Introduction: Tumors of spleen are generally rare disorders. The most common primary splenic neoplasm is haemangioma, although very rare. Giant, cavernous splenic haemangioma is extremely rare, less than 100 cases have been reported in the literature. Case report: We present a case of giant haemangioma in a 65 years-old patient. Radiological diagnostic methods were not conclusive. Magnetic resonance imaging showed en expansive, heterogenous lesion with signs of necrosis and haemorrhage in the central part. Those characteristics raised suspicion in malignant neoplasm, especially haemangiosarcoma and metastatic neoplasm. The surgical team performed total splenectomy, with special attention to possible bleeding as a severe complication. Pathohistological finding was undoubted. There were certain signs of benign, cavernous splenic haemangioma with areas of coagulative necrosis. Conclusion: We need to be aware of such rare entity. MRI is the most reliable diagnostic method, but the pathohistological analysis is definitive. Surgery is a treatment of choice.

Abstract Glioblastoma, also known as glioblastoma multiforme, is an aggressive type of cancer that is made up of abnormal astrocytic cells, but also contain a mixture of different cell types (including blood vessels) and areas of necrosis. It is often seen in the brain and spinal cord, but glioblastomas are rarely found in the third ventricle. In this case, it was diagnosed in a 22-year-old male patient and we intended to draw attention to its atypical localization and surgical access to this third ventricle glioblastoma.

Abstract Objective To provide relevant insight into the current degree of usage of the research potential of students of biomedical sciences in Bosnia and Herzegovina. Method The chosen data collection method was online surveying via Google search engine. The target group were students of biomedical sciences in Bosnia and Herzegovina. The surveying was conducted in July 2019, and responses were subjected to descriptive statistics. Results Although the majority of participants claimed that they were familiar with the seminar and scientific papers writing methodology and that the related course is available in their faculty’s curriculum, the quality of such courses may be questioned as the majority of study participants self-reported that they do not possess or did not posses necessary knowledge for writing and publishing a scientific paper. Also, the majority of respondents reported that they have never participated in any scientific research, which questions the involvement of students in scientific research in our country as well. More than half of respondents were actively reading scientific papers, but a third of them did not have that habit. Two-thirds of students reported that they have never attended any scientific event where they could learn more about the scientific research methods. Inadequate awareness of the importance of research, lack of students’ interest in making a research, and lack of knowledge were characterized as main obstacles in conducting scientific research according to survey responses. Conclusion Information obtained through research indicate that the student potential in scientific research in Bosnia and Herzegovina has not been used in its maximal capacity, requiring several steps to be taken towards its improvement.

Abstract Objective: To determine the incidence of gliomas in Zenica - Doboj Canton. Moreover, to analyse its potential connection to sociodemographic characteristics and its distribution throughout municipalities of Zenica - Doboj Canton in the period of 2009-2019. Method: This retrospective, descriptive - analytical, 10 - year study included 146 patients from Zenica -Doboj Canton. Data were obtained and reviewed from patient’s medical records. Patients’ sociodemographic characteristics and pathohistological diagnosis were included in the study. Age, gender, and the place of birth were analysed and correlated with types and grades of glial tumors according to the World Health Organisation’s latest classification. Results: The study consisted of 146 patients including 84 (58%) males and 62 (42%) females. The most common pathohistological diagnosis was glioblastoma multiforme, a grade IV glioma in both females (26%) and males (35%), in total 91 (62%) patients, and the rarest was oligoastrocytoma, in 2 (1%) cases. The municipality of Kakanj had the highest incidence of glioma with 29 out of total of 146 cases (0.077%) and the highest incidence in females (0.069%) with 13 cases. The municipality of Vareš had the highest incidence of glioma (0.114%) with 5 out of 84 male cases, while in the cities of Breza and Olovo any cases with glioma were not detected The results showed statistically significant differences in incidences of gliomas according to the region of residence. Conclusion The analysis of data indicated that there are significant connections between the occurrence of gliomas and sociodemographic characteristics of patients from Zenica - Doboj Canton.

Aim To analyse potential clinical implications of the distance between large retroperitoneal vessels and lower segment of the lumbar spine in the supine and prone position. Methods Prospective, non-randomised study included 40 patients of different age and gender. For all patients magnetic resonance imaging of the lumbar spine was performed in supine and prone position. The level of aortal bifurcation, common iliac vein confluence, the distance from the anterior and posterior aspect of the annulus to the posterior wall of the large retroperitoneal vessels were analysed. Results The study included 40 patients, 22 (55%) males and 18 (45%) females. The level of aortal bifurcation was higher in prone compared to supine position (χ2 = 29.88571; p<0.05). In supine and prone positions, the common iliac veins confluence was most commonly at the level of the lower third of the L4 vertebra (p>0.05). There was a statistically significant difference between the distance from the left common iliac artery to the anterior contour of L4/L5 intervertebral disc (p<0.05). Conclusion Knowledge of the anatomic relationship between iliac vessels and structures of the lower segment of the lumbar spine is very important in the prevention of a potentially severe complication, such as artificial common iliac vessels rupture. Our study showed that the risk of lesions of the common left iliac artery was lesser in the prone position.

