Introduction Spinal tumor surgery mandates complete removal with preserved neurological function and stability. Total Laminectomy (TL) provides access but risks complications (pain, deformity) from extensive tissue removal. The safer, tissue-sparing Unilateral Hemilaminectomy (UHL) is limited by concerns about complete resection via its narrower corridor. Research question This study was comparing the clinical and radiological characteristic between unilateral TL and total laminectomy UHL and they clinical outcomes and complications. Material and methods This was a retrospective cohort study comparing UHL and TL for intradural/extradural spinal tumors. We analyzed consecutive patients operated between January 2018 and December 2024, excluding those with confounding factors. Surgical approach was selected based on tumor location and intraoperative needs. Data on patient demographics, pre/postoperative neurological status, surgical parameters, and tumor characteristics were collected. Primary outcomes were postoperative neurological status and complications rate. Statistical analysis compared variables between groups using appropriate tests, with significance at p = 0.05. Results Baseline characteristics were similar between groups, and the overall postoperative complication rate was low (6.3 %) and comparable. The postoperative KPS score between UHL and TL showed improvement, without significant difference between them. Both approaches yielded significant improvements in functional status and neurological recovery from preoperative baselines. Discussion and conclusion Our findings indicate that the tissue-sparing UHL approach can achieve similar functional outcomes and complication rates as TL for similarly sized tumors. This supports UHL as a safe and effective option, although the final surgical approach must remain individualized based on specific tumor complexity and radiological findings.

BACKGROUND White cord syndrome (WCS) is a rare and extremely serious complication that can occur following spinal decompression procedures for severe mostly cervical spinal stenosis. It is often reported immediately after surgery or several hours to days postoperatively and is identified via a diagnosis of exclusion based on new-onset sudden motor weakness after a decompression procedure. OBSERVATIONS The authors report the illustrative case of a 54-year-old female patient with WCS, who was managed with surgical intervention, corticosteroid therapy, and mean arterial blood pressure support. Additionally, the authors systematically reviewed an additional 27 cases of WCS documented in the literature. LESSONS A relatively favorable clinical outcome was observed in this patient following surgical intervention combined with corticosteroid therapy and mean blood pressure support. Currently, there are no established guidelines for the treatment of WCS; however, in any patient experiencing sudden neurological deterioration after cervical spinal decompressive surgery—especially when a known cause is unidentified—WCS should be considered as a potential diagnosis, and prompt treatment should be initiated to attempt to improve outcomes. https://thejns.org/doi/10.3171/CASE25542

Background: Arteriovenous malformation (bAVM) presents maldevelopment of the brain’s vessels with a direct connection between cerebral arteries and veins. By current data, patients from Spetzler Ponce A (SP) are found to benefit from the treatment. Considering the outcome, most of SP C and some of the SP B are the most debatable. Objective: Arteriovenous malformation presents maldevelopment of the brain’s vessels with a consequent direct connection between cerebral arteries and veins. The annual risk of hemorrhage in adults is reported for 2-3 %. They usually present with unilateral headaches seizures and intracranial hemorrhage. By current data, patients from Spetzler Ponce A (SP) are found to benefit from the treatment. Considering the outcome, most of SP C and some of the SP B are the most debatable. Methods: The study included a cohort of bAVM patients referred to Fujita Health University Bantane Hotokukai Hospital, Nagoya, Aichi, Japan where the main author (AA) has completed an international cerebrovascular fellowship under the mentorship of Professor Yoko Kato. Japanese Stroke Guidelines (JSG) were used for the treatment decision. Patients were graded according to the Spetzler Ponce (SP) system. Considering American Heart Association criteria (AHA), embolization was used as a part of multimodal treatment. Intraoperative microscopic video tools included Indocyanine green ICG, FLOW 800 and dual image video angiography DIVA. Clinical outcomes were measured using Modified Ranking Score (mRs). Results: A total of eleven patients with brain bAVM were studied with a median age of 32 years [IQR = 22-52]. There were ten patients presented with supratentorial and a single patient with infratentorial AVM. Patients were graded according to the Spetzler Ponce (SP) system. There were eight patients in SP A (72,7%), one in group B (9 %) while the rest of them were in C (18 %). Two patients had associated aneurysms that required treatment. The median size of the AVM nidus was 3,50 cm [IQR= 2-5]. Deep venous drainage was found in six patients while three were located in eloquent zones. Clinical outcomes were considered good by mRs <2 in eight patients, seven from the surgically treated group (72,7 % respectively). Surgery median length time was 427, 5 minutes; [IQR =320 - 463] with complete AVM resection in all patients and no mortality recorded in this cohort with the median follow up of 39,5 months [IQR = 19-59]. Conclusion: Ideal management of bAVM is still controversial. Those complex vascular lesions require multimodal treatment in a majority of cases in highly specialized centers. In SP A patients, surgery provides the best results with a positive outcome and a small number of complications. With the improvement of endovascular feeder occlusion SP B patients become prone to a more positive outcome. Nowadays, intraoperative microscopic tools such as FLOW 800, ICG and DIVA are irreplaceable while improving safety to deal with bAVM. For SP C patients, a combination of endovascular and stereotactic radiosurgery was found to be a good option in the present time.

