Introduction: Despite the presence of various constraints, Bosnia and Herzegovina has managed to establish healthcare services in the field of spinal surgery. Limiting factors associated with resource scarcity and a shortage of neurosurgeons may pose challenges, but they are not insurmountable in the context of spinal tumor surgery. This study aims to provide a comprehensive 10-year analysis of intradural spinal tumors in resource-constrained healthcare settings and assess surgical outcomes in these challenging environments. Methods: A retrospective study was conducted involving 39 patients with intradural spinal tumors in Zenica-Doboj Canton, Bosnia and Herzegovina, from 2011 to 2021. Patients underwent neurological examinations and spinal magnetic resonance imaging scans, followed by post-surgery assessments at 3 and 6 months using the McCormick scale. Results: Among the 39 patients, tumor distribution was as follows: meningioma (15, 38.5%), ependymoma (3, 7.7%), schwannoma (11, 28.2%), neurenteric cyst (1, 2.6%), primary melanoma (2, 5.1%), lipoma (1, 2.6%), and metastasis (6, 15.4%) (p < 0.001). A majority of patients reported localized and radicular pain (37, 94.9%, p < 0.001) and paresthesia (33, 84.6%, p < 0.001). Motor weakness was noted in 20 (51.3%) patients, while sphincteric dysfunction was reported by 17 (43.6%) patients. The average symptom duration was 397.9 ± 380.9 days, ranging from 14 to 1460 days (p < 0.001). Pneumonia and liquorrhea were reported by 1 (2.6%) patient each. Regarding mortality, 1 (2.6%) patient passed away within a 6-month follow-up period (p < 0.001), and 2 (5.1%) patients were diagnosed with primary malignant melanoma. Significant improvements in McCormick scores were observed between postoperative and 3-month assessments (p < 0.001) and between 3-month and 6-month assessments (p = 0.024). Conclusions: This study offers valuable insights into the management of intradural spinal tumors in resource-constrained healthcare settings. Timely diagnosis and surgical intervention are essential for achieving positive patient outcomes in these challenging environments.

AIM To investigate clinical and morphometric characteristics of patients with lower urinary tract symptoms (LUTS) due to lumbar spinal stenosis (LSS). METHODS This study evaluated LSS patients using clinical assessments of motor, sensory, bladder, and bowel functions, and functional disability scores from the Oswestry Disability Index (ODI) and Swiss Spinal Stenosis Questionnaire (SSSQ). Morphometric analysis included MRI measurements of the anteroposterior diameter of the intervertebral disc and dural sac, and the modified Torg-Pavlov ratio (mTPR), with follow-up re-evaluations at 6 months. RESULTS Of 159 patients, 49 (30.8%) had LUTS and 110 (69.2%) were in the control group. LUTS patients had a significantly higher prevalence of neurogenic claudication (100% vs. 47.3%; p<0.001), lower back pain (93.9% vs. 77.3%; p=0.011), and lower extremity pain (57.1% vs. 34.5%; p=0.008). The LUTS group also had higher ODI (54.0 vs. 50.0; p=0.019) and SSSQ score (44.0 vs. 34.0; p<0.001). Morphometric analysis showed significantly lower mTPR in LUTS patients (median 0.31 vs. 0.45; p<0.001), with an AUC of 0.704 (95%CI 0.627-0.774). mTPR ≤0.31 predicted surgical revision within 6 months (OR:3.4, CI: 1.2-9.8), motor deficiency (OR:2.1, 95%CI: 1.4-5.2), and persistent LUTS post-surgery (OR:4.5, 95%CI: 1.1-18.9). mTPR ≤0.34 was associated with worse follow-up outcome, including increased ODI (β:3.2; 95%CI: 1.1-5.3; p=0.004) and SSSQ score (β:4.8; 95%CI:2.1-7.5). CONCLUSION LUTS patients with LSS exhibit more severe symptoms and poorer outcome, with mTPR ≤0.34 being a predictor of adverse clinical outcome and the need for surgical revision within 6 months.

