Browsing by Author "Bascarevic, Vladimir (36485908900)"

Lightning strikes pose a rare but catastrophic risk for a variety of injuries, including damage to the central nervous system. We present the case of a 79-year-old farmer who survived a lightning strike directly in the chest resulting in an intracerebral hemorrhage in the region of the left basal ganglia. The patient was initially comatose with right-sided paralysis and central facial palsy but displayed gradual improvement with supportive medical therapy. This unique case highlights the potential for lightning strikes to cause rare and severe neurological complications, including intracerebral hemorrhage. A review of the literature proposes possible pathophysiology of lightning-induced intracerebral hemorrhage, but the exact mechanism is yet to be found. Early diagnosis, classification, and treatment of neurological symptoms are crucial for optimal patient outcomes following lightning strikes. This case report adds valuable information to the limited body of literature on lightning strike-induced central nervous system injuries, emphasizing the importance of prompt medical intervention and multidisciplinary care for lightning strike survivors. Further research is needed to better understand the mechanisms underlying lightning-induced intracerebral hemorrhage and to develop optimal treatment strategies for these rare but potentially devastating events. © 2024. The Author(s).

Background/Objectives: Endovascular embolization is an effective treatment option for cerebral arteriovenous malformation (AVM) and dural arteriovenous fistulas (DAVFs). The objective of this study was to assess the safety and efficacy of MenoxTM in patients with cranial dural arteriovenous fistulas. Methods: From January 2021 to January 2023, 19 patients with intracranial DAVFs underwent embolization procedures. All patients were treated by embolization with MenoxTM or/and in combination with other embolization products such as Onyx (Covidien, Irvine, California), PHIL (MicroVention, Tustin, California), and Squid (Balt Extrusion, Montmorency, France). Treatment approaches were selected depending on the anatomical location of the fistula. Patients were monitored and followed-up for 12 months. Results: The patients’ mean age was 56.26 ± 16.49 years. Of these 19 patients, 58% (n = 11) were treated with the MenoxTM liquid embolizing agent (LEA) alone or in combination with different LEAs, while n = 7 were treated with other LEAs and 1 patient was treated solely with coils. Complete occlusion of DAVFs with MenoxTM and other agents was evident in 68.4% (n = 13/19) of patients. Complete occlusion (100%) was observed in the sinus rectus, transverse sinus, and diploic veins of the orbital roof, while complete occlusion was observed in 50% of falcotentorial patients and 60% of superior sagittal sinus patients. The lowest rate of complete fistula obliteration was observed in the dural carotid cavernous fistula (CCF) group (25%). An intra-procedural adverse event occurred in one patient. No other post-procedural adverse events were noted. Furthermore, in patients treated with MenoxTM, total occlusion was achieved in 72.7% (n = 8) of patients, whereas the non-MenoxTM group had 62.5% (n = 5) of patients with 100% occlusion and 37.5% (n = 3) of patients with subtotal occlusion. Conclusions: Outcomes using MenoxTM alone and in combination with other agents were effective, and it is safe for the treatment of dural arteriovenous fistulas. © 2024 by the authors.

