Minimalno invazivni keyhole pristup danas je uvriježeni operacijski postupak koji se koristi u Kl... more Minimalno invazivni keyhole pristup danas je uvriježeni operacijski postupak koji se koristi u Klinici za neurokirurgiju KBC Zagreb u operacijskom liječenju intrakranijskih patoloških promjena. U proteklih sedam godina u Klinici za neurokirurgiju keyhole pristupom je operiran 631 bolesnik s različitom intrakranijskom patologijom. Najveći broj bolesnika operiran je zbog intrakranijskih aneurizmi, a ostali zbog različitih patoloških procesa u području orbite i lubanjske osnovice. Sve operacije su načinjene uporabom standardnog mikrokirurškog postupka, a u pojedinih je bolesnika primijenjen endoskopski potpomognuti operacijski postupak. Minimalno invazivni keyhole pristup u liječenju intrakranijskih aneurizmi ima značajne prednosti kao što su skraćivanje trajanja operacije, manji kraniotomijski otvor, manje izlaganje mozga izvanjskim čimbenicima, brži poslijeoperacijski oporavak i izvrstan kozmetski učinak
In the last 20 years neurological and neurosurgical follow up of our patients with pineal region ... more In the last 20 years neurological and neurosurgical follow up of our patients with pineal region expansions (118 patients) pointed to certain clinical and neurophysiological regularities. We performed retrospective study which included 84 patients with pineal region expansions in the period from 1992 to 2009. The study included 55 women and 29 men, mean age 30.08 +/- 13.93 years, with positive brain magnetic resonance imaging (MRI)--70 patients (83.4%) had simple pineal gland cysts, and 14 patients (16.67%) had expansive process in pineal region with compressive effect. All patients had headache, while 32 patients (38%) had epileptic phenomena--primary generalized seizures. Patients had common electroencephalography (EEG) pattern with paroxysmal discharges of 3Hz (or more than 3 Hz) spike-and-wave complexes. Operation with supracerebellar infratentorial approach was performed in 70 patients. In most of our patients indication for the operation was established based on the size of th...
Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or ... more Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or without secondary generalisation in patients older than 12 years was approved in Europe in 1994 and in the United States in 1997. We have studied the efficacy of VNS in patients with pharmacoresistant epilepsy hospitalized in the Neurology Department of the University Hospital Centre Zagreb. From 1997 to 2001 we have implanted VNS in 11 patients with pharmacoresistant epilepsy, who were magnetic resonance imaging (MRI) negative and from May 2007 to May 2009 in 11 patients with pharmacoresistant epilepsy, 9 of them were MRI positive, and were inoperable due to localisation of the pathomorphologic changes (ganglioglioma, hamartoma, various types of cortical dysplasia, porencephalic cysts), 2 were MR negative. In the group of MRI negative patients 1 patient had complex partial seizures (CPS), 6 patients had CPS with secondary generalisation, 2 patients had primary generalized epilepsy (PGE)...
In this paper, our experience with originally constructed Neurosurgical Endoscopic Contact Ultras... more In this paper, our experience with originally constructed Neurosurgical Endoscopic Contact Ultrasound Probe "NECUP-2" in neuroendoscopy is reported. Between June 1997 and June 2007, 132 neuroendoscopic procedures have been performed: 102 endoscopic thrid ventriculostomies (ETV), 15 arachnoid cysts and 5 intraventricular tumours operations. The "NECUP-2" was applied effectively in all cases in which blunt perforation was not possible: 38/102 ETY, 10/10 septostomies, 15/15 arachnoid cysts. In five cases of intraventricular tumours, neuroendoscopic procedure was combined with open microsurgery for tumour removal with preservation of vascular structures. There were no "NECUP-2" related complications. Of postoperative complications, we had liquorrhea (9 patients), and symptoms of meningitis (6 patients). In the follow-up period (6 months to 6 years), we had a patency rate of 80% (50/63 patients). All patients improved in clinical status. According to the fir...
