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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 kyphosis angle ≥ 60° 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 a small number 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° dorsolumbar spine kyphosis due to spinal TB and ligamentum flavum hypertrophy which led to spinal canal stenosis with myelopathy, and consequent paraplegia. The patient underwent dorsal decompression with hypertrophic yellow ligament removal 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 personalized medical approach is the best approach for each patient.

Introduction/Objective. Pseudoprogression represents an enlarging contrast-enhancing lesion that occurs after chemoradiation and stabilizes with time without any changes in the therapeutic procedure. This phenomenon is highly significant, because it can have influence on further therapeutic procedures; however, precise criteria for pseudoprogression diagnosis have not yet been defined. The main goal of this study is to examine the endothelial hyperplasia influence on pseudoprogression. Methods. We analyzed a group of 106 patients with glioblastoma who had undergone surgical treatment from 2010–2012, at the Clinic of Neurosurgery, Clinical Center of Serbia, who received Stupp protocol. Pre- and post-treatment imaging was evaluated using RANO criteria. Lesions that improved or stabilized were defined as pseudoprogression, and lesions that progressed were defined as true progression. Endothelial hyperplasia was identified based on the hematoxylin and eosin pathohistological examination. Results. Thirty-two (30.2%) of the patients were diagnosed with pseudoprogression. Endothelial hyperplasia was observed in 51 (48.1%) of glioblastoma tissue samples, and 28 (87.5%) of all the patients with pseudoprogression were found to have endothelial hyperplasia. The group of 51 (68.9%) patients without pseudoprogression did not show the presence of endothelial hyperplasia. Statistical analysis showed significantly higher incidence of pseudoprogression in patients with endothelial hyperplasia. (χ2 = 26.269, p < 0.01) Conclusion. Taking into account that there are no precise diagnostic methods that could determine the presence of endothelial hyperplasia with certainty, it could be an indicator, as a pathohistological entity, of a higher likelihood of pseudoprogression, which could be used in everyday clinical practice. In order to reach definite conclusions, we believe it is necessary to conduct prospective controlled studies with larger sample sizes.

Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent.

ABSTRACT: Carotid-cavernous fistulas (CCF) are vascular malformations characterized by an aberrant shunt between one or more sources of arterial inflow and the cavernous sinus (CS). They are subdivided into direct and indirect fistulas. This last one, called dural CCF involve dural fistulous connections between branches of the internal carotid artery or the external carotid artery. When conventional routes are not eligible, surgical exposure of the vein is the only access to the fistula. We present the case of a patient successfully treated for right sided dural CCF, by a hybrid approach. Furthermore, through a literature review, we analyze the possible risks and benefits associated with this approach.