Objective: Risk factors for epilepsy in meningioma patients are not yet clearly defined, however, seizure freedom is a significant factor for quality of life after surgery. Methods: We performed a retrospective study of the 333 adult patients who received surgery for supratentorial meningioma at our center. Various clinical, radiological, and surgical variables were included in the multivariate regression, and the outcomes measured were the occurrence of seizure(s) preoperatively, during the hospitalization, and during the follow-up period. Results: A total of 89 (26.7%) patients experienced preoperative seizures, of whom 62.9% were seizure free after the surgery. Of 244 patients without epilepsy before surgery, 11.9% had at least one seizure postoperatively. In total, 63 of our patients (18.9%) experienced seizures after the surgery, of whom 20 had refractory epilepsy. Multivariate analysis identified the following predictors of preoperative seizures: the absence of headache (OR: 0.23, CI: 2.55–8.50), the presence of significant peritumoral edema (OR: 4.35, CI: 2.57–7.35), and younger age (OR: 0.97 per year increase, CI: 0.95–0.99). Factors associated with early postoperative seizures were: younger age (OR: 0.96 per year increase, CI: 0.93–0.99) and the presence of preoperative seizures (OR: 2.73, CI: 1.13–6.57), while the presence of preoperative seizures (OR: 4.73, CI: 2.05–10.92), tumor progression (OR: 5.38, CI: 2.25–12.89), and neurological worsening (OR: 5.21 CI: 1.72–15.81) were significant for late postoperative seizures. Significance: Our results from a single-center meningioma cohort confirm, in general, data from some previous studies regarding patients' characteristics for both preoperative and overall postoperative epilepsy. Besides previously described risk factors, younger age was important for preoperative and early postoperative seizures. Epilepsy is common in patients with recurrence of meningioma, but the variables of significance for refractory seizures in these patients require further examination. © 2023 International League Against Epilepsy.

Objective: Risk factors for epilepsy in meningioma patients are not yet clearly defined, however, seizure freedom is a significant factor for quality of life after surgery. Methods: We performed a retrospective study of the 333 adult patients who received surgery for supratentorial meningioma at our center. Various clinical, radiological, and surgical variables were included in the multivariate regression, and the outcomes measured were the occurrence of seizure(s) preoperatively, during the hospitalization, and during the follow-up period. Results: A total of 89 (26.7%) patients experienced preoperative seizures, of whom 62.9% were seizure free after the surgery. Of 244 patients without epilepsy before surgery, 11.9% had at least one seizure postoperatively. In total, 63 of our patients (18.9%) experienced seizures after the surgery, of whom 20 had refractory epilepsy. Multivariate analysis identified the following predictors of preoperative seizures: the absence of headache (OR: 0.23, CI: 2.55–8.50), the presence of significant peritumoral edema (OR: 4.35, CI: 2.57–7.35), and younger age (OR: 0.97 per year increase, CI: 0.95–0.99). Factors associated with early postoperative seizures were: younger age (OR: 0.96 per year increase, CI: 0.93–0.99) and the presence of preoperative seizures (OR: 2.73, CI: 1.13–6.57), while the presence of preoperative seizures (OR: 4.73, CI: 2.05–10.92), tumor progression (OR: 5.38, CI: 2.25–12.89), and neurological worsening (OR: 5.21 CI: 1.72–15.81) were significant for late postoperative seizures. Significance: Our results from a single-center meningioma cohort confirm, in general, data from some previous studies regarding patients' characteristics for both preoperative and overall postoperative epilepsy. Besides previously described risk factors, younger age was important for preoperative and early postoperative seizures. Epilepsy is common in patients with recurrence of meningioma, but the variables of significance for refractory seizures in these patients require further examination. © 2023 International League Against Epilepsy.

Peripheral nerve injuries are often associated with injuries of adjacent tissue. As a result of anatomic proximity between nerves and vascular structures, there is a high chance of combined injuries of these structures (23 %). The aim of our study is to describe and analyze associated nerve and vascular injuries of the upper extremity in patients treated at the Clinic of Neurosurgery in Belgrade over a 10-year period. This study included 83 patients that received surgical treatment at the Clinic of Neurosurgery in Belgrade after having been diagnosed with upper extremity nerve injury. The study included all patients that satisfied these criteria over a period of 10 years. The patients with associated vascular injuries, 36 of them, were considered our study group, while 47 patients without associated vascular injuries were considered our control group. Finally, we compared treatment outcome between these groups. The final outcome evaluation was performed 2 years after surgical treatment. In our study group, 84.8 % surgical nerve repair was successful (fair, good, and excellent outcome), while in the control group (patients without vascular injury), surgical nerve repair was successful in 87.9 %. The overall satisfactory neurological outcome (M3–M5) was present in 86.6 % of nerve repairs. Our study shows that there is no significant difference between the treatment outcome in patients with associated nerve and vascular injuries and patients with isolated nerve injuries if they are diagnosed in time and treated appropriately. Successful treatment can only be accomplished through a multidisciplinary approach undertaken by a highly qualified medical team. © 2016, Springer-Verlag Berlin Heidelberg.

