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Introduction/objective: Anaplastic gliomas compromise about 5.9% of primary CNS tumors. The main goal of the operation is the maximum removal of the tumor, reduction of the tumor mass and reduction of the increased intracranial pressure. Different pathohistological subtypes of anaplastic gliomas show significantly different prognosis depending on the applied oncological therapeutic protocol as well as the modality of the applied radiotherapy. Materials and methods: The study was designed as a retrospective, clinical observational study. The study included 34 participants who were diagnosed with anaplastic glioma in the followed time period. Survival rates were calculated based on the localization, modality of therapy and complications. Results: we concluded that 20,4% of anaplastic gliomas were formed by transformation from previously operated lower grade gliomas. The initial sign of the disease is the appearance of epileptic seizures. Anaplastic gliomas most oftenly occur in the frontal region, with a frequency of 47%. The incidence of anaplastic gliomas in the temporal lobe is 23,5%. The length of survival is in relation to the localization of tumor expansion(p Conclusion: The application of different chemotherapy modalities is not significant predictor in the length of survival. The radical nature of the operation has significance in the length of patient survival, which confirms the conclusions of most of the conducted studies cited in oncology textbooks.

Introduction. The spine is involved in less than 1% of all tuberculosis (TB) cases, and it is a very dangerous type of skeletal TB as it can be associated with neurologic deficit and even paraplegia due to compression of adjacent neural structures and significant spinal deformity. The spine TB is one of the most common causes for an angular kyphotic deformity of spine. Patients with 60 or more degree kyphosis at dorsolumbar spine are at great risk to develop late onset neurological deficit and paraplegia due to chronic compression and stretching of the spinal cord over bonny ridges. In small portion of cases other conditions may lead to neurological deficit in patients with long standing angular kyphosis which also alters the treatment strategy that otherwise involves prolonged and mutilant surgery. Case outline. We present a case of a 61-year-old male patient with concomitant 90-degree dorsolumbar spine kyphosis due to spinal TB and ligamentum flavum hypertrophy, which led to spinal canal stenosis with myelopathy and consequent paraplegia. The patient undergoes dorsal decompression with removal of the hypertrophic yellow ligament after which he recovered to the level of walking. Conclusion. Many authors propose guidelines for treatment of spinal TB taking into account the stage of the disease, the age of the patient, the angle of kyphosis, and other factors. We find that the best approach for each patient is personalized medical approach.

Background. Mortality rates following aneurysmal subarachnoid haemorrhage (aSAH) have decreased due to improvements in diagnoses and the management of complications, as well as early obliteration of the aneurysms. Neurogenic pulmonary oedema (NPO) is a clinical syndrome associated with an acute increase in intracranial pressure and a release of catecholamines into the circulation. This study investigated independent predictors of unfavourable outcomes (Glasgow Outcome Scores 1, 2 or 3) in patients with aSAH. Materials and methods. A total of 262 patients with aSAH (162 females) were included in this prospective study. Clinical characteristics were assessed, and electrocardiographic, serum cardiac and inflammatory biomarker measurements were recorded on admission. Outcomes were assessed three months after admission. Univariate and multivariate analyses of these data were used to predict unfavourable outcomes. Results. A total of 156 patients (59.54%) had unfavourable outcomes. Compared to those who had favourable outcomes, patients with unfavourable outcomes were significantly older (54.37 ± 10.56 vs. 49.13 ± 10.77 years; p < 0.001) and had more severe aSAHs (Hunt and Hess grades ≥ 3: 82.7% vs. 39.6%; p < 0.001). Patients with unfavourable outcomes were more likely to have NPO (10.3% vs. 2.8%; p = 0.023), hydrocephalus (34.0% vs. 20.8%; p = 0.02), and aneurysm reruptures (28.2% vs. 3.8%; p < 0.001). Independent predictors of an unfavourable outcome included Hunt and Hess grades ≥ 3 (odds ratio [OR], 4.291; 95% confidence interval [CI], 2.168–8.491; p < 0.001), increased systolic blood pressure on admission (OR, 1.020; 95% CI, 1.002–1.038; p = 0.03), increased heart rate (HR) on admission (OR, 1.024; 95% CI, 1.001–1.048; p = 0.04), and aneurysm rerupture (OR, 4.961; 95% CI, 1.461–16.845; p = 0.01). Conclusions. These findings suggest that aneurysm reruptures, as well as increased blood pressure and HR, are associated with unfavourable outcomes in patients with aSAH.

AIM To analyze the impact of intraoperative neurophysiological monitoring (IONM) on the extent of removal and long-term neurological outcomes in a series of grade II ependymomas. MATERIAL AND METHODS We retrospectively reviewed 88 consecutive patients who underwent surgical resection of an intramedullary spinal cord tumor (IMSCT) at the Clinic of Neurosurgery of the Clinical Center of Serbia in Belgrade between January 2012 and December 2017. In all, 39 patients (25 males and 14 females; mean age 46.16 years) with grade II ependymomas were enrolled in this study; the mean follow-up time was 49.84 months. The modified McCormick Scale (mMCS) was used to assess the short- and long-term outcomes, and the patients were divided into two groups based on whether they underwent IONM. RESULTS The gross-total removal rate was 89.7%, and it was not influenced by use of IONM, location or tumor size. Upon admission,43.2% of the patients were dependent (grades IV and V), while 56.8% were independent (grades I, II and III), according to the mMCS. After 3 months of follow-up, 76.9% of the patients maintained or improved their neurological status, but this percentage was reduced after long-term follow-up. CONCLUSION Total surgical resection with good neurological outcomes can be achieved in the vast majority of patients with grade II ependymomas; it is important to emphasize that the use of IONM allows acceptable extent of resection and provides better results in terms of functional outcomes, with lower morbidity rates. Therefore, no correlation was demonstrated between the decrease in the basal amplitudes of IONM and D-waves and poor neurological outcomes.