Objective - To present the most efficatious management of raised intracranial pressure after severe trauma brain injury in a pediatric patient. Case report - A 5-year-old Caucasian presented to the emergency room due to head injury caused by falling down stairs. At the time of admission the patient was comatose with pediatric Glasgow Coma Score 6 (V-1, E-1, M-4) and signs of recent posterior head trauma. Computed tomography (CT) scan showed a multifragmented fracture of the occipital bone above the “sinus lake” causing an epidural mass, contusion in the right cerebellar hemisphere, a skull base fracture without signs of midline shifting. Six hours later, during monitoring in the intensive care unit, the patient became cardiorespiratory unstable with signs of uncal brain herniation and Cushing’s triad. Control CT revealed previously verified posttraumatic changes with new signs of decompensating internal hydrocephalus. Considering that evacuation of the epidural collection and decompression of impaired bone fragments in the area of the “sinus lake” would be too risky, extraventricular drainage as the first tier management was properly selected as the option of treatment. Taking into account the hazard / benefit ratio it was shown to be the most effective form of treatment, which was confirmed after six-month follow-up without any form of neurocognitive impairment. Conclusion – Treatment of traumatic brain injury (TBI) in the pediatric population requires a multidisciplinary approach. Different mechanisms of pediatric TBI injury vary widely by age groups and its impact on the development of primary and secondary brain lesions differs. Although many general principles of managing pediatric TBI are similar to adults, cerebral plasticity is one of the features which ultimately always leaves space for a better final outcome of treatment.

SUMMARY The aim of the study was to analyze correlation between morphological characteristics of intracranial meningiomas and Ki67 labeling index (Ki67 LI), and their influence on peritumoral brain edema (PTBE). There were 41 consecutive patients with intracranial meningiomas surgically treated at the Department of Neurosurgery, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina, during the period from January 2010 to December 2015. We reviewed clinical data including patient age, gender, magnetic resonance imaging (MRI) characteristics of the tumor and peritumoral edema, tumor margins, intraoperative characteristics, histopathologic grade and Ki67 LI. In all cases, follow up MRI was obtained at about three months after resection and PTBE was analyzed. Our research showed the tumor volume, tumor margins, and intraoperative signs of arachnoidal and pial invasion to be associated with PTBE in intracranial meningiomas. Ki67 LI expression correlated with PTBE. This study showed the resolution of PTBE to depend on invasive behavior of meningioma and KI67 LI. PTBE, pial/cortical and arachnoidal invasion significantly influence the extent of surgical resection.

<p style="text-align: justify;">Cranioplasty is the surgical repair of a bone defect in the skull that is left behind after a severe injury or previous operation. It is usually done to protect underlying brain tissue, reduce local pain and to improve the cranial vault aesthetics. Cranial prostheses can be made from different types of materials: autologous bone, titanium, ceramics and polymers. Their production is costly and often requires complex intraoperative processes which sometimes cause poor aesthetic results in large and complex defects. Using a real case, this paper presents a customised polymethyl methacrylate implant production method which involves three dimensional reconstruction based on CT scans, technology of 3D printing and moldmaking<br />from dental plaster.</p>

Aim To investigate the presence, type and distribution of spontaneous brain and arachnoid herniation into the dural venous sinuses as well as a clinical significance of these herniations. Methods This retrospective - prospective, non-randomised anatomical and clinical study included 990 patients who were referred to Magnetic Resonance Imaging at the Department of Radiology of the Cantonal Hospital in Zenica in the period from January to December 2016. The T1 and T2 sequences in axial, sagittal, and coronary section were used for brain or arachnoid herniation analysis. In all patients with intra-sinusal herniation health records were analysed and symptoms and reasons to refer for MRI examination were evaluated . Results In 26 (2.6%) patients (19 females; 73.08%) the arachnoid or brain herniation was found. Average age of patients was 40.269±16.496 years. Arachnoid herniation was presented in 15 (57.69%) and brain herniation in 11 (42.31%) patients. Statistical significance in relation to type of herniation was not found (p=11.070). Statistical significance between the symptoms and localisation of herniation (except for nausea and vomiting and posterior fossa herniations) (p=0.05) as well us between symptoms and type of herniation was not found (p>0.05). Conclusion The results suggest that there is a possibility of interconnection between arachnoid or/and brain herniations and some clinical symptoms such as nausea and vomiting.