Objective: Cortical atrophy close to medial temporal structures has been described consistently in patients with temporal lobe epilepsy (TLE). Successful TLE surgery may have a neuroprotective effect preventing further atrophy of temporal and extratemporal cortex. However, the effects of epilepsy surgery on subcortical structures demand additional enlightenment. This work aimed to determine how epilepsy surgery affects volumes of subcortical structures in medically refractory temporal lobe epilepsy patients. Methods: We compared MRI volumes of subcortical structures in 62 patients with TLE (36 left, 26 right) before and after anterior temporal lobectomy with 38 TLE patients (20 left, 18 right) who were considered to be good surgical candidates and had at least two brain MRIs. Results: There were no volume differences in subcortical structures on preoperative and initial MRIs of non-operated TLE patients. At baseline, the ipsilateral thalamus and putamen in TLE patients were marginally smaller than contralateral structures. Operated patients showed a significant postoperative volume reduction in ipsilateral thalamus, putamen, and globus pallidus. In contrast, there were no significant volumetric reductions in non-operated patients longitudinally. There were no volumetric changes associated with different surgical outcomes or different postoperative cognitive outcomes. Significance: Our study demonstrated postoperative volume loss of thalamus, putamen and globus pallidus ipsilaterally to the side of resection. Our findings suggest surgery-related changes, likely Wallerian degeneration within subcortical networks not related to seizure or cognitive outcome. Plain Language Summary: We studied 100 patients with epilepsy, comparing those who had surgery to those who did not. After surgery, the thalamus, putamen and globus pallidus on the same side as the surgery shrank significantly, but not in non-surgery patients. This suggests surgery-related changes in deeper brain structures, unrelated to seizure freedom or cognitive outcomes. This research sheds additional light on the response of the subcortical structure to epilepsy surgery, highlighting potential areas for further study. © 2024 The Author(s). Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.

Objective: Cortical atrophy close to medial temporal structures has been described consistently in patients with temporal lobe epilepsy (TLE). Successful TLE surgery may have a neuroprotective effect preventing further atrophy of temporal and extratemporal cortex. However, the effects of epilepsy surgery on subcortical structures demand additional enlightenment. This work aimed to determine how epilepsy surgery affects volumes of subcortical structures in medically refractory temporal lobe epilepsy patients. Methods: We compared MRI volumes of subcortical structures in 62 patients with TLE (36 left, 26 right) before and after anterior temporal lobectomy with 38 TLE patients (20 left, 18 right) who were considered to be good surgical candidates and had at least two brain MRIs. Results: There were no volume differences in subcortical structures on preoperative and initial MRIs of non-operated TLE patients. At baseline, the ipsilateral thalamus and putamen in TLE patients were marginally smaller than contralateral structures. Operated patients showed a significant postoperative volume reduction in ipsilateral thalamus, putamen, and globus pallidus. In contrast, there were no significant volumetric reductions in non-operated patients longitudinally. There were no volumetric changes associated with different surgical outcomes or different postoperative cognitive outcomes. Significance: Our study demonstrated postoperative volume loss of thalamus, putamen and globus pallidus ipsilaterally to the side of resection. Our findings suggest surgery-related changes, likely Wallerian degeneration within subcortical networks not related to seizure or cognitive outcome. Plain Language Summary: We studied 100 patients with epilepsy, comparing those who had surgery to those who did not. After surgery, the thalamus, putamen and globus pallidus on the same side as the surgery shrank significantly, but not in non-surgery patients. This suggests surgery-related changes in deeper brain structures, unrelated to seizure freedom or cognitive outcomes. This research sheds additional light on the response of the subcortical structure to epilepsy surgery, highlighting potential areas for further study. © 2024 The Author(s). Epilepsia Open published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.

