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Vasospasm is the principal cause of a poor outcome in patients with SAH. The aim of the study is to establish the effect of the therapeutic modalities on vasospasm, to establish morbidity and mortality of patients with SAH, as well as the causes of the poor outcome. The study is prospective and analyzes 192 patients treated at C ward of the INH KCS. Vasospasm incidence was 22.40%. Therapeutic modalities depended on prescribed quantities of colloid solutions and MgSO4 solution. Differences in the vasospasm incidence between the groups were not significant, the reason probably being that the maximal doses of colloid solutions were prescribed mostly to the higher graded patients. In patients who received MgSO4 vasospasm was less frequent, but not statistically significant (11.11% vs. 23.56%) Of 192 patients, 78.1% completely recovered, 9.9% had a certain degree of invalidity, and 12.0% did not survive. The most frequent cause of death was vasospasm (41.67%) and then general medical complications (20.93%).

Besides current development of the new diagnostic procedures conventional angiography still represents the golden standard in the diagnosing of intracranial aneurysms. Since it gives a two-dimensional image if the presentation of the third dimension is wanted it is necessary to apply appropriate algorithm structures and computers. In this study we show our experience in the application of space reconstruction of blood vessels and aneurysms of the vertebrobasilary confluence in 6 patients operated at the Institute for Neurosurgery, Clinical Center of Serbia. Intraoperative finding in all patients matched the finding that we got by space reconstruction of the blood vessels, which was possible to observe from different angles. Postoperative course in all patients was satisfying. Upon discharge the patients were without rough lateralization of the pyramidal system. Our initial results and their practical agreement with the interoperative finding give us right to recommend this method as the standard for the preoperative diagnostic protocol.

Aneurysms on cerebral blood vessels due to their localization, size, relationship with neurovascular structures, even today, represent besides the constant progress of the diagnostic techniques and instruments in the operating theaters, a great therapeutic challenge. Gigantic aneurysms, aneurysms localized within the cavernous sinus and aneurysms of the vertebrobasilary confluence carry a great perioperative risk of mortality and morbidity. In fact, development of the endovascular procedures for the occlusion of their lumen made possible great progress in the treatment of aneurysms of this localization. In a not so small number of cases endovascular procedure means remodeling of the lumen of the main blood vessel. Endovascular obliteration of aneurysms has a certain advantage as regards the surgical treatment of aneurysms in which, on the basis of the expected natural course and presumed operative risk, may be judged that there exists unacceptably great operative risk. We present a personal series and results in 6 patients with aneurysms of various localizations.

Arteriovenous cerebral malformations represent congenital malformations. Considering the anatomical characteristics of the cerebral angiomas and their localization, in a great number of cases they demand a combined therapeutic approach - surgery,. embolization and radiotherapy. Besides the constant progress of technology, 5% of all cerebral angiomas can not be completely excluded from the circulation. Therefore, the need to understand their natural course became a necessity. Our results point to the fact that they are vascular malformations of a considerably more benign clinical course than the aneurysms. Our clinical model points to an annual risk of hemorrhage which is 3.3% with total mortality of 5.3%, especially if the size of the angioma is 2.5-5 cm, localized in the motor zone of the brain, with combined type of vein drainage and arterial supply from the vertebrobasilary confluence. Epilepsy caused by the cerebral angioma is in 26.7% refractory to medicamentous therapy and in 25% (every 4th patient) will have hemorrhage with an annual risk of 0.14%.