Introduction: Aim of this study is to analyze gender-related epidemiological characteristics of cauda equina syndrome (CES) in Zenica-Doboj Canton in 10 years period. Methods: The study was conducted in the Zenica-Doboj Canton, and data were obtained from the time period between 2012 to 2022. The study included a total sample of 1709 patients diagnosed with disc herniation who underwent surgical decompression. In total, 48 patients developed cauda equine syndrome (CES). Results: The analysis unveiled noteworthy gender disparities, with male predominance (79.2% vs. 20.8%, p<0.001) and varying employment distributions (males: 23.7% unemployed, 63.2% employed, 13.1% retired; females: 40.0% unemployed, 20.0% employed, 40.0% retired, p<0.001). The calculated OR for 2012-2022 was 2.969 (95% CI: 1.576-5.593, p=xxx), signifying a substantial gender-incidence relationship for CES. CES-I incidence ranged 0.80-1.60/100,000 and CES-R ranged 0.25-0.83/100,000. Highest CES incidence was 4.17/100,000 (2015); the lowest was in 2019 with no CES-R cases reported. Male incidence peaked at 2.64/100,000 (2018), and the lowest was 1.06/100,000 (2013, 2017). For females, the highest was 1.17/100,000 (2018, 2021), with no cases reported in certain years. The affected level demonstrated gender differences, with L4/L5 prevalence in males (47.4%) and L3/L4 in females (50%, p=0.165). Conclusion: This study revealed a higher incidence of CES in males compared to females in the Zenica-Doboj Canton. The heterogenicity of data regarding CES occurring due to the lumbar disc herniation is significant. This indicates a clear need for additional research and epidemiological studies that would highlight the population of patients that have higher risk of CES onset.

The modern period of neurosurgery in Bosnia and Herzegovina began with the first neurosurgical procedure performed by Dr. Karl Bayer in 1891 on 3 patients with depressed skull fractures and epilepsy. In 1956 the Department of Surgery in Sarajevo designated several beds specifically for a neurosurgical unit. A significant milestone in the history of neurosurgery in Bosnia and Herzegovina was the establishment of the Division of Neurosurgery at the Clinical Center University of Sarajevo in 1970. The first neurosurgeon to complete his training in Bosnia and Herzegovina was Dr. Faruk Konjhodžić. The first female neurosurgeon was Dr. Nermina Iblizović. Presently, there are 7 neurosurgical departments in the country, located in Sarajevo, Tuzla, Zenica, Mostar, Banja Luka, Bihać, and Foča. The Association of Neurosurgeons in Bosnia and Herzegovina, founded in 2003, is a member of the European Association of Neurosurgical Societies and the World Federation of Neurosurgical Societies. The aim of this historical paper is to provide a concise chronology of important events and mention key individuals who have contributed to the development of modern neurosurgery in Bosnia and Herzegovina.

Introduction: Meningiomas are the most common benign tumor of the central nervous system, accounting for 53.3% and 37.6% of all central nervous system tumors (1). The World Health Organization (WHO) Grade I meningiomas account for 80.5% of all meningiomas and are considered benign meningiomas; the WHO Grade II meningiomas account for 17.7% of all meningiomas and exhibit more aggressive behavior. Methods: In the period 2015-2022, a retrospective single-center study at the clinic of neurosurgery at the Clinical Center University of Sarajevo was conducted, which included patients with a pathohistological finding of WHO Grade I or II meningioma. Depending on the pathohistological grade of the tumor, patients were divided into two groups: Grade I and Grade II patients. Patients were examined clinically and radiologically. Clinical data collected included in the study: Gender, age, number of symptoms before surgery, whether patients were symptomatic or asymptomatic, pre-operative Eastern Cooperative Oncology Group,and Karnopsky performance scale. Pre-operative contrast magnetic resonance imaging of the head measured tumor volume, temporal muscle thickness (TMT), sagittal midline shift, and surrounding cerebral edema. Results: A total of 80 patients were enrolled in the study, 68 with WHO Grade I and 12 with WHO Grade II meningiomas. We found that patients with Grade I meningioma were younger and that the mean thickness of the temporal muscle was statistically thicker than in patients with Grade II. Increasing TMT was significantly and positively associated with Grade I tumors and negatively associated with Grade II tumors (p = 0.032). Conclusion: This study demonstrates that TMT can serve as a radiologic pre-operative indicator of meningioma grade and provide valuable guidance to neurosurgeons in surgical planning. Further studies are needed to validate these results.

