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The use of multidetector computed tomography (MDCT) is an integral part of contemporary diagnostics of Graves‘ orbitopathy. Th e aim of this study was to assess proptosis measurement by MDCT and to compare it to the current standard, Hertel exophthalmometry. A crosssectional study was conducted at the Clinical Centre of Serbia and included 91 patients (19 male and 72 female) with verified Graves‘ orbitopathy. Globe protrusion measured by MDCT (globe protrusion, GPR) was correlated to Hertel measured protrusion (HR). Th ere was no constant or any systematic bias between the two methods. GPR significantly correlated with the best-corrected visual acuity, while HR did not. Age, body mass index and duration of the disease did not influence proptosis measurement by either method. Proptosis was significantly larger in males. According to our results, GPR compared to HR provides better assessment of the protrusion in Graves‘ disease. GPR measurement is simple and should always be part of the radiological assessment of orbits in Graves‘ disease., Korištenje multidetektorske kompjutorizirane tomografije (MDCT) je sastavni dio suvremene dijagnostike Gravesove orbitopatije. Cilj ovoga istraživanja bio je ispitati mjerenje stupnja protruzije bulbusa pomoću MDCT i to usporediti s trenutnim standardom, Hertelovom egzoftalmometrijom. Presječno istraživanje je provedeno na Kliničkom centru Srbije, a uključilo je 91 bolesnika (19 muškaraca i 72 žene) s provjerenom Gravesovom orbitopatijom. Stupanj protruzije bulbusa mjeren pomoću MDCT (globe protrusion, GPR) je povezan s izmjerenim stupnjem protruzije bulbusa prema Hertelu (HR). Nije bilo stalne ili sustavne pristranosti između dviju metoda. GPR je bio značajno povezan s najbolje korigiranom oštrinom vida, a HR nije. Dob, indeks tjelesne mase i trajanje bolesti ne utječu na mjerenje stupnja protruzije bulbusa bilo kojim postupkom. Stupanj protruzije bulbusa bio je značajno veći u muškaraca. Prema našim rezultatima, GPR u odnosu na HR omogućuje bolju procjenu stupnja protruzije bulbusa kod Gravesove orbitopatije. Mjerenje GPR je jednostavno i treba uvijek biti dio radiološke procjene orbite kod Gravesove orbitopatije.

Introduction: The objective of this study was to demonstrate the predictive value and the presence of diagnostic comorbidity and perioperative factors in the outcome of shunt surgery for hydrocephalus. Methods: We retrospectively analyzed a series of 32 patients who underwent surgery for NTH on Neurosurgical Service KBC Zemun in the 2006-2012 period year. Diagnostic factors were analyzed: clinical signs (gait disturbance, cognitive deficits and incontinence), Evans' index and lumbar puncture. Perioperative comorbidity factors analyzed were: arterial hypertension, diabetes mellitus, and cerebrovascular insult. Results: Of the total of 32 operated patients had gait disturbance, cognitive deficits 24 and 23 urinary incontinence. Improving gait disturbance had 20, 13 had cognitive deficits and 11 urinary incontinence. Improvement of gait disturbance was significantly different (p

Gioblastoma multiforme localized in the motor area is the surgical challenge because of the need for more radical resection in order to extend the life of the patient, and the other due to the risk that radicalism could lead to additional-crippling neurological deficit. Method. We present a series of 26 patients with Glioblastoma multiforme localized in and around the motor area in front of the central sulcus who were hospitalized from October 2004 to February 2009. During all operations we conducted cortical electrostimulation on displayed area of the brain, to the anatomical location of M1 segment of the motor cortex. Results. Distance of the central sulcus in relation to the coronary suture, measured by magnetic resonance imaging (MRI) was 18.38 mm?9.564 mm. The volume of electricity required for a motor response was 9.26?1.286 mA(min. 7mA, max. 11mA), with increasing distance from the coronary suture the amperage required to explicit motor responses decreased (p

We present the results of treatment of 15 patients with brain arteriovenous malformation initially presented by epilepsy in Neurosurgery, Clinical Center of Serbia in Belgrade, in the period 2004-2010 year. Results: Most of the patients had a grand mall type of epilepsy, 14 of them, while one was present petit mall epilepsy. The attacks are manifested individually in 14, and in 1 case series. Response to treatment was good in 11 and 4 patients with refractory. In 26.7% of cases, seizures alternated with bleeding. Anatomical features of malformations did not show a significant difference in the predisposition to epilepsy treatment response . Conclusion: Good control of epilepsy by medication supports the view that there is no need for urgent surgical treatment of brain AVM so we can generally conclude that brain AVM in relation to a wide range of neurosurgical patients are in benign lesions, which requires patience and good workmanship and strategic therapeutic approach.

Introduction. Cavernous malformations localized in the brain stem are considered as a separate entity in relation to other intracranial cavernoma. Clinical presentation is specific in terms of focal neurologic deficit, they show aggressive biological behavior and unfavorable clinical course, whereas localization in the brain stem naturally represents the largest surgical problem and challenge and significantly higher operational risk. Results. We report a series of 10 patients with brainstem cavernoma, operated at the Department of Neurosurgery, Clinical Center of Serbia in the period of 2008-2012. In cavernous lesions of the dorsal pons and upper cerebellar peduncul we used the approach through the fourth ventricule, in the laterally localized pontine cavernoma we used the cerebellopontine angle approach, in the cavernoma localized in the central midbrain tegmental area was used supreacerebellar infratentorially approach. Conclusion. Surgical removal of the brainstem cavernoma is absolutely expedient both from the standpoint of preventing recurrent and debilitating hemorrhage and in terms of recovery of neurologic deficit. In patients with disturbed vital functions, the evacuation of the hematoma and removal of the malformation eliminate compression of effects on vital structures of the brain stem.