Since Dandy first reported vascular compression of the trigeminal nerve, the concept of neurovascular compression syndrome for trigeminal neuralgia and hemifacial spasm (HFS) has been accepted, and neurovascular decompression has been performed for this condition. The further investigations indicated that some other clinical syndromes such as glossopharyngeal neuralgia, disabling positional vertigo, tinnitus, geniculate neuarlgia, spasmodic torticolis, essential hypertension, cyclic oculomotor spasm with paresis and superior oblique myokymia also may be initiated by vascular compression of the glosopharyngeal, cochleovestibular, intermediate, accessory, oculomotor and trochlear nerves or the ventrolateral medulla oblongata. In this study several hypotheses regarding the development of cranial nerves vascular compression syndromes are presented. It is also emphasized the value of high-resolution magnetic resonance tomographic angiography for visualization of vascular compression. The most frequent clinical syndromes caused by vascular compression of the cranial nerves are discussed regarding the pathogenesis, symptoms and therapy. We present our series of 124 patients with preoperative evidently positive finding of vascular compression to the trigeminal nerve (MRI). Microvascular decompression (MVD)was performed in all of them. Initial postoperative result was excellent in 110/124 (89%) patients, while in 11/124 (9%) patients the pain relief was satisfactory. In the remaining three patients MVD failed. Recurrence of pain after two years reached 19 %. Complications were related to diplopia associated with transient fourth nerve dysfunction in 5 (4%) patients, facial motor dysfunction in 4 (3%) patients, transient facial hypesthesia in 27 (22%) patients and partially hearing loss in 4 (3%) patients. Cerebellar hemorrhagic infarction occurred in 1 ( 0,8 %) patient and cerebrospinal fluid leaks appeared in two (1,6%) cases. There was no lethal outcome.

Haemorrhage is most important sequelae of brain cavernoma, so the surgical treatment is very important for treatment that complication. There are two types of bleeding - chronic subclinical microhaemorrhage and acute real hemorrhage. Patophisiologycal factors which are reasponsible for bleeding are not still understanding. The reason for this study is understanding of clinical curse of cavernomas and identification of factors of influence. This is retrospective and prospective study. We analyzed 36 patients with symptomatic brain cavernoma, surgically treated in Institute of neurosurgery KCS in 10 years period (1987-1997). Female were dominant but without statistical significance (p>0,05). Male patients were older (32,1:29,8), but without statistical significance (p>0,05). Almost 75% lesions were supratentorial, 25% infratentorial (p0,05). Clinical presentation according the age was not statistically significant (p>0,05). Clinical presentation was very different according the size of lesion (p

There have been 34 patients with spontaneous intracerebral haematomas (ICH) operated, from the 1st January 2002. Yr to the 31st December 2002. Yr., at the Neurosurgical Department of Trauma Centre (Clinical Centre of Serbia). They all were with the serious disturbance of consciousness. For all these patients, indication for operation was established according to CT findings, state of consciousness, defined Glasgow Coma Score (GCS) and neurological state. Due to the established incarceration or its risk, none of these patients had angiography, so preoperatively we didn't know the reason of bleeding. From 34 operated patients, 22 or 64.7% died and 12 or 35.3% survived. There were 14 patients in the deepest state of coma, where preoperatively GCS score was 3 to 5. Only one patient age 25 survived postoperatively. Other survivors have less disturbed state of consciousness, CT findings without intraventricular bleeding and were also in younger age group.

From January 1st to August 31st 2002 yr., Neurosurgical department of the Trauma Center, Clinical Center of Serbia, has operated 43 patients with posttraumatic intracerebral haemathoma (PTIH). From that number, 9 patients survived and 34 died. Only 4 patients with acute PTIH were in terminal state of incarceration and in spite they were operated immediately, all died. Other 39 patients have delayed PTIH where secondary CT cerebral scans showed the development of posttraumatic intracerebral haematoma that has not been verified at the incipient scanner. Indication for repeated CT scan was found for 19 patients for their focal or general neurological deterioration. 20 patients had no delayed neurological disturbances. Survivers were younger, in lower grade of coma and were mostly with temporal localization of haemathoma.

Newly formed aneurysms developing from a cerebral vessel which had appeared to be normal in a previous angiographic study are very rare. Four cases of angiographically documented newly developed saccular aneurysms are described in this report. In all four patients, the new aneurysms were symptomatic, causing subarachnoid hemorrhage (SAH). Repeat angiography, performed after the second SAH, revealed new aneurysms that were not demonstrated on initial angiograms after the first SAH. They were clipped with good postoperative course. Our observations and literature data suggest that some patients with SAH need further neuroradiological followup. The presence of the risk factors and age of the patient should be taken into consideration.

