OBJECTIVE Tumors of the brain and spine make up about 20% of all childhood cancers; they are the second most common form of childhood cancer after leukemia. Brain tumors are the most common solid tumor in children. Symptoms depend on a variety of factors, including location of the tumor, age of child, and rate of tumor growth. The aim of study was to present our experience with the diagnosis and treatment of brain tumors in children. PATIENTS AND METHODS The aim of this study is to analyze clinicopathological characteristics, treatments, complications, and outcomes in children with brain tumors. This study is a retrospective analysis of 27 consecutive patients younger than 16 years and hospitalized for surgical treatment of brain tumors. Intracranial hypertension, neurological status, radiological computerized tomography (CT) or magnetic resonance imaging (MRI) findings, tumor localization, type of resection, hydrocephalus treatment, histopathology, complications, and outcome were analyzed. RESULTS Twenty-seven surgeries were performed in patients for brain tumors. There were 9 females and 18 males. The average patient age was 7.8 years. There were 11 (40%) children with astrocytoma; of these, there were 9 (82%) pilocytic astrocytomas and 2 (18%) ordinary histopathological subtypes of high-grade tumors. CONCLUSION As with any cancer, prognosis and long-term survival vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a brain tumor.

Marinacci anastomosis, also known as Ulnar-Median anastomosis, is an anastomosis in which the branch anastomotic originates proximally in the ulnar nerve and unites distally with the median nerve. A purpose of this study was to determine the incidence and  the characteristics of Marinacci anastomosis in the Bosnian population. The 60 anterior forearms of fresh frozen adult cadavers were dissected in the Department of Pathology,  University Clinical Centre Tuzla and the morgue of Tuzla during a time period of two years. The Marinacci anastomosis was evidenced in one male forearm in the right side behind the ulnar artery, following an transversal course of 5.2 cm until its connection with the median nerve in only one branch. The incidence of Marinacci anastomosis was 1.67%. Since this anastomosis can expalin some cases where injuries in the forearm nerves are not reflected in the hand muscles, it is important to study. Our study contributes to a limited research on the Marinacci anastomosis, a condition that is rarely found and reported in anatomical research.

Myopericytoma is a benign tumor with the most common presentation as a well-circumscribed, slow-growing mass. It is frequently misdiagnosed as a sarcoma. We presented a 23-year-old patient with a history of a sciatic pain of the right leg. A careful physical examination discovered tumor-like mass in the posterior part of the thigh. Neurological finding showed a reduction of myotatic reflexes on the right leg with a weaker muscle strength on the right leg. The right leg musculature was slightly hypotrophic in the range of 2-3 cm comparing to left leg. Initially electrophysiological and radiological diagnostic with magnetic resonance imaging (MRI) of the lumbar spine, pelvis and thighs were normal. Magnetic resonance imaging of the right thigh discovered a slow growing 2.1 × 3.8 cm sized mass that was initially described by radiologist as a neurinoma. Patient was admitted to department of neurosurgery and operated on for a tumor removal. Tumor was located intimately to femur and sciatic nerve and after careful dissection completely removed. Patient was doing well after surgery and discharge after three days from the hospital. In the postoperative period the symptoms disappeared. Histopathology showed a myopericitoma. Postoperative MRI after three months of follow up showed no tumor residues, and after 6 and 12 months there was no tumor recurrence. Myopericytoma behave in a benign fashion, but, because local recurrences and rarely metastases may occur in atypical and malignant neoplasms, a careful follow-up after radical resection is recommended.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome with seizures, altered consciousness, visual disturbances and headache among other symptoms. Hinchey et al. first described Pres in 1996, with two other case series published shortly after. CASE REPORT: A 23-year-old women patient was emergency sent from General Hospital Tešanj due to a crisis of consciousness and repeated epileptic seizures. The patient had a second birth before 10 days (postpartum cesarean) in general endotracheal anaesthesia (two cesarean-born babies). On magnetic resonance imaging (MRI) of cranium described both sides of the symmetrically frontal, parietal (and pre-ventricular gyri) and occipitally visible T2W/FLAIR hyperintensity focuses on the cortex and the thin layer of white mass subcortically. In the projection of the lesions parts, discrete DWI hyperintensity is seen without a reliable ADC correlate. The patient improved after management with intravenous fluids, antibiotics, antiepileptics and monitoring of blood pressure. According to latest experiences delayed diagnosis and treatment may lead to mortality or irreversible neurological deficit. Aggravating circumstances are differential diagnoses that include cerebral infarction (ischemic, haemorrhage), venous thrombosis, vasculitis, pontine or extrapontine myelinolysis. CONCLUSION: MRI of the brain is key to make this distinction with crucial recognition and an open mind from radiology and neurology specialist.

