Browsing by Author "Grujić, Jovan (57218345904)"

[No abstract available]

Introduction: Radial nerve lesions present a clinical entity that may lead to disability, psychological distress, and job loss, and thus requires great attention. Knowledge of the etiology and exact mechanism of the nerve impairment is of great importance for appropriate management of these patients, and there are only a few papers that focused on these features in patients with surgically treated radial nerve lesions. The lack of studies presenting the etiology and injury mechanisms of surgically treated radial nerve lesions may be due to a relatively small number of specialized referral centers, dispersion to low-flow centers, and a greater focus on the surgical treatment outcomes. Aim: The aim of this study was to describe the etiological and epidemiological characteristics of patients with surgically treated radial nerve lesions of various origins. Methods: This retrospective study evaluated 147 consecutive patients with radial nerve lesion, treated in the department during the last 20 years, from January 1, 2001, until December 31, 2020. Results: The majority of patients belonged to the working population, and 70.1% of them were male. Most commonly, the etiology of nerve lesion was trauma (63.3%) or iatrogenic injury (28.6%), while the less common origin was idiopathic (4.1%) or neoplastic (4.1%). The most frequent location of the lesion was in the upper arm, followed by the elbow and forearm. Fracture-related contusion was the most common mechanism (29.9%), followed by postoperative fibrosis (17.7%), lacerations (17.7%), and compression (15.6%). Conclusion: Based on the fact that traumatic or iatrogenic injuries constitute the majority of cases, with their relevant mechanisms and upper arm predomination, it is crucial to raise awareness and understanding of the radial nerve injuries among orthopedic surgeons to decrease the numbers of these patients and properly preserve or treat them within the initial surgery. 2022 Rasulić, Djuraskovic, Lakićević, Lepić, Savić, Grujić, Mićić, Radojevic, Cordoba Mosqueda, Visani, Puzovic, Kovačević, Vitošević, Mandic-Rajcevic and Knezevic.

Giant cavernomas (GC) are rare lesions, with less than 50 cases reported so far. Clinical presentation usually involves epileptic seizures and less typically focal neurological deficit, due to repeated hemorrhages and GC mass effect and consequentially increased intracranial pressure. Although individual cases have been reported, due to the rarity and variable imaging appearance, GCs are usually not considered in the differential diagnosis of large hemorrhagic lesions, especially when significant mass effect is present. A 17-year-old boy presented due to severe headache, right-sided weakness, and slurred speech. Symptoms started three days before with occasional headaches, which intensified gradually. Emergency computed tomography revealed a left frontal massive heterogeneous lesion. Soon after, right-sided hemiparesis and speech impairment progressed, and the patient became drowsy with the slightly dilated left pupil. Emergency surgery was performed, and the lobed grayish lesion was entirely removed. Based on the macroscopic appearance, the surgeon assumed it was a metastasis of melanoma. Histopathologic analysis result was cavernoma. GC should be considered as an option in hemorrhagic lesions, especially in the young age population. Emergency surgery for mass lesions is not uncommon in neurosurgery; however, bleeding cavernomas are usually planned for elective surgery due to the specific approach and complications.

This paper aims to provide an overview of recent advances in the diagnosis and treatment of peripheral nerve tumors (PNTs) with regard to biological and technological nuances, and to highlight some recommendations for achieving better outcomes in the treatment of patients suffering from PNT. PNTs are probably the most challenging entity in the field of peripheral nervous system surgery. The goal of removing a nerve tumor while also preserving nerve function at the same time is often complicated, regardless of the surgeon's experience. Still, in most cases, high-quality results can be achieved upon carefully planned surgery. Clinical presentation, diagnosis, and indications for a specific type of treatment of PNTs still remain a topic of debate. Recent technological advances have led to an exponential improvement in the field with utilization of intraoperative ultrasound, neurostimulation devices, and intraoperative electrophysiological monitoring, along with the development of modern surgical techniques, whereby a multidisciplinary and individually shaped approach is necessary. CONCLUSION: These advances, however, still remain limited, and recent research is focused on the development of biological therapy. Biologically targeted therapies will emerge when there is a better understanding of the genetic and molecular mechanisms driving the development and growth of PNTs. Copyright © 2020 by Academy of Sciences and Arts of Bosnia and Herzegovina.

