Biomedical subjects

Kemal Dizdarević

Publications and source records attributed to Kemal Dizdarević.

5 recordsLinked to original sources

PubMed2006

[Subarachnoid hemorrhage: neurosurgical treatment modalities and etiological analysis].

INTRODUCTION: The subarachnoid hemorrhage (SAH) is excess presence of blood in the subarachnoid space. The most frequent cause of SAH is cerebral aneurysm rupture and neurotrauma. The treatment strategy is specific for the different forms of SAH but all therapeutic options are based on the prevention of secondary ischemic brain injury generating after initial hemorrhage. OBJECTIVE: To point out the varieties of SAH etiology and different modalities of its treatment, especially presenting the aneurismal SAH. PATIENTS, METHODS AND RESULTS: The retrospective-prospective study was performed at the Department of Neurosurgery in Sarajevo (DNS). Over a span of two years, from January 1st 2003 to December 31st 2004, 161 patients with etiologically different SAH were treated. The higher number of patients was treated during 2004 compared with a year before, respectively 101 and 60 patients. Totally, eighty three patients were operated on (52%, 83/161). The surgery was performed in 60% (61/101) of cases in the second year but only 37% in the first year of study (22/60). The most frequent cause of SAH was the rupture of cerebral aneurysm (48%). The other causes were trauma (28%), brain arteriovenous malformations (4, 3%) and hypertension with atherosclerosis (1.8%). The cause is not found in 18% of cases (29/161) and this SAH category is defined as an idiopathic SAH. A total of 64 patients with ruptured aneurysms were operated on by the author (KD) during two years 17 in 2003, and 47 in 2004. DISCUSSION: We use the defined treatment protocols for the different forms of SAH which are based on current knowledge and particulars of locality aiming to decreased possibilities of repeated bleeding and delayed ischemia. The higher number of patients with aneurysmal SAH compared to those with traumatic SAH was admitted. The reason for this is the fact that systematic management of patients with cerebral aneurysms in Bosnia and Herzegovina has been doing exclusively in our Department. CONCLUSION: The number of treated patients with SAH, especially aneurismal SAH, is significantly increased in DNS during two last years. Our patients received the standard and current treatment which implies micro neurosurgery and conservative care at the separate Neurosurgical intensive care unit. The introduction of endovascular neurosurgery and developing of neuroanesthesia as a subdiscipline is expected to increase the quality of our serves.

Adolescent↗

PubMed2006

[Craniofacial surgical treatment of the gigantic plasmacytoma of the skull base: case report].

The complex craniofacial surgery of solitary bone plasmacytoma (SBP) of the skull base with excellent postoperative outcome was presented. This surgical management was result of the team approach and strategy of neurosurgeon (KD) and maxillofacial surgeon (TM). SBP of the skull base is very rare condition which should be treated by radical microsurgical resection and postoperative radiotherapy.

Adult↗

PubMed2005

[Neurofibromatosis type 2--case report].

Young female patient, diagnosed and treated by ophthalmologist and neurosurgeon, are presented. Through this case the basic characteristics of NF 2 are stressed. The different clinical implications and similarities of NF I as a neurocutaneous disorders and NF 2 as a central form of disease are pointed out.

Adult↗

PubMed2005

[Operative treatment of the vestibular schwannoma (acoustic neuroma): correlation between the microsurgical approach and cranial nerve lesion].

INTRODUCTION: Vestibular schwannoma (VS) is a benign tumour of cerebellopontine angle which total microsurgical resection is considered as a complex surgery. In Bosnia, VS microsurgical resection is performed occasionally and exclusively at the University Neurosurgical Depart. in Sarajevo, but radiosurgery of these tumours is completely absent. METHODS AND RESULTS: The role of microsurgery in resection of VS is being presented. Through analyzed series of operated patients (MJLink), we evaluated the correlation of VII and VIII nerves postoperative lesion with different operative approaches. House-Brackmann grading scale is used for VII nerve deficit appraisal. Current postoperative results of recognized experts are compared with our series and the similar morbidity rates are found. DISCUSSION: Microsurgery is a dominant and superior way of VS treatment. However, the most frequently used microsurgical approaches (retrosigmoid, translabyrinthine and extradural subtemporal) are still connected with certain morbidity rate, especially regarding the postoperative VII and VIII nerves lesion. CONCLUSION: Team approach, intraoperative cranial nerves monitoring and microsurgery with utilizing different surgical approaches optimize the outcome of VS neurosurgical treatment. In Bosnia, we are just stepping in the field of serious approach to this problem.

Facial Nerve Injuries↗

PubMed2004

[Early and urgent (micro)surgery of single and multiple intracranial aneurysms of anterior and posterior circulation and total mortality rate after operative and conservative treatment].

INTRODUCTION: The early and urgent ruptured cerebral aneurysm microsurgery principle is being presented. In Bosnia, this principle was pioneered by author (KD) as a part of aneurysmal subarachnoid hemorrhage treatment. The main goal of this strategy was to prevent the rehemorrhage which mortality rate is up to 80%. PATIENTS AND RESULTS: A one-year (April 2003-April 2004) prospective study of 24 no selected patients with 33 anterior and posterior circulation aneurysms was conducted. Patients were operated on early (42%) and urgently (58%) regardless of their Hunt-Hess grade, age and vasospasm, but also localization, size and number of aneurysms. Twenty four ruptured aneurysms underwent the clip occlusion (100%). A total of 30 (91%) aneurysms were clipped with only one intraoperative rupture (3.3%). The overall mortality rate for anterior circulation aneurysms regardless of HH grade was 12.5%. All patients with HH gr I and II had excellent outcome (100%). Mortality rate of patients with HH gr III harboring anterior circulation aneurysms was 7.6%. The patients with HH gr IV and V died in 50% of cases despite surgical treatment. Multiple aneurysms increased mortality rate of operated patients. DISCUSSION: Ruptured aneurysm should be occluded immediately although the operative outcome of early and urgent surgery is worse than late surgery. Especially urgent surgery has bad outcome because it is mainly performed during cerebral vasospasm. But the overall outcome is the worst after utilizing the principle of late surgery. In one month period of time, no operated patients have 50% of chance to experience rehemorrhage (80% mortality rate), 36% of chance to develop symptomatic vasospasm with 7-15% mortality, and 20-50% possibility of occurring the hydrocephalus. According to recent studies, the overall mortality rate of untreated patients with aneurysmal SAH is over 50%. Mortality of surgically and conservatively treated patients is 20-30%. The survival rate of patients with HH gr IV and V who are exclusively treated by conservative therapy is only 10%. CONCLUSION: Early and urgent aneurysm microsurgery resulted in outcome improvement of operated patients up to 30% compared with expected outcome of patients without surgery. The justification for early and urgent aneurysm surgery was found in almost all patient groups, HH gr I&II patients had benefit in 23-30% of cases, HH gr IV&V had benefit in 20-40% and HH gr III with anterior circulation aneurysms had benefit in 15-20% of cases.

Aged↗