Entrapment neuropathy of the deep peroneal nerve, also recognized as anterior tibial nerve, typically occurs at the anterior ankle and dorsal foot.

ABSTRACT The aim: of this study was to compare two methods of polypropylene mesh fixation for inguinal hernia repair according to Lichtenstein using fibrin glue and suture fixation. Material and Methods: The study included 60 patients with unilateral inguinal hernia, divided into two groups of 30 patients – Suture fixation and fibrin glue fixation. All patients were analyzed according to: age, gender, body mass index (BMI), indication for surgery–the type, localization and size of the hernia, preoperative level of pain and the type of surgery. Overall postoperative complications and the patient’s ability to return to regular activities were followed for 3 months. Results and discussion: Statistically significant difference in the duration of surgery, pain intensity and complications (p<0.05) were verified between method A, the group of patients whose inguinal hernia was repaired using polypropylene mesh–fibrin glue and method B, where inguinal hernia was repaired with polypropylene mesh using suture fixation. Given the clinical research, this systematic review of existing results on the comparative effectiveness, will help in making important medical decisions about options for surgical treatment of inguinal hernia. Conclusions: The results of this study may impact decision making process for recommendations of methods of treatment by professional associations, making appropriate decisions on hospital procurement of materials, as well as coverage of health funds and insurance.

Objective – The aim of this case report is to present the results of surgical treatment of a patient with the pineal germinoma. Case report – A 12-year-old patient presented with two months history of headache, nausea, and vomiting, following by neuro-ophthalmologic disturbances (Parinaud syndrome). Computed tomography of the head showed a 3 cm mass in the pineal region, followed by obstructive hydrocephalus, and magnetic resonance imaging showed a pineal gland lesion with heterogeneous enhancement on contrast studies, with surrounding peritumoral edema, suggesting pineal germinoma. The patient underwent surgery to place a ventricular-peritoneal shunt, and second surgery using the occipital interhemispheric transtentorial approach to remove the tumor totally. Conclusion – Pineal germinomas that compress adjacent structures result in a typical clinical syndrome with endocrine malfunction, hydrocephalus or neuro-ophthalmological disturbances. A multimodality approach, including chemotherapy, radiotherapy and surgery, can offer excellent chances of free survival, and even cure.

Objective – To analyze the clinical and histological characteristics, as well as to evaluate the results of surgical treatment of pediatric neuroepithelial tumors. Patients and methods – A retrospective study was conducted, including 40 pediatric patients surgically treated at the Clinic of Neurosurgery, University Clinical Hospital Tuzla in the period 2002-2012. During the study we formed groups and the analysis was conducted by age, gender, clinical signs, histopathologic types and type of surgical treatment. The results are presented in tables and expressed by relative values. Results – Neuroepithlial tumors are more common in male patients. There was no statistically significant difference in distribution of neuroepithelial tumors (I‡2=0.400; p=0.527) related to supratentorial and infratentorial localization. Infratentorial neuroepithelial tumors are most common at a younger age (F=6.516; p=0.015). Increased intracranial pressure and seizures are the most common initial presentation of neuroepithelial tumors (I‡2=0.022; p=0.882). There was no statistically significant difference between types of surgical resection and localization of the tumor. Usually we performed total resection (I‡2=0.246; p=0.620). There was a statistically significant difference in tumor grade regarding supratentorial and infratentorial localizations (p=0.013). Infratentorial tumors are higher grade (I‡2=5.495; p=0.019). Conclusion – The most common initial presentations of neuroepithelial tumors are increased intracranial pressure and seizures. Infratentorial tumors are higher grade. The most common initial treatment of neuroepithelial tumors is radical surgical resection.

Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate.Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system.Results: Significant difference was observed only 1 minute after extubation (p=0,025) finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046). In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008). Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference.Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost.