Objective: Cubital tunnel syndrome (CuTS) results from compression of the ulnar nerve at the elbow, resulting in pain, weakness, and numbness of the hand and forearm. This work describes the Quality of Life (QoL) and satisfaction after CuTS surgery and identifies the factors associated with those outcomes. Methods: This cross-sectional study included patients surgically treated for CuTS from January 2011 to September 2021 at the Neurosurgery Clinic of the Clinic Center in Serbia. The questionnaires applied were the Short Form 36 (SF-36), EuroQol instrument (EQ-5D-5 L), Bishop’s score and Patient-Rated Ulnar Nerve Evaluation (PRUNE). Results: Sixty-two patients met the inclusion criteria. Bishop’s score: The median score was 10 (7.75–11), 54.8% of the cases presented excellent results. PRUNE: The median score for symptoms was 19 (6–38.5); for functional, was 14 (0.75–38); and the total was 18.25 (5.87–34.12). SF-36: The subscale with the best result was social functioning (84.68 ± 22.79). The scale with the worst value was emotional well-being (49.35 ± 7.87). EQ-5D-5L: Over 50% patients did not present problems with mobility, self-care, activity, and anxiety. The average EQ-VAS was 72.77 ± 18.70; and 0.72 ± 0.21 of the EQ-index, revealing a good QoL. Models for QoL and satisfaction: Ten models showed statistical significance. The variables with major involvement were body mass index and time evolution of the symptoms. Conclusion: Surgical decompression has proved to diminish the symptoms, improving QoL and satisfaction. Many fixed and changeable factors can affect the satisfaction levels after surgery. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Objective: Cubital tunnel syndrome (CuTS) results from compression of the ulnar nerve at the elbow, resulting in pain, weakness, and numbness of the hand and forearm. This work describes the Quality of Life (QoL) and satisfaction after CuTS surgery and identifies the factors associated with those outcomes. Methods: This cross-sectional study included patients surgically treated for CuTS from January 2011 to September 2021 at the Neurosurgery Clinic of the Clinic Center in Serbia. The questionnaires applied were the Short Form 36 (SF-36), EuroQol instrument (EQ-5D-5 L), Bishop’s score and Patient-Rated Ulnar Nerve Evaluation (PRUNE). Results: Sixty-two patients met the inclusion criteria. Bishop’s score: The median score was 10 (7.75–11), 54.8% of the cases presented excellent results. PRUNE: The median score for symptoms was 19 (6–38.5); for functional, was 14 (0.75–38); and the total was 18.25 (5.87–34.12). SF-36: The subscale with the best result was social functioning (84.68 ± 22.79). The scale with the worst value was emotional well-being (49.35 ± 7.87). EQ-5D-5L: Over 50% patients did not present problems with mobility, self-care, activity, and anxiety. The average EQ-VAS was 72.77 ± 18.70; and 0.72 ± 0.21 of the EQ-index, revealing a good QoL. Models for QoL and satisfaction: Ten models showed statistical significance. The variables with major involvement were body mass index and time evolution of the symptoms. Conclusion: Surgical decompression has proved to diminish the symptoms, improving QoL and satisfaction. Many fixed and changeable factors can affect the satisfaction levels after surgery. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Radial nerve injuries are often associated with humeral shaft fractures. The results of treatment of these injuries, by contemporary surgical approaches, remain diverse. In this paper we presented the outcomes and analyzed the patient, clinical, and surgical procedure related characteristics and factors that may influence the outcome overall, in 77 patients treated at Clinic for Neurosurgery, Clinical Center of Serbia during a 20 years period. The nerve injuries were verified by US and EMNG. The majority of patients were treated by neurolysis or sural nerve grafting, while only few were treated by direct suture. The final recovery was evaluated by muscle strength assessment and classified using MRC. We analyzed extension of the wrist, extension of the fingers including the thumb, and abduction of the thumb. There was a significant statistical difference in MRC grade following the treatment. The total rate of useful functional recovery was achieved in 69 (89.61%) out of all studied patients, out of whom 20 (28.99%) achieved excellent recovery, 26 (37.68%) achieved good recovery and 23 (33.33%) achieved fair recovery. Only 8 (10.39%) out of all studied patients achieved poor recovery. The injured nerves, that were preserved in continuity, acquired by a low-energy trauma, and treated earlier than the 6 months were associated with better functional outcome following the surgery. In addition, there was a trend of better functional improvement with aging, keeping in mind that the old were subjected to lower energy trauma. The expectant management followed by surgery of radial nerve injury associated with humeral shaft fracture should be around 3 months, and the surgical nerve repair should not be performed later than the 6 months after injury. The energy of trauma may be a factor predicting patient's final recovery following the treatment. Copyright © 2021 Rasulić, Djurašković, Lakićević, Lepić, Savić, Grujić, Mićić, Radojević, Puzović, Maletić and Mandić-Rajčević.