The aim of this study is to present the principal clinical manifestations and neurosurgical results of the treatment of patients with supratentorial cavernoma and epilepsy. The retrospective study included 14 patients with supratentorial lesion on MRI and CT scan of the brain that manifested with epileptic seizures. All patients were surgically treated and pathophysiologic evaluation in all patients confirmed that cavernoma was in question. Results were analyzed and compared with data from the literature. Epileptic seizures are the most frequent clinical manifestation found in supratentorial cavernoma and neurosurgical treatment gives excellent result as regards the control of epilepsy, with a very low incidence of morbidity and mortality. A complete resection of all cavernomas in this study was confirmed by postoperative neurosurgical diagnosing. 12 patients did not have any more epi seizures in the postoperative period, and in 2 patients we found decrease in the occurrence of epi seizures.

Aneurysmal subarachnoid hemorrhage (SAH) is a dramatic, frequently fatal event. With the incidence of 10 to 15 in 100 000 and a total mortality which even today is 40-50%, it represents a significant problem. Early surgical care for the hemorrhaging aneurysms has, without doubt, an importance in prevention of the rupture, however different series show different results as regards surgical timing and they are very different as regards giving advantage to the early or delayed time of the operation. Our aim was to perceive the results of the treatment in our group of 197 consequently operated patients for ruptured aneurysms with a special attention to the time of operation. This was a prospective clinical study and it was carried out at the Institute for Neurosurgery in Belgrade. Mortality of the operative treatment was a total of 15.74% in the entire group. According to operative intervals from the early to the delayed mortality the range is 35.71%, 22.22%, 11.63% and 8.88% respectively. The results of the treatment are in direct connection with the seriousness of the clinical picture. Being in the group graded from 1-3 decreases the probability of a fatal outcome, and graded from 1-2 decreases probability of morbidity. Early operated patients who in our group included also the most serious cases, life endangered ones, although with higher mortality do not have higher morbidity.

Results of our series of 10 operated patients who had cavernous malformation of the brain stem, in accordance with the findings of other authors, have confirmed that surgical removal of cavernomas is an absolutely appropriate approach as regards the prevention of repeated and disabling hemorrhages, also from the point of view of the recovery of the neurological deficit. In patients with disturbed vital functions (breathing, swallowing) evacuation of hematomas and removal of the malformation eliminate life endangering compressive effect on the vital structures of the brain stem. It is not disputable that patients with superficially localized cavernomas and progressing neurological deficit should be subjected to surgical treatment. In cases of deep lying lesions that are covered by a considerable layer of nervous parenchyma, it is indispensable to have a very careful preoperative planning of a safe entry into the brain stem, without damage to the vital functional structures. In case of a complete neurological recovery after a single hemorrhagic episode, the decision to perform surgery is delicate and demands individual appraisal of each patient. As regards the procedure with incidentally found and clinically asymptomatic lesions, regardless of the MR-signs of hemorrhage in the form of the hemosiderin ring around the lesion, we support the view of those authors who think that such lesions should not be operated but should be subjected to clinical treatment and MR with periodical MR check-ups.

Spontaneous intracerebral haemorrhage is a common cause of stroke especially in the young. The term "spontaneous intracerebral haemorrhage" refers to bleeding without coincident trauma. About 80% of this haemorrhage occur supratentorial in the basal nuclei and they are associated with hypertension. Etiological factors range from congenital vascular malformations (aneurysmas, AVM, cavernomas) to acquired and degenerative vascular and brain conditions. In primary intracerebral hemorrhage arterial hypertension and consequent vascular changes are the major etiological factors. In secondary- nonhypertensive hemorrhage cause may be associated with aneurysms, AVM, tumors, coagulation disorders. Contemporary diagnosis imaging (CT, MRI) and neurological evaluation, allow early diagnosis and effective medical and/or surgical therapy in a majority patients. Without treatment, the risk of mortality and morbidity is high. Medical management involves normalization of blood pressure, reduction of intracranial pressure, control of brain edema and prevention of seizures. In design for operative treatment must be include age of the patient, hematoma size and location, clinical condition, the level of consciousness and patient outcome. The role of surgery remains controversial.