Introduction: There is no simple answer to the question as to when the brain function is back to normal after anaesthesia. Research done so far has identified different factors influencing the rate of cognitive function recovery and type of anaesthetic as one of those factors.Methods: This study encountered 90 patients hospitalized in neurosurgical department of University Clinical Centre Tuzla in period from October 2011 to may 2012 year. Aim of the study was to compare influence of three different anesthetics (propofol, isofl urane and sevofl urane) on recovery rate of cognitive performance 1, 5 and 10 minutes following extubation. Assessment of cognitive functions was preformed using the short Orientation-Memory-Concentration (OMC) Test. All patients included in the study underwent lumbar microdiscectomy surgery and were allocated to one of three groups: propofol, sevoflurane and isoflurane.Results: Trough comparison of OMC test values there is obvious superiority in recovery of cognitive functions between propofol group and inhaled anesthetic group, after 1 minute (p = 0.008) and after 5 minutes (p =0.009). Comparison of propofol and isoflurane anesthesia shows significantly faster recovery of cognitive performance in propofol group (after 1 minute p = 0.002, 5 minutes p = 0.004, 10 minutes p = 0.038). Faster recovery of cognitive function is present in sevoflurane compared to isoflurane group only 1 minute after extubation p = 0.049.Conclusions: Fastest recovery of cognitive performance appears after propofol anesthesia, than follows sevofl urane based anesthesia and after that isoflurane anesthesia.

Background: Recognition that total laminectomy may perpetuate or cause segmental instability heralded the introduction of less invasive techniques of decompression in lumbar spinal stenosis surgery. Aim : It was our aim to compare formal laminectomy and minimally invasive decompressive procedures in terms of safety and clinical outcome, specifically in respect to the development of postoperative spinal instability. Methods: A retrospective analysis of medical records for 73 patients operated on for lumbar spinal stenosis (22 patients after laminectomy and 51 patients after minimally invasive decompression), with available follow-up data was performed. Basic variables were analyzed in respect to clinical outcome and in regard to development of radiological instability. Results: Radiologic instability was present in 27,3% of patients after laminectomy, as compared to only 2,0% after laminotomy (p<0,001). Regression analysis identified presence of preoperative slip (p=0,0056) and type of surgery (p=0,0204) as sole predictors of instability after surgery. Clinical outcome analysis (laminectomy vs. laminotomy) revealed favorable outcome in both treatment groups, although significantly in favor of the laminotomy group (VAS p= 0,013 and RM p=0,031). Finally, difference in outcome was affected by weather radiologic instability was present or not (p=0,04 and p=0,09 for difference in outcome graded by VAS and RM values respectively) Conclusion: Our results suggest that laminectomy is associated with prohibitively high incidence of postoperative radiologic instability when compared to minimally invasive decompression techniques. Furthermore, radiological instability translates to worse clinical outcome. Finally, patients undergoing laminectomy experience less favorable clinical outcome when compared to those undergoing minimally invasive decompression surgeries.

The aim of the study was to analyze the prevalence, occurrence by gender, age, place of residence, location and pathohistological type, focusing on peculiarities of the surgically removed meningiomas in the first post-war decade in Bosnia and Herzegovina. The study was conducted in the region comprising more than 600.000 inhabitants. During the post-war decade 162 patients were surgically treated. Females accounted for 65.4%, convexity meningioma accounted for 43.8%. WHO grade I meningiomas occurred in majority of patients, 60.5%, grade II in 23.5%, and grade III in 16.0% patients. The prevalence of malignant menigeomas was significantly higher in males, 26.8%. Meningiomas were more common during the sixth (33.9%) and seventh (35.2%) decade of life. The somewhat higher prevalence of atypical and malignant meningiomas especially in males requires further analysis that would clarify this phenomenon.

Introduction: Craniocerebral injury is a leading cause of mortality and morbidity among predominantly young population. Outcome prediction after head injury can be useful as an aid to clinical decision making, to explore possible pathological mechanisms and as part of the clinical audit process. Many studies have constructed predictive models for survival after traumatic brain injury, but these have often used expensive, time consuming or highly specialized measurements. The aim of this study was to develop a simple, yet easy to use, model involving only variables which are rapidly and easily clinically achievable in routine practice. Patients and methods: All consecutive patients older than 14 years with moderate or severe isolated head injury admitted to our department in period between 01.01.2007. and 30.06.2008. were enrolled in the study. Basic demographic and clinical data (Glasgow coma score, pupil size and reactivity, revised trauma score) were recorded. Outcome at 1 and 3 months after injury graded by GOS was used to construct a simple predictive model. Results: We analyzed records 82 patients with moderate or severe head injury according to GCS. Multiple logistic regression resulted in a model containing age (p=0.0001 ), GCS (p < 0.0001), systolic blood pressure of the RTS (p < 0.0001; t=7.388) and pupil reactivity (p < 0.0001; t=-5.605) at admission as fair independent outcome predictors, with motor component of the GCS scale exhibiting greater predictive value over the entire GCS score (p < 0.0001; t=5.732). Conclusion: All four variables have previously been shown to be related to survival. All variables in the model are clinically simple and easy to measure rapidly resulting in a model that is clinically useful.