Introduction: Rare peripheral nerve lesions comprise a histologically diverse group of neoplastic and non-neoplastic entities, characterized by infrequent occurrence and variable clinical presentations, presenting significant diagnostic and therapeutic challenges. This study presents eight cases of surgically treated rare peripheral nerve lesions with previously unreported long-term outcomes involving quality of life (QOL) assessment. Methods: A retrospective analysis was conducted on medical records from 2012 to 2022 to identify surgically treated cases of rare peripheral nerve lesions, selecting eight cases based on determined inclusion and exclusion criteria. Long-term outcomes and QOL were assessed 12 months post-surgery by patient examination, control imaging and self-reporting questionnaires. Results: The study included 4 benign (hemangioblastoma, angiomatoid fibrous histiocytoma, endometriosis (n=2)) and 4 malignant lesions (NTRK-rearranged spindle cell neoplasm, lymphoma, metastatic breast carcinoma (n=2)). Even though benign lesions generally presented with better outcomes, this was more closely related with level of nerve invasion and postoperative sequele, rather than presence of malignancy. Discussion: Because of a global lack of experience in handling such cases, this study aimed to present the cases we encountered in detail to serve as a basis for future literature reviews. The findings highlight the importance of individualized treatment strategies and long-term follow-up to optimize functional recovery and patient well-being. Copyright © 2025 Savić, Lepić, Grujić, Mićić, Stojiljković, Putra, Terzić, Vujić and Rasulić.

Introduction: Rare peripheral nerve lesions comprise a histologically diverse group of neoplastic and non-neoplastic entities, characterized by infrequent occurrence and variable clinical presentations, presenting significant diagnostic and therapeutic challenges. This study presents eight cases of surgically treated rare peripheral nerve lesions with previously unreported long-term outcomes involving quality of life (QOL) assessment. Methods: A retrospective analysis was conducted on medical records from 2012 to 2022 to identify surgically treated cases of rare peripheral nerve lesions, selecting eight cases based on determined inclusion and exclusion criteria. Long-term outcomes and QOL were assessed 12 months post-surgery by patient examination, control imaging and self-reporting questionnaires. Results: The study included 4 benign (hemangioblastoma, angiomatoid fibrous histiocytoma, endometriosis (n=2)) and 4 malignant lesions (NTRK-rearranged spindle cell neoplasm, lymphoma, metastatic breast carcinoma (n=2)). Even though benign lesions generally presented with better outcomes, this was more closely related with level of nerve invasion and postoperative sequele, rather than presence of malignancy. Discussion: Because of a global lack of experience in handling such cases, this study aimed to present the cases we encountered in detail to serve as a basis for future literature reviews. The findings highlight the importance of individualized treatment strategies and long-term follow-up to optimize functional recovery and patient well-being. Copyright © 2025 Savić, Lepić, Grujić, Mićić, Stojiljković, Putra, Terzić, Vujić and Rasulić.

Objective: Brachial plexus injuries are among the most complex injuries of the peripheral nervous system and among the most devastating injuries overall. In complete lesions, functional priorities include the reinnervation of the musculocutaneous and axillary nerves for proximal functions restoration. Three major nerves–radial, median, and ulnar–and the corresponding muscles remain denervated, which results in subsequent muscle atrophy. This study was aimed at the evaluation of arm volumes in surgically treated patients with brachial plexus injuries, in correlation with the type of palsy, recovery and associated factors. Methods: The study included 36 patients with brachial plexus injuries who were surgically treated in our institution over a 15-year-long period. The evaluation of arm and arm segments volumes was carried out using water displacement testing, based on the Archimedes principle. Results: Statistically significant differences were noted between the operated arm and the healthy arm in all of the measured segments (hands, forearms and upper arms), as well as between the patients with complete and upper palsy, and in correlation with the shoulder abduction recovery. Conclusions: Previous studies were mainly focused on the functional outcome and quality of life; although related to both, arm volumes in patients with brachial plexus injuries were not analyzed before. Significant differences between the operated arm and the healthy arm volumes, as well as between the various types of palsy, found in the present study should trigger further prospective research in relation to neurophysiology, useful functional recovery and quality of life. © 2020 Informa UK Limited, trading as Taylor & Francis Group.

Objective: Brachial plexus injuries are among the most complex injuries of the peripheral nervous system and among the most devastating injuries overall. In complete lesions, functional priorities include the reinnervation of the musculocutaneous and axillary nerves for proximal functions restoration. Three major nerves–radial, median, and ulnar–and the corresponding muscles remain denervated, which results in subsequent muscle atrophy. This study was aimed at the evaluation of arm volumes in surgically treated patients with brachial plexus injuries, in correlation with the type of palsy, recovery and associated factors. Methods: The study included 36 patients with brachial plexus injuries who were surgically treated in our institution over a 15-year-long period. The evaluation of arm and arm segments volumes was carried out using water displacement testing, based on the Archimedes principle. Results: Statistically significant differences were noted between the operated arm and the healthy arm in all of the measured segments (hands, forearms and upper arms), as well as between the patients with complete and upper palsy, and in correlation with the shoulder abduction recovery. Conclusions: Previous studies were mainly focused on the functional outcome and quality of life; although related to both, arm volumes in patients with brachial plexus injuries were not analyzed before. Significant differences between the operated arm and the healthy arm volumes, as well as between the various types of palsy, found in the present study should trigger further prospective research in relation to neurophysiology, useful functional recovery and quality of life. © 2020 Informa UK Limited, trading as Taylor & Francis Group.