Managing Complications Related to Peripheral Nerve Surgery: Selected Illustrative Cases.

Peripheral nerve surgery mostly involves elective procedures; thus, the associated complications are of great clinical, social, and medicolegal importance. Apart from the general perioperative morbidity, complications during interventions on peripheral nerves are extremely rare. However, iatrogenic peripheral nerve injuries during unrelated surgical procedures performed by those not specialised in peripheral nerve surgery remain the most significant group of complications, accounting for up to approximately 17% of all cases.

Peripheral nerve surgery in Serbia: "Think global, act local" and the privilege of service.

Introduction: The phrase "think globally, act locally", which has often been used to refer to conservation of the environment, highlights the importance of maintaining a holistic perspective and stipulates that each individual has a role to play in their community and larger world. Although peripheral nerve surgery has been largely unemphasized in global neurosurgical efforts, a wide disparity in peripheral nerve surgery is presumed to exist between high-income and low- and middle-income countries. Serbia is an upper middle-income country with a long history of peripheral nerve surgery.

A Brief History of Peripheral Nerve Surgery in Serbia.

Peripheral nerve surgery in Serbia has become the most fruitful subsection of national neurosurgery, with international recognition of Serbian surgeons and institutions. We chronicle landmark events in the history of the field in Serbia, highlighting the development of the field over time and outlining future prospects. This manuscript provides an example of the development of peripheral nerve surgery and associated training in a challenging social, political, and economic context and may guide the development of peripheral nerve surgery care and training in other settings.

The role of arm volumes evaluation in the functional outcome and patient satisfaction following surgical repair of the brachial plexus traumatic injuries.

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.

Viable C5 and C6 Proximal Stump Use in Reconstructive Surgery of the Adult Brachial Plexus Traction Injuries.

Background: In patients with only upper (C5, C6) brachial plexus palsy (BPP), the pooled international data strongly favor nerve transfers over nerve grafts. In patients with complete BPP, some authors favor nerve grafts for the restoration of priority functions whenever there is a viable proximal stump.

Objective: To evaluate functional recovery in cases of upper and complete BPP where only direct graft repair from viable proximal stumps was performed.

MANAGEMENT OF BRACHIAL PLEXUS MISSILE INJURIES.

- Missile injuries are among the most devastating injuries in general traumatology. Traumatic brachial plexus injuries are the most difficult injuries in peripheral nerve surgery, and most complicated to be surgically treated. Nevertheless, missile wounding is the second most common mechanism of brachial plexus injury.

Nerve Grafting versus Common Infraclavicular Intraplexal Nerve Transfer in Elbow Flexion Restoration.

Aim: To compare the results of nerve grafting versus common infraclavicular intraplexal nerve transfer in elbow flexion restoration.

Material And Methods: The study included 39 patients with upper brachial plexus palsy who were operated using common intraplexal nerve transfer (Oberlin procedure) and the thoracodorsal and medial pectoral nerve transfer to the musculocutaneous nerve or grafting of C5 to the musculocutaneous nerve, for elbow flexion restoration. All patients underwent detailed preoperative evaluation, which included clinical and neurological examinations, electrophysiological investigation and neuroradiological studies.

Outcome after brachial plexus injury surgery and impact on quality of life.

Background: The aim of this study was to investigate outcomes after surgery for brachial plexus injury (BPI), not only motor outcomes but also the quality of life of the patients.

Methods: We operated on 128 consecutive patients with BPI from 1992 to 2012. We documented the information on the injured nerve, level of injury, type of treatment used, timing of surgery, patient age, and preoperative and postoperative motor deficits.

Nerve injuries of the upper extremity associated with vascular trauma-surgical treatment and outcome.

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.

The Prevalence of Spine Deformities and Flat Feet among 10-12 Year Old Children Who Train Basketball--Cross-Sectional Study.

The aim of this study is to estimate the prevalence of spine and feet deformities among children who are regularly involved in basketball trainings, as well as finding differences in the prevalence of those deformities between children of different gender and age. The study included a total of 64 children, of which 43 were boys and 21 were girls, ages 10-12. All subjects have been regularly participating in basketball trainings for at least one year.

Etiology and mechanisms of ulnar and median forearm nerve injuries.

Unlabelled: BACGRAUND/AIM: Most often injuries of brachial plexus and its branches disable the injured from using their arms and/or hands. The aim of this study was to investigate the etiology and mechanisms of median and ulnar forearm nerves injuries.

Methods: This retrospective cohort study included 99 patients surgically treated in the Clinic of Neurosurgery, Clinical Center of Serbia, from January 1st, 2000 to December 31st, 2010.