Cerebrospinal fluid (CSF) fistula as a consequence of brain missile injury and following infectio... more Cerebrospinal fluid (CSF) fistula as a consequence of brain missile injury and following infectious complications has been recognized for years. Different methods of treatment have been advocated. Missiles used in war cause extensive destruction of the skull and brain as a result of their high kinetic energy. On its transfer through the skull, such high kinetic energy causes fractures called "discontinuous fractures," which are distant from the entry wound and not related to the fracture of the vault. The role of the timely diagnosis of CSF fistulas and their early repair in the management of these wounds is emphasized. Data on 312 patients with missile injuries of the brain inflicted during the war in Croatia were retrieved and analyzed, with special reference to the complications of CSF fistulas and infection. Forty-five patients developed CSF fistula, 15 (33%) of them at the wound site, 23 (51%) as CSF rhinorrhea, and seven (15%) as CSF otorrhea. Six patients developed ...
In 1998, a teleradiology system was established in Croatia. It connects 34 CT, MRI and DSA scanne... more In 1998, a teleradiology system was established in Croatia. It connects 34 CT, MRI and DSA scanners in 29 hospitals with a referral centre in the neurosurgery department in Zagreb. In the first three years of its use, the network saved more than 400,000 km of patient transportation (i.e. without a teleconsultation, all of the patients would have had to be transported to the nearest referral neurosurgical unit). During the first seven years, an archive with 25,366 expert opinions was collected. A total of 7103 (28%) expert opinions were provided for the distant regional hospitals. The most common diagnoses for patients from regional hospitals were neurotrauma (53%), cerebrovascular diseases (22%) and brain tumours (19%). The teleradiology system was used less often for lumbar disc disease (4%), hydrocephalus or other neurosurgical disorders (2%). The most valuable results from teleradiology were the decisions about proper and effective patient treatment. In Croatia, the national teleradiology network for neurosurgery has speeded up therapy, avoided unnecessary travelling for patients and reduced costs.
Today laser has become a standard tool in modern minimal invasive microneurosurgery and it is bei... more Today laser has become a standard tool in modern minimal invasive microneurosurgery and it is being increasingly used in functional neurosurgery as well. Lasers have found their full and extensive application for their capacity of acting on pathological tissues without direct contact, through relatively small craniotomy, and in deep hardly accessible regions. In accordance with worldwide experience in successful use of laser power in neurosurgical procedures, in 1986 laser instruments were introduced into clinical practice at
We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping... more We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping or coiling in a 4-year-old child managed with aneurysm resection and RA interposition graft. A 4-year-old child presented with repeated severe headache and vomiting. Computed tomography, magnetic resonance imaging and magnetic resonance angiography and digital subtraction angiography showed a giant fusiform aneurysm on the right MCA. Because of the complex shape, endovascular treatment or clip reconstruction was not possible, and a bypass procedure was planned. Right frontotemporal craniotomy and orbitotomy was performed. Two aneurysms involving the M1 segment of the MCA were found in line, one giant, and the other large in size. The aneurysms were resected and treated with short radial artery interposition graft, which was narrower than the proximal or distal MCA. The child recovered normally, and the bypass was patent after 1 year. Large fusiform MCA aneurysms may be difficult to treat but there are treatment options that include a bypass procedure. Resection and short interposition radial artery graft is an excellent but rare treatment option in a very young child. This was very successful treatment in this child.