Purpose: The aim of this study is to highlight the role of the endoscopic endonasal approach (EEA) in pediatric craniopharyngiomas by reviewing our experience and the key lessons learned from the application of this approach in children. Methods: Between 1998 and 2017, 12 pediatric craniopharyngiomas were treated via EEA at our institution. Demographic data, preoperative assessment, tumor features, surgical results, complications, and recurrences were analyzed. Results: Visual defects were the most frequent presenting sign. Seven craniopharyngiomas were infradiaphragmatic, and five were supradiaphragmatic. The EEA was successfully performed in all cases with no complication related to children’s sinonasal anatomy. Gross total resection (GTR) rate was of 75%. Endocrinological disturbances improved in one case (20%) and worsened in three (60%). New onset of diabetes insipidus was observed in four (36%) children. Visual defect improved in 91% of cases, with no new postoperative deficit. Postoperative cerebrospinal fluid (CSF) leak occurred in one patient (8%). Three patients (27%) experienced tumor regrowth, and one craniopharyngioma recurred (mean follow-up, 78 months). Conclusions: The EEA offers a straight route to the sellar-suprasellar, making it the ideal approach for pediatric infradiaphragmatic craniopharyngiomas. In supradiaphragmatic craniopharyngiomas, the extended EEA provides a clearer and close-up visualization of the tumor-hypothalamus interface, which can grant better results in terms of quality of life. The pediatric skull base anatomy should not represent a contraindication for the endoscopic technique. Larger series encompassing a wider spectrum of pediatric craniopharyngiomas are needed to further support the benefits of this surgical approach.

BACKGROUND: Current treatment protocol for glioblastoma multiforme (GBM) is based on maximal safe resection followed by the Stupp protocol. In Serbia, temozolomide was introduced as adjuvant therapy in 2011. The aims of this study were to confirm the safety and efficacy on overall and progression-free survival of the Stupp protocol and evaluate the influence of prognostic factors in one of the largest series of patients with GBM treated over a 2-year period. METHODS: Between January 2010 and December 2012, 110 patients with newly diagnosed GBM underwent surgical removal at the Neurooncology Department of the Clinic Center of Serbia. Patients were divided into 2 groups according to postoperative treatment. Group A (n= 24 patients), treated before January 2011, received adjuvant standard radiation therapy and carmustine (bis-chloroethyl-nitrosourea), and group B (n= 86 patients), treated after January 2011, received postoperative treatment according to the Stupp protocol. RESULTS: The Stupp protocol had a significant favorable impact on overall survival at 1-year follow-up (79.1% in group B vs. 62.5% in group A; P= 0.016); no differences were noted in regard to progression-free survival. Multivariate analysis identified younger age and gross total resection of tumor as positive prognostic factors. CONCLUSIONS: Adoption of the Stupp protocol had a favorable impact on overall, but not on progression-free, survival rate. Wider surgical resection involving the peritumoral brain zone, as confirmed by univariate and multivariate analysis, represents the most favorable prognostic factor.

Background Primary intraventricular meningiomas (IVMs) make up 0.5%–5% of all intracranial meningiomas and represent one of the most challenging lesions in neurosurgery. Methods Between 1990 and 2013, 42 patients (30 female, 12 male; mean age, 43.6 years) underwent resection of their IVM. The removal was performed by a posterior parietal approach in 19 of the 40 lateral ventricle tumors, and 1 third ventricle meningioma. The transcallosal approach was used for 3 meningiomas, and patients with other lesions underwent temporal (7 cases) and temporoparietal approaches (12 patients), respectively. Results The most common presenting signs were increased intracranial pressure (83.3%), visual impairment (78.6%) and cognitive changes (50%). Forty lesions (95.2%) arose in the lateral ventricles, and 2 (4.8%) in the third ventricle, ranging in size from 3 to 10 cm. Total removal was achieved in 39 cases and the pathology report disclosed World Health Organization grade I lesions in 41 cases. Hydrocephalus, cerebrospinal fluid leakage, and cerebral edema were the postoperative complications (7.15%); 1 patient died of respiratory problems not directly related to surgery. Thirty-five patients (83.3%) showed a 6-month Glasgow Outcome Scale of 5. One patient, who underwent partial resection, presented a recurrence after 1 year that remained stable until last follow-up. Conclusions IVMs usually reach a large size before being diagnosed. Surgical treatment is the most suitable option and total removal should represent the main goal of the procedure. The posterior parietal transulcal approach and the temporoparietal approach are the most common surgical routes used in our series.