Background and Objectives: To investigate the role of augmented reality (AR) in skull base (SB) neurosurgery. Materials and Methods: Utilizing PRISMA methodology, PubMed and Scopus databases were explored to extract data related to AR integration in SB surgery. Results: The majority of 19 included studies (42.1%) were conducted in the United States, with a focus on the last five years (77.8%). Categorization included phantom skull models (31.2%, n = 6), human cadavers (15.8%, n = 3), or human patients (52.6%, n = 10). Microscopic surgery was the predominant modality in 10 studies (52.6%). Of the 19 studies, surgical modality was specified in 18, with microscopic surgery being predominant (52.6%). Most studies used only CT as the data source (n = 9; 47.4%), and optical tracking was the prevalent tracking modality (n = 9; 47.3%). The Target Registration Error (TRE) spanned from 0.55 to 10.62 mm. Conclusion: Despite variations in Target Registration Error (TRE) values, the studies highlighted successful outcomes and minimal complications. Challenges, such as device practicality and data security, were acknowledged, but the application of low-cost AR devices suggests broader feasibility.

Aim To investigate the correlation of body mass index (BMI) with severity of intervertebral disc degeneration. Methods The study enrolled patients who had undergone surgical intervention for a herniated disc at the Department of Neurosurgery of the Cantonal Hospital Zenica. Patients underwent thorough preoperative evaluation, including medical history, neurological and physical assessments, and radiological analysis. The surgical intervention consisted of a posterior lumbar discectomy, and the excised disc material was preserved and subjected to histopathological analysis based on Histopathologic Degeneration Score (HDS). Patients were divided in two groups according to Body Mass Index (BMI): study group with BMI≥25 and control group with BMI<25. Results Among 69 patients with herniated IVD, 26 (37.7%) were with BMI≥25 (study group), and 43 (62.3%) were with BMI<25 (controls). The study group displayed substantial increase in height, 1.80±0.06 m compared to controls, 1.74±0.06 m (p=0.001). Weight and BMI were significantly higher in the study group of patients (weight: 91.60±10.22 vs. 67.37±9.20 kg, BMI: 28±2 vs. 22±2; p<0.001). Differences were confirmed in HDS values in the study group comparing to the control group (p<0.001). The study group exhibited significant differences in chondrocyte proliferation, tears and clefts, granular changes, and mucous degeneration (p<0.05), and positive correlations were found between BMI and these alterations found in the herniated discs (p<0.05). Therefore, HDS showed positive correlations with BMI (R=0.599; p<0.001) and weight (R=0.696; p<0.001). Conclusion The study's findings confirmed that BMI has a significant impact on intervertebral disc degeneration, emphasizing the importance of weight management in preventing disc degeneration.

This scoping review examines the use of CRISPR/Cas9 gene editing in glioblastoma (GBM), a predominant and aggressive brain tumor. Categorizing gene targets into distinct groups, this review explores their roles in cell cycle regulation, microenvironmental dynamics, interphase processes, and therapy resistance reduction. The complexity of CRISPR-Cas9 applications in GBM research is highlighted, providing unique insights into apoptosis, cell proliferation, and immune responses within the tumor microenvironment. The studies challenge conventional perspectives on specific genes, emphasizing the potential therapeutic implications of manipulating key molecular players in cell cycle dynamics. Exploring CRISPR/Cas9 gene therapy in GBMs yields significant insights into the regulation of cellular processes, spanning cell interphase, renewal, and migration. Researchers, by precisely targeting specific genes, uncover the molecular orchestration governing cell proliferation, growth, and differentiation during critical phases of the cell cycle. The findings underscore the potential of CRISPR/Cas9 technology in unraveling the complex dynamics of the GBM microenvironment, offering promising avenues for targeted therapies to curb GBM growth. This review also outlines studies addressing therapy resistance in GBM, employing CRISPR/Cas9 to target genes associated with chemotherapy resistance, showcasing its transformative potential in effective GBM treatments.