We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping... more We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping or coiling in a 4-year-old child managed with aneurysm resection and radial artery interposition graft. A 4-year-old child presented with repeated severe headache and vomiting. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography and digital subtraction angiography showed a giant fusiform aneurysm on the right middle cerebral artery (MCA). Because of the complex shape, endovascular treatment or clip reconstruction was not possible, and a bypass procedure was planned. Right frontotemporal craniotomy and orbitotomy was performed. Two aneurysms involving the M1 segment of the MCA were found in line, 1 giant, and the other large in size. The aneurysms were resected and treated with short radial artery interposition graft, which was narrower than the proximal or distal MCA. The child recovered normally, and the bypass was patent after 1 year. Large fusiform MCA aneurysms may be difficult to treat, but there are treatment options that include a bypass procedure. Resection and short interposition radial artery graft is an excellent but rare treatment option in a very young child. This was a very successful treatment in this child.
Journal of Neurological Surgery Part B: Skull Base, 2012
We retrospectively reviewed the hospital charts of six members of a family affected with NF2, inc... more We retrospectively reviewed the hospital charts of six members of a family affected with NF2, including clinical and operative reports, radiology, and neuropathology findings. Follow-up data, including functional outcome, was conducted
Minimalno invazivni keyhole pristup danas je uvriježeni operacijski postupak koji se koristi u Kl... more Minimalno invazivni keyhole pristup danas je uvriježeni operacijski postupak koji se koristi u Klinici za neurokirurgiju KBC Zagreb u operacijskom liječenju intrakranijskih patoloških promjena. U proteklih sedam godina u Klinici za neurokirurgiju keyhole pristupom je operiran 631 bolesnik s različitom intrakranijskom patologijom. Najveći broj bolesnika operiran je zbog intrakranijskih aneurizmi, a ostali zbog različitih patoloških procesa u području orbite i lubanjske osnovice. Sve operacije su načinjene uporabom standardnog mikrokirurškog postupka, a u pojedinih je bolesnika primijenjen endoskopski potpomognuti operacijski postupak. Minimalno invazivni keyhole pristup u liječenju intrakranijskih aneurizmi ima značajne prednosti kao što su skraćivanje trajanja operacije, manji kraniotomijski otvor, manje izlaganje mozga izvanjskim čimbenicima, brži poslijeoperacijski oporavak i izvrstan kozmetski učinak
In the last 20 years neurological and neurosurgical follow up of our patients with pineal region ... more In the last 20 years neurological and neurosurgical follow up of our patients with pineal region expansions (118 patients) pointed to certain clinical and neurophysiological regularities. We performed retrospective study which included 84 patients with pineal region expansions in the period from 1992 to 2009. The study included 55 women and 29 men, mean age 30.08 +/- 13.93 years, with positive brain magnetic resonance imaging (MRI)--70 patients (83.4%) had simple pineal gland cysts, and 14 patients (16.67%) had expansive process in pineal region with compressive effect. All patients had headache, while 32 patients (38%) had epileptic phenomena--primary generalized seizures. Patients had common electroencephalography (EEG) pattern with paroxysmal discharges of 3Hz (or more than 3 Hz) spike-and-wave complexes. Operation with supracerebellar infratentorial approach was performed in 70 patients. In most of our patients indication for the operation was established based on the size of th...
Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or ... more Vagus nerve stimulation (VNS) for the treatment of refractory partial epileptic seizures with or without secondary generalisation in patients older than 12 years was approved in Europe in 1994 and in the United States in 1997. We have studied the efficacy of VNS in patients with pharmacoresistant epilepsy hospitalized in the Neurology Department of the University Hospital Centre Zagreb. From 1997 to 2001 we have implanted VNS in 11 patients with pharmacoresistant epilepsy, who were magnetic resonance imaging (MRI) negative and from May 2007 to May 2009 in 11 patients with pharmacoresistant epilepsy, 9 of them were MRI positive, and were inoperable due to localisation of the pathomorphologic changes (ganglioglioma, hamartoma, various types of cortical dysplasia, porencephalic cysts), 2 were MR negative. In the group of MRI negative patients 1 patient had complex partial seizures (CPS), 6 patients had CPS with secondary generalisation, 2 patients had primary generalized epilepsy (PGE)...