Introduction: Surgery of tumors localized in the motor cortex is challenging because of the accompanying risk of de novo occurrence of motor deficits. Materials and methods: We report a series of 34 patients with slow-growing brain tumors localized in and around the motor areas of the brain, which were treated at the Institute of Neurosurgery, Clinical Center in Belgrade in the period 2008-2012. Result. The average distance of the central sulcus in relation to the coronary suture verified ES is 18.38 mm ? 9,564 mm, the strength of the current required to obtain motor responses was 9.26?1.286 mA. If the distance from the coronary suture is higher, the current intensity required to cause the motor response is lower (p

Introduction. Intracranial aneurysms are very rare in the pediatric population . Very rarely they are accompanied by subarachnoid hemorrhage (SAH). As in the adults they are most often discovered after their rupture. Case report. We report the case of a child 14 months old at the time of rupture of the aneurysm , which led to intraventricular hemorrhage and accompanied by left side body weakness. After diagnosis - digital subtraction angiography (DSA) aneurysm on the posterior chorioid artery was verified. Consultatory there was no decision for surgical treatment. The child is now 6 years old, there is a discrete left side pyramidal deficit , control DSA - finding stationary. Conclusion: Despite the development of modern diagnosis of intracranial aneurysms their treatment is still a big challenge. Child?s brain has great recovery potential, which encourages aggressive therapy for these disorders and provide good results. In younger patients with ruptured aneurysms and vascular anomalies associated with neurological deficit, where surgical treatment or endovascular procedures associated with the high risk of complications, conservative treatment is indicated.

Introduction. We report a series of 30 patients with spontaneous intraventricular hemorrhage (IVH) and hydrocephalus, in which is placed subcutaneous (Omaya) tank at the University Children?s Hospital in Belgrade from March 2006 to March 2011. Results. Predictors of poor outcome in treatment in getting Omaya reservoirs are low birth weight (t=2.560, p=0.016), low Apgar score (t=3.059, p=0.005), an extended number of days on mechanical ventilation (Z=4,404 , p< 0.001), the presence of peripartal asphyxia (X2=9.977, p=0.002) and cardio-respiratory arrest (X2=12.804 , p< 0.001). Conclusion. The outcome of treatment of hydrocephalus caused by spontaneous intraventricular hemorrhage in premature infants is worst in perinatology. There is no consensus on the diagnosis and treatment of posthemorrhage hydrocephalus, our results suggest that the main prediction factor is preoperative condition of the child.

Multidetector computed tomographic angiography (MDCTA) is a non-invasive, highly sophisticated and readily available diagnostic method nowadays gained primacy in the algorithm of the blood vessels of the brain. MDCTA showed the highest sensitivity and specificity for early detection of ruptured intracranial aneurysms. Saccular aneurysm geometry (shape and size), anatomic localization, and patient-dependent factors individually and together determine the risk of rupture of the aneurysm. Unruptured aneurysms in anterior communicating artery showed twice the possibility of rupture than other intracranial aneurysms. Clinical history ACoA aneurysms after rupture is particularly difficult. This justifies the efforts to determine the real risk of these aneurysms when SAH was not found on the native scan endocranium. It is here that the diagnostic value and usefulness of MDCTA examination increases significantly and its true dimension.

The study includes a series of 39 patients with AVM of the brain that are not subjected to any method of treatment, except for the symptomatic treatment who were hospitalized and diagnosed AVM at the Institute of Neurosurgery, Clinical Center, in the period 2005-2011. Results: The structure of the patients was measured by gender are male. Average age of the respondents was 27.4 ? 7.6 years. With the average length of the follow-up of 4.8 years, new hemorrhage occurred in 24 patients (58 episodes). Predictor (p

The verified presence of a glioblastoma multiforme (GBM) tumor in the motor area of the brain, in a patient lacking preoperative neurological deficit, offers no certainty that the tumor can be radically removed without the possibility of causing postoperative motor deficit. We present a series of 60 patients hospitalized at the Clinical Department of Neurosurgery, Clinical Center of Serbia in Belgrade between October 2011 and February 2015, harboring tumors located within and in the vicinity of the motor zone of the brain. By using Karnofsky's index (KI), the pre- and postoperative conditions of the patients were evaluated. Regarding electrical stimulation of the motor cortex, significantly lower values of the electrical current intensity, frequency, and pulse wave duration (p0.01) were needed for triggering motor response in case of GBM tumor compared to a slowly growing tumor (low-grade). Patients with low-grade gliomas (LGG) had statistically significantly higher KI values pre- and postoperatively than patients with GBM (p0.01). Using electrical stimulation of the cortex, a higher grade of resection of LGG could be achieved as compared with the group presenting with GBM (χ² = 5.281; df = 1; p0.05). Our findings and review of the results reported by other authors underline the necessity of routine application of electrical stimulation of the cerebral cortex in order to identify the primary motor field (M1).