Abstract Background  Many recent studies show that exoscopes are safe and effective alternatives to operating microscopes (OM). Developments of robotics and automation are present in neurosurgery with the appearance of a newer device such as RoboticScope (RS) exoscope with a digital three-dimensional (3D) image and a head-mounted display. The body of the RS is connected to a six-axis robotic arm that contains two video cameras, and serves as stereovision. This robotic arm allows accurate 3D camera motions over the field of view, giving the user a great degree of freedom in viewpoint selection. The surgeons may specify the direction and speed of the robotic arm using simple head movements when the foot pedal is pressed. Since its development in 2020, the RS has occasionally been used in neurosurgery for a multitude of procedures. Methods  This study showcases vessel microanastomosis training on chicken legs using the RS. The aim of this study is to demonstrate the feasibility of the RS without a comparative analysis of the standard OM. The study was conducted in 2023 during a month-long trial period of the device at the Department of Neurosurgery of the Clinical Center of the University of Sarajevo. All procedures including RS-assisted anastomosis were performed by a neurosurgeon in anastomosis training (A.A.) supervised by a senior vascular neurosurgeon (E.B.). For the purpose of the study, we evaluated occlusion time in minutes, bypass patency with iodine, and overall satisfaction of the trainee in terms of light intensity, precision of automatic focus, mobility of the device, ergonomics, and convenience of the helmet. Results  Ten RS-assisted microanastomoses were performed by interrupted suturing technique with 10.0 nylon thread. Bypass training included seven “end-to-side,” two “end-to-end,” and one “side-to-side” microanastomoses. The smallest vessel diameter was 1 mm. Occlusion time improved by training from 50 to 24 minutes, with contrast patency of the anastomoses in all cases without notable leakage of the contrast, except one case. Complete satisfaction of the trainee was achieved in 7 out of 10 cases. During this period, we also performed different RS-assisted surgeries including a single indirect bypass, convexity brain tumor resection, and microdiscectomies. Conclusion  RS provides a new concept for microanastomosis training as an alternative or adjunct to the standard microscope. We found a full-time hands-on microsuturing without the need for manual readjustment of the device as an advantage as well as instant depth at automatic zooming and precise transposition of the focus via head movements. However, it takes time to adapt and get used to the digital image. With the evolution of the device helmet's shortcomings, the RS could represent a cutting-edge method in vessel microanastomosis in the future. Nevertheless, this article represents one of the first written reports on microanastomosis training on an animal model with the above-mentioned device.

Background: MRI techniques of the lumbar spine have not provided data on the effect of gravity on the spine and on the relationship of anatomic structures during its action. Because conventional MRI examinations of the spine are usually performed in the supine position these are often exacerbated by standing upright and are not evident in the supine position the loading conditions differ from those known to cause symptoms in patients with lumbar instability. Axial loading imaging may improve diagnostics in the clinical management of LBP and lead to appropriate treatment decisions. Objective: The aim of this study is to determine the significance of alMRI in detecting the morphologic changes of the lumbar spine caused by axial loading and to compare it with conventional MRI images of the lumbar spine without loading. Methods: The study was conducted as a prospective, descriptive clinical trial. Imaging was performed with a MRI 1.5 T in the head-first supine position. Imaging was performed in two acts: without load and under load. Loading for alMRI was performed with the DynaWell L-Spine device. The onset of loading was 10 minutes before the start of alMRI. The loading continued throughout the imaging procedure. The height of the IV, AP and LL diameters of IV, IV disk surface area, DSCA and width of the IV foraminas before and under load was measured. Results: After evaluating the changes in the height and size of the lumbar disks, the size of the DSCA, and the narrowing of the intervertebral foramina significant differences were found between the images before and after axial loading. Conclusion: alMRI provides information on morphological changes of all segments of the lumbar spine. This data represents significant information that can lead to more accurate and effective treatment of LBP.

