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.

Objective – This research was undertaken to analyse the clinical characteristics, treatment methods, complications and outcome in paediatric patients with medulloblastomas.  Patients and method – The study comprised a retrospective analysis of 13 consecutive patients younger than 15 years, who were hospitalized for surgical treatment of medulloblastomas. The clinical characteristics, radiology findings on the initial and control CT or NMR images, the localization and size of the tumour, the type of resection, the method of treatment of hydrocephalus, complications and outcome of treatment were analysed.  Results – There were 13 (26%) children with medulloblastomas in the total number analysed of tumours of the posterior fossa. The average age of the patients was 103±45 months. The average size of the medulloblastoma was 39 mm. The most common symptoms and signs were related to increased intracranial hypertension.  Conclusion – The best form of treatment of medulloblastomas is maximum surgical resection with the appropriate use of radiotherapy and/or chemotherapy depending on the age of the child.

Objective – The aim of the study was to analyse the clinico-pathological characteristics, treatment, complications and outcome in paediatric patients with infratentorial ependymomas.  Patients and Methods – A retrospective analysis of 6 patients younger than 15 years and hospitalized for surgical treatment of infratentorial ependymomas was performed. The intracranial hypertension, neurological status, radiological CT or MRI findings, tumours localization, type of resection, hydrocephalus treatment, histopathology, complications and outcome were analysed.  Results – There were 6 (12%) of children with infratentorial ependymomas among the posteror cranial fossa tumours. The average age of the patients was 48±55 months. The average size of ependymomas was 42 mm. The most common neurological signs and symptoms before diagnostic procedures were high intracranial pressure and ataxia.  Conclusion  – The best treatment option for infratentorial ependymomas is surgery with a complete resection whenever possible, followed by radiotherapy and/or chemotherapy taking into consideration the age of the patients and histological characteristics of the tumours.

Trigonocephaly denotes the calvarial deformity caused by premature closure of the metopic suture (metopic synostosis). The frequency of craniosynostosis in general is estimated to be 0.4 per 1000 live births, and trigonocephaly accounts for 5% of all craniostenoses, meaning that this condition is fairly rare. Several studies disclosed that craniosynostosis in twins is a very rare occurrence among craniofacial anomalies. We present a rare case of trigonocephaly in twins where surgery yielded cosmetically satisfactory results.

OBJECTIVE Intraparenchimal mesencephalic cyst which occurs in lateral part of the mesencephalon is very unusual. In addition to describe this case, the authors also review other brainstem cysts described in literature and briefly discus concept of their origin. METHODS We report a patients with cyst in right part of the mesencephalon of a 10-years old girl presenting symptoms of increased intracranial pressure and local compression. We discuss the clinical presentation, radiological investignation, pathological features and surgical treatment options for this lesion. DISCUSSION First surgical intervention was fenestration cysts, second ventricular-peritoneal shunt and third stereotactic navigation cysto-cysternostomo mesencephalic cyst with ponotocerebelar subarachnoidal space. Biochemical examination showed fluid in cyst and patohistological examination showed fibrilar connective tissue without epithelial cell of the wall cysts. CONCLUSION Eight years later she is in good condition. Surgical resection or total extirpation cyst like that is not recommended.

INTRODUCTION In this study was analyzed 49 persons with lumbar lateral recess stenosis who were treated by operation. Resection articular facets was main principe for decompression root of nerve in lateral recess region. After operation we noticed sings of recovory during next sixth mounts. Many study were wrote results of treatment lumbar spinal stenosis. Results of treatment central, lateral, lateral recess or foramina stenos is, were not announced. In this study we were analyzed intensity recovery neurological sings sixth mounts after operation lumbar lateral recess stenosis. METHODS Diagnosis was establish after neurological examines, functional X-ray and CT of lumbar spine et electromyography lower extremities. We analyzed, also, and patients opinion about them condition and treatments. RESULTS It was noticed good recovery of neurogenic claudication, paresthesic and pain in leg. Local pain in lumbar spine and damages sensibilities were significant presents after therapy. It was registered opinion of good recovery in high grade stenosis and stenois associated with disc protrusion. CONCLUSION Nerve root decompression in stenotic lateral recess of lumbar spine could achieved removing part of hypertrophy artricular facets. Good recovery was achieved after operation and rehabilitations treatment. Some grade disability could stayed because damages snezibilitics and local pain in lumbar spine.

Isolated cavernous and venous angiomas are common vascular cerebral malformations but their association is less frequent. Presence of venous angioma enhances the risk of bleeding from cavernous angioma. Also, this association is important for surgical planning. While early extirpation of cavernous angioma is recommended, the associated venous angioma has to be preserved due to the possible venous infarction. We report a case of venous angioma associated with cavernous angioma revealed by magnetic resonance imaging after the administration of contrast material, which was not visualised on unenhanced MRI images. The importance of contrast administration in the diagnosis of venous angioma in a close vicinity of cavernous is emphasised in this report.