Backgroud: Intervertebral disc herniations are caused by rupture of the fibrous ring and migration of one part of the nucleus pulposus towards the spinal canal. The most commonly affected levels are C5-C6 and C6-C7. Surgical treatment of cervicobrachialgia is indicated in the presence of long-term intense pain syndrome with or without radicular sensory-motor deficit and magnetic resonance (MRI) verified disc herniation with a compressive effect. Objective: The most common surgical treatment is anterior lateral microdiscectomy with or without the use of implants. In addition to this method, dorsolateral microsurgical treatment can be used for foraminal hernias. Methods: This retrospective study included 110 (58 / 52.7% male and 52 / 47.3% female) patients with cervical disc herniations who were surgically treated at the Neurosurgery clinic of Clinical Center of Sarajevo University (CCUS) in a five-year period. Stability, postoperative curvature, arthrodesis, implants, and changes in adjacent segments were radiographically analyzed. In the outcome assessment, functional outcome and patient satisfaction were analyzed using the Pain Self-Evaluation Scale (VAS), Prolo functional and economic score, and White’s classification of treatment outcomes. Results: The dominant prevalence of changes was recorded at the levels of C5-C6 (58%) and C4-C5 (28%) with a ventrolateral approach performed in 90% of patients. The largest representation is hard dorsolateral discs (n = 77). In the group of patients with placed implant, hard discs were present in 96 (90%) cases (p <0.001), while soft discs were dominant in patients without implant placement (p <0.001). In the group of subjects with implant, the most common are hard dorsolateral discs and those of mixed localization in 41 of 55 patients (65.5%; p = 0.001). The most common implant is PEEK cage (74.5%). From complications, we had partial vertebral body fractures in 4.5% of patients. Furtehr, the most common are sensory disturbances in 2.73% of respondents. Reduction of symptoms and improvement of preoperative neurological status were observed in over 95% of patients. Conclusion: Surgical treatment of cervical disc herniation is a safe method with a minimal percentage of complications. Microsurgical discectomy significantly contributes to the improvement of the functional status of patients, the reduction of pain, and the improvement of neurological deficit and overall mobility.

Background Mirror aneurysms represent 2 adjacent arterial protrusions. Although the size is considered a major risk factor in terms of rupture, sometimes it is the smaller aneurysm that ruptures. Here, we present the contemporary management of mirror distal anterior cerebral artery (DACA) aneurysms associated with multiple aneurysms. Computational fluid dynamic (CFD) analysis was performed when assessing multiple aneurysms using Hemoscope, version 2015. Case Description Among multiple aneurysms, a mirror A2/A3 DACA aneurysm was found in a single patient. Surgical treatment was provided for all aneurysms through a single-stage procedure. The left ruptured A2/A3 aneurysm was smaller compared with the right (7.5 × 3.5 mm/10.8 × 3.2 mm). CFD showed greater wall pressure (WP) in the left ruptured A2/A3 aneurysm (left A2/A3 WP 84,000–84,402 Inst. mm Hg/right A2/3 WP 84,224–84,315). WP in the left middle cerebral artery and anterior communicating artery aneurysms showed lesser values compared with the ruptured aneurysm (WP upper values 84,361 and 84,367, respectively). Wall shear stress showed low values for all aneurysms with the lowest flow rate values in the left A2/A3 aneurysm. Conclusions In cases of ruptured mirror aneurysms followed by the presence of intracerebral hematoma, surgery is considered the primary option with the best results. A one-stage dual craniotomy procedure was found safe in the associated treatment of other multiple aneurysms. At present, the size of the aneurysm, the hemodynamic influence, and the local configuration are all considerations during the preoperative assessment of multiple aneurysm cases. According to our knowledge, this article presents the first CFD analysis of mirror DACA aneurysms associated with aneurysm multiplicity.

BACKGROUND Migration of distal ventriculoperitoneal (VP) shunt catheter into another body part has been described as a potentially serious surgical complication. We present the first case of sepsis caused by transcardial and pulmonary migration of distal catheter into the heart and pulmonary artery, which was subsequently colonized by Klebsiella pneumoniae. CASE REPORT A 56-year-old men underwent VP shunt insertion for hydrocephalus that developed after the surgery for intracranial meningioma. Three years later, he was admitted to Department for Infectious Diseases due to persistent fever. Klebsiella pneumoniae was isolated from the blood cultures. Computerized tomography (CT) of the thorax showed migration of the distal catheter into the heart and pulmonary artery. The migrated shunt catheter was retrieved without any complication with the assistance of a cardiovascular surgeon; microbiology confirmed that the catheter was colonized with Klebsiella pneumoniae. We decided to delay new VP shunt placement due to positive blood cultures, and 3 weeks after the surgery, patient was without signs of increased intracranial pressure and without any heart problems. CONCLUSION Migration of a distal VP shunt catheter into the heart should be considered in patients with a previously placed VP shunt presenting with cardiopulmonary problems, arrhythmia, and/or fever. Neurosurgeons should be involved as soon as possible, and a multidisciplinary approach is warranted.

Glioma surgery has been the main component of glioma treatment for decades. The surgi- cal approach changed over time, making it more complex and more challenging. With molecular knowledge and diagnostic improvement, this challenge became maximally safe resection of tumor, which resulted in prolonged overall survival, progression-free period, and a better quality of life. Today, the standard glioma treatment includes maximally safe resection, if feasible, administration of temozolomide, radiotherapy, and chemotherapy. Surgical resection is performed as subtotal resection, gross total resection, and supratotal resection. Subtotal resection is the resection where a part of tumor is left. Gross total resection is a complete removal of the magnetic resonance imaging (MRI) visible tumor tissue. Supratotal resection is performed as gross total resection with excising the MRI visible tumor tissue borders into the unaffected brain tissue. Before we make final decision on which type of resection should be performed, many factors have to be considered. The question has to be answered: what the actual impact of resection on the progression of glioma is and what the functional risk of resection is.