Uvod: Do sad korištene tehnike magnetno rezonantnog oslikavanja lumbalne kičme nisu davale podatke o djelovanju sile gravitacije na kičmu, te o odnosu anatomskih struktura prilikom djelovanja iste. Budući da se konvencionalni MRI pregledi kičme obično izvodi u ležećem položaju, u funkcionalnom mirovanju, stanje opterećenja se razlikuje od stanja za koje se zna da izaziva simptome kod pacijenata pogođenih nestabilnošću lumbalne kičme, to se često pogoršava uspravnim stajanjem i nevidljivo je u ležećem položaj. alMRI može poboljšati kvalitet dijagnosticiranja patologije lumbalne kičme i dovesti do lakšeg odlučivanja o daljem tretmanu. Cilj ovog istraživanja je utvrditi značaj alMRI u otkrivanju morfoloških promjena lumbalnog dijela kičme uzrokovanih aksijalnim opterećenjem i uporediti ga sa konvencionalnim MRI snimcima lumbalne kičme bez opterećenja. Metode: Studija je provedena kao prospektivno, deskriptivno kliničko ispitivanje. Snimanje je izvedeno na MR aparatu 1,5 T u ležećem položaju. Snimanje je izvedeno u dva čina: bez opterećenja i pod opterećenjem. Opterećenje za alMRI obavljeno je DynaWell L-Spine uređajem. Početak opterećenja bio je 10 minuta prije početka snimanja alMRI, a opterećenje se nastavilo tokom čitave procedure snimanja. Izmjerena je visina inetrevtebralnih (IV) prostora, AP i LL prečnik IV diska, površina IV diska, površina duralne vreće i širina IV foramena prije opterećenja i pod opterećenjem. Rezultati: Nakon evaluacije promjena visine i veličine lumbalnih diskova, površine duralne vreće i širine intervertebralnih prostora utvrđene su značajne razlike između slika prije i pod aksijalnim opterećenjem. Zaključak: alMRI daje informacije o morfološkim promjenama svih segmenata lumbalnog dijela kičme. Ovi podaci predstavljaju značajnu informaciju koja može dovesti do preciznijeg i efikasnijeg liječenja LBP.

Background: Epilepsy is a brain disorder characterised by unpredictable and excessive nerve cell activity that causes epileptic seizures. Epileptic seizures are more common in children and adolescents than in elderly population. Electroencephalography (EEG) is a diagram of electrical activity of the brain and it is used as a method of choice for diagnosing epilepsy. Despite the accurate EEG tracing of electrical activity in the brain, the disadvantage of this type of analysing is the doctor’s skill to read the EEG correctly. Objective: The aim of this study was ro represents further research presented in our pevious works with wavelet based EEG analysis after masuring a multiresolution as relation between time and frequency resolution. Methods: Signal database set consist of 51 patients: a) healthy patient; b) 50 patients with a diagnosis of epilepsy. Additional characteristics of the analysed data: a) 19 signals-channels of EEG, b) Duration – 20 s or 2688 samples and. Nowadays, we can find dozens of EEG signal analysis papers using mathematical approach and with a focus on identification of epilepsy. Results: This paper represents some results relating to the analysis of EEG in children using Wavelet Transform (WT). The signals was collected and analysed at the Department of neuropediatrics, Pediatric Clinic at the University Clinical Center, University of Sarajevo. Conclusion: Using this approach it is possible to clearly differentiate patients with a diagnosis of epilepsy from healthy ones.