The most common location for intracranial arachnoid cysts is the region of the Sylvian fissure, where they can be found in 49% of cases. Management of these cysts is still quite controversial. We present our surgical technique for the treatment of large Sylvian fissure arachnoid cysts which involves cyst decompression and simultaneous calvarial remodeling. After decreasing cyst size, remodeling of the frontal, temporal, and parietal bones follows. The cyst itself is treated with a cystoperitoneal shunt. In immediate postoperative period, correction of the deformity is observed. The cyst volume is reduced immediately after surgery, and adequate adaptation of the bone is achieved. Our surgical procedure for simultaneous bone remodeling and cyst decompression is a fast, simple, and effective treatment option for patients with large Sylvian fissure arachnoid cysts associated with significant cranial disfigurement. We consider cranial remodeling in case of large arachnoid cyst important not just because of the cosmetic result but also for reducing remaining intracranial space filled with cerebrospinal fluid. It may be an important factor to reduce the risk of intracystic and subdural hemorrhage. It is a widely applicable procedure that does not require special tools and expensive equipment, and yet it can help avoid multiple surgeries and complications tied to them. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

The incidence of concomitant extracranial carotid artery stenosis and ipsilateral intracranial carotid aneurysm has been reported to vary between 2.8% and 5%. These complex lesions may present a challenge for treatment decision-making. This case report describes an asymptomatic male patient with severe carotid bifurcation stenosis, coupled with an unruptured supraclinoid internal carotid aneurysm. Both lesions were treated simultaneously. Patient underwent carotid stenting followed by aneurysm coiling in the same setting without any complication. © SAGE Publications.

Introduction: Developmental venous anomaly (DVA) is a common cerebral vascular variant, typically considered benign and clinically silent. We report an exceptional case of a symptomatic infratentorial DVA in a 9-year-old child that became clinically evident after a minor head trauma. Case Report: The patient presented with neurological symptoms indicative of posterior fossa involvement, including headache, nausea, and ataxia. MRI revealed a cluster of abnormally dilated medullary veins in the right cerebellar hemisphere converging into an enlarged collector vein, consistent with a DVA. Significant cerebellar edema was identified in association with detected vascular malformation. The patient was managed conservatively with antiedematous therapy and analgesics, which led to rapid resolution of symptoms and complete recovery. Conclusion: This case demonstrates that DVAs can become acutely symptomatic secondary to significant vasogenic edema following even minor head trauma, likely due to transient hemodynamic disturbance without thrombosis or hemorrhage. Our findings challenge the perception of DVAs as invariably benign entities and warrant further investigation into their post-traumatic pathophysiology. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.

Introduction: Developmental venous anomaly (DVA) is a common cerebral vascular variant, typically considered benign and clinically silent. We report an exceptional case of a symptomatic infratentorial DVA in a 9-year-old child that became clinically evident after a minor head trauma. Case Report: The patient presented with neurological symptoms indicative of posterior fossa involvement, including headache, nausea, and ataxia. MRI revealed a cluster of abnormally dilated medullary veins in the right cerebellar hemisphere converging into an enlarged collector vein, consistent with a DVA. Significant cerebellar edema was identified in association with detected vascular malformation. The patient was managed conservatively with antiedematous therapy and analgesics, which led to rapid resolution of symptoms and complete recovery. Conclusion: This case demonstrates that DVAs can become acutely symptomatic secondary to significant vasogenic edema following even minor head trauma, likely due to transient hemodynamic disturbance without thrombosis or hemorrhage. Our findings challenge the perception of DVAs as invariably benign entities and warrant further investigation into their post-traumatic pathophysiology. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.