Backgroud: Intervertebral disc herniations are caused by rupture of the fibrous ring and migration of one part of the nucleus pulposus towards the spinal canal. The most commonly affected levels are C5-C6 and C6-C7. Surgical treatment of cervicobrachialgia is indicated in the presence of long-term intense pain syndrome with or without radicular sensory-motor deficit and magnetic resonance (MRI) verified disc herniation with a compressive effect. Objective: The most common surgical treatment is anterior lateral microdiscectomy with or without the use of implants. In addition to this method, dorsolateral microsurgical treatment can be used for foraminal hernias. Methods: This retrospective study included 110 (58 / 52.7% male and 52 / 47.3% female) patients with cervical disc herniations who were surgically treated at the Neurosurgery clinic of Clinical Center of Sarajevo University (CCUS) in a five-year period. Stability, postoperative curvature, arthrodesis, implants, and changes in adjacent segments were radiographically analyzed. In the outcome assessment, functional outcome and patient satisfaction were analyzed using the Pain Self-Evaluation Scale (VAS), Prolo functional and economic score, and White’s classification of treatment outcomes. Results: The dominant prevalence of changes was recorded at the levels of C5-C6 (58%) and C4-C5 (28%) with a ventrolateral approach performed in 90% of patients. The largest representation is hard dorsolateral discs (n = 77). In the group of patients with placed implant, hard discs were present in 96 (90%) cases (p <0.001), while soft discs were dominant in patients without implant placement (p <0.001). In the group of subjects with implant, the most common are hard dorsolateral discs and those of mixed localization in 41 of 55 patients (65.5%; p = 0.001). The most common implant is PEEK cage (74.5%). From complications, we had partial vertebral body fractures in 4.5% of patients. Furtehr, the most common are sensory disturbances in 2.73% of respondents. Reduction of symptoms and improvement of preoperative neurological status were observed in over 95% of patients. Conclusion: Surgical treatment of cervical disc herniation is a safe method with a minimal percentage of complications. Microsurgical discectomy significantly contributes to the improvement of the functional status of patients, the reduction of pain, and the improvement of neurological deficit and overall mobility.

Abstract This article reframes the formation of the Ottoman-Habsburg frontier after 1699 in social historical terms. By going beyond diplomatic and military factors, it identifies how the contraction of Ottoman borders affected taxation, landholding, and Muslim-Christian relations in Bosnia. The article argues that peasants in Ottoman Bosnia experienced the mounting pressures of increasing taxation, manipulation over landownership, and religiously inflected hostility, often driven by those Muslim noblemen who tried to capitalize on the destabilizing wake of several wars that the Ottoman Empire fought with the Habsburg, Venetian, and Russian states in the eighteenth century. Through these processes, by the end of the century the meaning of the reaya or raya—an Ottoman term for taxpaying “subjects” that theoretically applied to all denominations, including Muslims—had become synonymous with “Christians,” acquiring a new political significance.

BACKGROUND Migration of distal ventriculoperitoneal (VP) shunt catheter into another body part has been described as a potentially serious surgical complication. We present the first case of sepsis caused by transcardial and pulmonary migration of distal catheter into the heart and pulmonary artery, which was subsequently colonized by Klebsiella pneumoniae. CASE REPORT A 56-year-old men underwent VP shunt insertion for hydrocephalus that developed after the surgery for intracranial meningioma. Three years later, he was admitted to Department for Infectious Diseases due to persistent fever. Klebsiella pneumoniae was isolated from the blood cultures. Computerized tomography (CT) of the thorax showed migration of the distal catheter into the heart and pulmonary artery. The migrated shunt catheter was retrieved without any complication with the assistance of a cardiovascular surgeon; microbiology confirmed that the catheter was colonized with Klebsiella pneumoniae. We decided to delay new VP shunt placement due to positive blood cultures, and 3 weeks after the surgery, patient was without signs of increased intracranial pressure and without any heart problems. CONCLUSION Migration of a distal VP shunt catheter into the heart should be considered in patients with a previously placed VP shunt presenting with cardiopulmonary problems, arrhythmia, and/or fever. Neurosurgeons should be involved as soon as possible, and a multidisciplinary approach is warranted.