INTRAOPERATIVE ANEURYSMAL RUPTURE: CLINICAL OUTCOME FOLLOWING OPEN SURGERY OR ENDOVASCULAR TREATMENT.

The aim of this study was to evaluate and compare the outcomes of intraoperative aneurysmal rupture in patients with subarachnoid hemorrhage undergoing open surgical or endovascular treatment. This retrospective study included 742 patients with aneurysmal subarachnoid hemorrhage treated at the Clinical Department of Neurosurgery, Clinical Center of Serbia, during a three-year period. Among them, 167 (31.

Factors Influencing Intraoperative Rupture of Intracranial Aneurysms.

Aim: The study deals with intraoperative rupture of intracranial aneurysms (IOR) during microsurgery, analyzing factors that may be connected with IOR.

Material And Methods: During the three-year period (2006-2008), 934 patients were operated for aneurysms at the Institute of Neurosurgery, CCS, Belgrade. In total, 536 patients were observed.

The epidemiology of forearm nerve injuries--a retrospective study.

The aim of this study was to investigate the mechanisms and etiologic factors of forearm nerve injuries. This retrospective survey included all patients treated surgically in Clinical Department of Neurosurgery, Clinical Center of Serbia, from January 1, 2000 to December 31, 2010. All relevant data were collected from medical records.

A rare case of peripheral nerve hemangioblastoma—case report and literature review.

Hemangioblastoma is a rare benign tumor that consists of neoplastic vacuolated stromal cells and highly developed capillary blood vessels. These tumors are almost exclusively found in the central nervous system, but in extremely rare cases, it can arise in peripheral nerves. In the majority of cases, it occurs sporadically (60 to 75%), but in about 25% of cases, it is associated with von Hippel-Lindau disease.

Collateral branches of the brachial plexus as donors in nerve transfers.

Background/aim: Nerve transfers in cases of directly irreparable, or high level extensive brachial plexus traction injuries are performed using a variety of donor nerves with various success but an ideal method has not been established. The purpose of this study was to analyze the results of nerve transfers in patients with traction injuries to the brachial plexus using the thoracodorsal and medial pectoral nerves as donors.

Methods: This study included 40 patients with 25 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve.

Surgical treatment of glioblastoma multiforme localized in the motor area of the brain using the technique of cortical electrostimulation.

Aim: Glioblastoma multiforme in the motor area is the surgical challenge because of the need for more radical resection in order to extend the life of the patient, and the risk that radicalism could lead to additional neurological deficit.

Material And Methods: We present series of 26 patients with glioblastoma multiforme localized in and around the motor area, who were hospitalized from October 2004 to February 2009. During all operations, we conducted electrostimulation display area of the brain, to the anatomical location of M1 segment of the motor cortex.

[Primitive trigeminal artery associated (corrected) with arteriovenous malformation of cerebellum].

Introduction: Persistence of fetal cerebral carotid basilar anastomoses is rare. When it occurs, it is often associated with other vascular malformations, and other pathological conditions. Trigeminal primitive artery persistence is the most often among them.

Nerve transfers using collateral branches of the brachial plexus as donors in patients with upper palsy--thirty years' experience.

Background: Nerve transfers in cases of directly irreparable or high-level extensive brachial plexus traction injuries have been done using a variety of donor nerves with various success, but an ideal method has not been established. The purpose of this study is to analyze the results of nerve transfers using the thoracodorsal and medial pectoral nerves as donors in patients with upper palsy.

Methods: This retrospective study included 40 patients with 29 procedures using the thoracodorsal nerve and 33 procedures using the medial pectoral nerve as donors for reinnervation of the musculocutaneous or axillary nerve.

Natural course of the arteriovenous malformations of the brain initially presented by hemorrhage: analysis of a clinical series of 39 patients.

Aim: AVM because of outstanding tendency toward bleeding, even though 20 times more rare then aneurysm on the blood vessels of the brain and her own specific anatomical structure even today represents big neurosurgical challenge.

Material And Methods: Series which is shown here consists of 39 patients which were hospitalized in the institute for neurosurgery of the Clinical Center of Serbia in the period between 1995 and 2004. This group was exposed to symptomatic therapy or it was estimated that surgery, embolization and radio surgery.

Intrapontine malignant nerve sheath tumor: MRI and MRS features.

The primary source of malignant intracerebral nerve sheath tumors is still unclear We report the imaging and MR spectroscopic findings in a 39-year-old man with a very rare brain stem tumor MR examination revealed the presence of intraaxial brain stem tumor with a partial exophytic growth. On pathological examination, the neoplasm appeared to be an intrapontine nerve sheath tumor originating most likely from the intrapontine segment of one of the cranial nerve fibres. The tumor showed exophytic growth, with consequent spread to adjacent subaracnoid space.