE (PubMed), Web of Science, and Scopus. A total of 104 relevant studies underwent data extraction. Results: Among the 104 studies, global contributions were diverse, with China leading at 23.1%. The most productive year was 2019, accounting for 11.5%. Hypoxia-inducible factor 1 alpha (HIF1α) was frequently studied, followed by hypoxia-inducible factor 2 alpha (HIF2α), osteopontin, and cavolin-1. Commonly associated factors and pathways include glucose transporter 1 (GLUT1) and glucose transporter 3 (GLUT3) receptors, vascular endothelial growth factor (VEGF), phosphoinositide 3-kinase (PI3K)-Akt-mechanistic target of rapamycin (mTOR) pathway, and reactive oxygen species (ROS). HIF expression correlates with various glioblastoma hallmarks, including progression, survival, neovascularization, glucose metabolism, migration, and invasion. Conclusion: Overcoming challenges such as treatment resistance and the absence of biomarkers is critical for the effective integration of HIF-related therapies into the treatment of glioblastoma with the aim of optimizing patient outcomes.

The topic of this research, chronic subdural hematoma (CSH), is one of the most common pathologies in neurosurgery, and it is more frequent in the elderly. Surgical evacuation has been widely considered the gold standard treatment. Despite the excellent outcomes, sometimes some cases require a different approach. The treatment choice depends on the general condition of the patients, as well as the clinical presentation and hematoma volume. Also, preexisting comorbidities in elderly patients, postoperative complications, and the ability to recover must be considered. Consequently, conservative treatment can be effective in carefully selected cases, and can be considered if the patient's neurological and physical conditions allow. Some drugs contribute to CSH resolution by changing the capsule membrane permeability and inhibiting the fibrinolytic and inflammatory systems. Our work is based on the efficacy of dexamethasone as a method of conservative therapy, and it was demonstrated in the case of a 91-year-old patient.

This study explores the anatomical relationship between iliac blood vessels and the lower lumbar spine during supine and prone patient positions. The average height of participants was 174.02 cm ± 9.01, while the average weight was 80.38 kg ± 13.48. Body mass index (BMI) analyses showed differences (p = 0.002), with 34.7% classified as normal weight, 53.1% as overweight, and 12.2% as moderately obese. The study examined the distances between iliac arteries and veins in relation to intervertebral anterior and posterior disc contours. Patient positioning significantly affected these measurements at both L4/L5 and L5/S1 levels. The findings highlight the critical influence of body position on anatomical relationships in the context of lower lumbar spine surgery. The study underscores the importance of preoperative awareness of vascular anatomy to prevent iatrogenic lesions during spine surgery, contributing valuable insights for optimizing surgical approaches and minimizing complications in spine surgery, particularly microdiscectomy.

Aim To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration. Methods The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI≥25 and control group with BMI<25. Results Among 69 patients with herniated IVD, 26 (37.7%) were with BMI≥25 (study group), and 43 (62.3%) were with BMI<25 (controls). The study group displayed substantial increase in height, 1.80±0.06 m compared to controls, 1.74±0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60±10.22 vs. 67.37±9.20 kg, BMI: 28±2 vs. 22±2; p<0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p<0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p<0.05), and positive correlations were found between BMI and these alterations found in the herniated discs (p<0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p<0.001) and weight (R=0.696; p<0.001). Conclusion The study's findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the importance of weight management in preventing disc degeneration.

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.

Aim To investigate the correlations between tumour characteristics, symptoms, intraoperative findings, and outcomes in patient with meningioma. Methods A retrospective study was conducted on 86 surgically treated patients at Department of Neurosurgery of Cantonal Hospital Zenica from 2010 to 2020. Patients with intracranial meningiomas underwent neurological evaluation and MRI scans to analyse tumour characteristics, including volume (TV), peritumoral brain oedema (PTBE) and oedema index (EI). Surgical treatment was performed, followed by postoperative MRI and outcome assessment. Intraoperatively, the tumour's relationship with cortex, pial membrane, skull bones, and sinuses was evaluated, and the extent of tumour resection was graded. Meningioma samples underwent histopathological analysis to assess the grade and regularity of borders, and Ki-67 labelling index was determined using immunohistochemistry. Results Significant correlations were found between PTBE and Ki67 expression (p<0.001), PTBE and vomiting/nausea (p=0.002), cognitive impairment (p=0.047), venous compression (p=0.001), cortical, pial and dural invasion (p<0.05), and the postoperative presence of oedema (p=0.002). Venous compression, cortical, pial, dural and bone invasion positively correlated with Ki-67 expression (p<0.001). Grade and tumour border positively correlated with Ki-67 expression (p<0.001). Oedema persistence postoperatively showed a positive correlation with Ki-67 expression (p<0.001). Conclusion The study revealed significant correlations between Ki-67 expression and PTBE, with notable associations with clinical symptoms, tumour characteristics, and postoperative oedema presence.

This scoping review examines the use of CRISPR/Cas9 gene editing in glioblastoma (GBM), a predominant and aggressive brain tumor. Categorizing gene targets into distinct groups, this review explores their roles in cell cycle regulation, microenvironmental dynamics, interphase processes, and therapy resistance reduction. The complexity of CRISPR-Cas9 applications in GBM research is highlighted, providing unique insights into apoptosis, cell proliferation, and immune responses within the tumor microenvironment. The studies challenge conventional perspectives on specific genes, emphasizing the potential therapeutic implications of manipulating key molecular players in cell cycle dynamics. Exploring CRISPR/Cas9 gene therapy in GBMs yields significant insights into the regulation of cellular processes, spanning cell interphase, renewal, and migration. Researchers, by precisely targeting specific genes, uncover the molecular orchestration governing cell proliferation, growth, and differentiation during critical phases of the cell cycle. The findings underscore the potential of CRISPR/Cas9 technology in unraveling the complex dynamics of the GBM microenvironment, offering promising avenues for targeted therapies to curb GBM growth. This review also outlines studies addressing therapy resistance in GBM, employing CRISPR/Cas9 to target genes associated with chemotherapy resistance, showcasing its transformative potential in effective GBM treatments.