Vertebrobazilar aneurysms make about 15% of all intracranial aneurysms, from which one fifth belongs to aneurysms a. posterior inferior cerebelli (PICA). Majority of PICA aneurysms is located in the place of separation from a. vertebralis. Aneurysms of distal part of PICA are very rare, according to literature they make 0.5 to 3% of all aneurysms. 70 years old man came to neurologist because sudden headache, pain in the neck and a feeling of stiffness followed by throwing up in stream. On the occasion of medical check up attack of spontaneous subarachnoid hemorhage was suspected. Clinical gradus according to H&H III, initial CT of endocranium showed existence of smaller intracerebellar hematoma next to lateral wall of IV ventricle and trace of blood in the very ventricle without signs of acute hydrocephalus. The seventh day after the hemorrhage angio CT was done and it showed existence of aneurysm on distal part of PICA, more specially in the televelotonzilar segment on the right. After the diagnostics supplemented with standard digital substractional angiography which confirmed nature and localization of the lesion. In the postponed procedure, and in conformity with strategy of surgical timing of aneurysms in the back circulation, patient was operated three weeks after the attack of hemorrhage. Disregarding low incidence of existence of aneurysms of distal circulation (under 1% of all in the back circulation) high level of suspicion should be present and angio CT should be done as screening method, if CT shows hemorrhage which according to localization responses to possible aneurysm.

In the period from 01.01.2000 until 31.12.2002 34 patients with spontaneous intracerebral hematoma (ICH) and with deeply disturbed state of consciousness were operated in the Department of neurosurgery of the Urgent Center, Clinical Center of Serbia. In all operated patients the indication for surgery was given on the basis of CT scan of the brain, state of consciousness, defined Glasgow coma score (GCS) and neurological status, but due to existing or threatening incarceration not even one patient was submitted to angiography of the blood vessels at the cerebral base, thus preoperatively we did not know the cause of the hemorrhage. Of 34 operated patients 22 or 64.7% died, and 12 or 35.3% survived. 14 patients were in the deepest phase of coma, where the preoperative GCS is from 3 to 5 points, and in the postoperative course only one survived, aged 25. The other survivors had somewhat less disturbed state of consciousness, they also were younger, CT scan of the brain was without blood in the chamber system. In the same period, in the Department of Neurosurgery of the Urgent Center, Clinical Center of Serbia 43 patients with traumatic intracerebral hematoma (TIH) were operated; 9 patients survived, 34 died. Only 4 patients had acute TIH. All of them were in the terminal stage of incarceration, and despite being immediately submitted to surgery all of them died. The remaining 39 patients had, the so called delayed TIH where the secondary CT scan of the brain showed development of the traumatic intracerebral haematoma that was not verified on the incipient scanner. Indication for a repeated CT scan was given in 19 patients due to focal or general neurological deterioration. However in 20 patients subsequent neurological disturbances were not registered. Those that survived were younger patients, and they were not in the deepest stage of coma, most often they had a temporal localization of hematoma.

In past, cavernoma was frequently cause of symptomatic epilepsy without pathological substrate. We present the group of the patient (32) whose illness were presented by epilepsy, and who were treated in Institute for Neurosurgery from 1998 to 2003. There is the good correlation between presentation of epilepsy and largeness of the cavernoma (Phi 0.683). In 22 patients the epilepsy was controlled by medicaments, and in other the seizures were uncontrolled. Cavernoma initially presented with seizures had no inclination for massive intralesional or parenhimal bleeding. After surgical extirpation of lesion, there was good outcome during the following period of 3 years.

Anatomical localization of skull base meningioma link, their growth and relations with neurovascular structures reduce possibility for radical operation, and often request additional preoperative or postoperative radiotherapy. We compared personal results of extent surgical resection and skull base meningioma treating outcome with predispose factors scale for surgical radicality and postoperative outcome. We present 42 patients, who were operated in Institute of neurosurgery CCS during the period from 2004 to 2006. RESULTS: Radical resection was possible in 29 cases, and in 13 cases reduction of tumor mass has been performed. Statistical significant predispose factor for radical resection were: absence of preoperative radiotherapy, intact functions of n.III, n.VI, tumor borders inside one skull base fossa and outside of magistral blood vessels. Karnofsky index at the end of following period statistical significant higher in patients with radical resection of skull base meningeioma. Preoperative radiological finding is significant guide in planning of therapeutic protocol for skull base meningioma. Growth of tumor and relation with neurovascular structures restrict extent of resection and often request additional postoperative radiotherapy or reoperation. .