Received: 12.09.2017 Accepted: 28.10.2017 Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina1, Department of maxillofacial surgery, Cantonal Hospital Zenica, Bosnia and Herzegovina2, Department of infectious diseases, Cantonal Hospital Zenica, Bosnia and Herzegovina3 Yazışma adresi: Fahrudin Alić, Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina e-mail: alifahrudyn@gmail.com INTRODUCTION

O bjective − To evaluate the optimal neurosurgical treatment of rare paediatric transorbital penetrating brain injuries. C ase report − A 6 year-old male patient was admitted to the Department of Emergency Medicine of Zenica Cantonal Hospital, Bosnia and Herzegovina, be- cause of an injury to the right eye caused by a knife. The patient was fully conscious, oriented, hemodynamically stable and without any neurological deficit and with a Glasgow Coma Scale score of 15. Computed Tomography showed a knife blade entering the right orbital roof and the medial part of the right frontal lobe, with an underlying tract hematoma. The patient underwent bifrontal craniotomy. The knife was removed carefully. There were no signs of vascular or related injuries on the trajectory. After surgery, the eye was examined by an ophthalmologist. The patient recovered fully and was discharged about ten days after surgery. Conclusion − Early surgery with a multidisciplinary approach is indicated in patients with transorbital penetrating brain injury to prevent serious complications. The outcome depends on the type of object, the point of entry, the trajectory, the extent of parenchymal injury, the presence of vascular injury, adequate dural closure and septic complications. .

O bjective − To analyse the results of the surgical treatment of myelomeningocele in the Zenica Cantonal Hospital in a five-year period. P atients and methods − This retrospective study included 10 patients with myelomeningocele, surgically treated at the Department of Neurosurgery, Zenica Cantonal Hospital, in the 2011-2016 period. Patients were assessed based on their history, symptoms and neurological state. In all cases we performed a detailed neurological examination and craniospinal Magnetic Resonance Imaging. In most cases we performed surgery within the first 72 hours after birth. In three patients we did not perform early surgery because the parents did not give consent for the operation in this period. All patients were hospitalized at the Department of Paediatrics, Zenica Cantonal Hospital. The patients were followed up by a neurosurgeon, a paediatric surgeon and a paediatrician. R esults − In our research, the incidence of myelomeningoceles in females and males was equal. In most cases the surgery is the most devastating congenital malformation compatible with survival. Newborns with late antenatal diagnosis must undergo surgery as soon as possible, preferably within 24-72 hours. Despite limited resources and conditions we documented a significant recovery in most patients. Conclusion − Myelomeningocele is the most devastating congenital malformation compatible with survival. Newborns with late antenatal diagnosis must undergo surgery as soon as possible, preferably within 24-72 hours. Despite limited resources and conditions we documented significant recovery in most patients.

Aim To define direct anatomical relations of the sphenoidal (alae minores), ethmoidal sinuses and optic nerve, with an emphasis on determining the effect of age on pneumatisation and dehiscence. Methods This retrospective, descriptive study involved 60 consecutive patients: 30 patients younger than 30 and30 patients older than 60 years of age. All patients underwent computerized tomography(CT). The relationship of the optic nerve and the sphenoidal and ethmoidal sinuses was classified. The presence of dehiscence in the bone structures, forming the optic canal, was checked. Dehiscence was defined as absence of visible bone density located between the sinus and the optic nerve. Protrusion of the optic nerve into the sphenoidal sinus was defined as optic nerve surrounded by pneumatised space. Results The most common type of relation between the optic nerve and sphenoidal sinus was type I, where the optic nerve was immediately adjacent to the lateral or superior wall of the sphenoidal sinus, without impression on the sinus wall. Dehiscence was documented in 15 (25%) cases, it was more common in older patients (8, 27%) than in younger ones (7, 23%). The pneumatisation processes were more frequent in patients over 60 (5, 17%) than in those younger than 30 years (4, 13%). Conclusion Surgeons and ophthalmologists should be aware of high frequency of dehiscence of sphenoidal sinus walls when treating adult patients in our population, especially when evaluating risks and complications of surgical procedures or when diagnosing inflammatory or tumorous processes in the close vicinity of posterior paranasal sinuses.

Aim To emphasize the importance of early recognition, diagnostic processing and emergent surgical treatment of spontaneous spinal epidural hematoma (SSEH). Methods A 39-year-old female presented with sudden onset of severe pain between the shoulder blades followed by paraparesis and alerted sensibility in the lower extremities. An hour later she developed paraplegia with sensory deficits below ThIV level, absence of patellar reflex, ankle jerk reflex and sphincter dysfunction. Results Magnetic resonance imaging (MRI) demonstrated acute extensive epidural mass of thoracic spinal segments (ThI-ThIII). The patient underwent emergent decompressive laminectomy ThI-ThIII with epidural hematoma evacuation within 24 hours of symptoms onset. After the surgical treatment, because of suspicion on spinal arteriovenous malformation, complete diagnostic evaluation with spinal angiography was done and no form of vascular malformation was found. Idiopathic SSEH was diagnosed. Two months later the patient reached complete neurological improvement. Conclusion The SSEH is a rare condition that should be kept in mind in patients presenting with neurological deficit and a sudden onset of back pain like it was in our case. For early diagnosis, immediate MRI is essential. Prompt surgical decompression such as laminectomy is an absolute surgical indication widely accepted for patients with progressive neurological deficit. The SSEH should be considered as one of the important differential diagnoses in patients who have developed acute myelopathy.