In this paper, our experience with originally constructed Neurosurgical Endoscopic Contact Ultras... more In this paper, our experience with originally constructed Neurosurgical Endoscopic Contact Ultrasound Probe "NECUP-2" in neuroendoscopy is reported. Between June 1997 and June 2007, 132 neuroendoscopic procedures have been performed: 102 endoscopic thrid ventriculostomies (ETV), 15 arachnoid cysts and 5 intraventricular tumours operations. The "NECUP-2" was applied effectively in all cases in which blunt perforation was not possible: 38/102 ETY, 10/10 septostomies, 15/15 arachnoid cysts. In five cases of intraventricular tumours, neuroendoscopic procedure was combined with open microsurgery for tumour removal with preservation of vascular structures. There were no "NECUP-2" related complications. Of postoperative complications, we had liquorrhea (9 patients), and symptoms of meningitis (6 patients). In the follow-up period (6 months to 6 years), we had a patency rate of 80% (50/63 patients). All patients improved in clinical status. According to the fir...
Cerebrospinal fluid (CSF) fistula as a consequence of brain missile injury and following infectio... more Cerebrospinal fluid (CSF) fistula as a consequence of brain missile injury and following infectious complications has been recognized for years. Different methods of treatment have been advocated. Missiles used in war cause extensive destruction of the skull and brain as a result of their high kinetic energy. On its transfer through the skull, such high kinetic energy causes fractures called "discontinuous fractures," which are distant from the entry wound and not related to the fracture of the vault. The role of the timely diagnosis of CSF fistulas and their early repair in the management of these wounds is emphasized. Data on 312 patients with missile injuries of the brain inflicted during the war in Croatia were retrieved and analyzed, with special reference to the complications of CSF fistulas and infection. Forty-five patients developed CSF fistula, 15 (33%) of them at the wound site, 23 (51%) as CSF rhinorrhea, and seven (15%) as CSF otorrhea. Six patients developed ...
In 1998, a teleradiology system was established in Croatia. It connects 34 CT, MRI and DSA scanne... more In 1998, a teleradiology system was established in Croatia. It connects 34 CT, MRI and DSA scanners in 29 hospitals with a referral centre in the neurosurgery department in Zagreb. In the first three years of its use, the network saved more than 400,000 km of patient transportation (i.e. without a teleconsultation, all of the patients would have had to be transported to the nearest referral neurosurgical unit). During the first seven years, an archive with 25,366 expert opinions was collected. A total of 7103 (28%) expert opinions were provided for the distant regional hospitals. The most common diagnoses for patients from regional hospitals were neurotrauma (53%), cerebrovascular diseases (22%) and brain tumours (19%). The teleradiology system was used less often for lumbar disc disease (4%), hydrocephalus or other neurosurgical disorders (2%). The most valuable results from teleradiology were the decisions about proper and effective patient treatment. In Croatia, the national teleradiology network for neurosurgery has speeded up therapy, avoided unnecessary travelling for patients and reduced costs.
Today laser has become a standard tool in modern minimal invasive microneurosurgery and it is bei... more Today laser has become a standard tool in modern minimal invasive microneurosurgery and it is being increasingly used in functional neurosurgery as well. Lasers have found their full and extensive application for their capacity of acting on pathological tissues without direct contact, through relatively small craniotomy, and in deep hardly accessible regions. In accordance with worldwide experience in successful use of laser power in neurosurgical procedures, in 1986 laser instruments were introduced into clinical practice at
We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping... more We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping or coiling in a 4-year-old child managed with aneurysm resection and RA interposition graft. A 4-year-old child presented with repeated severe headache and vomiting. Computed tomography, magnetic resonance imaging and magnetic resonance angiography and digital subtraction angiography showed a giant fusiform aneurysm on the right MCA. Because of the complex shape, endovascular treatment or clip reconstruction was not possible, and a bypass procedure was planned. Right frontotemporal craniotomy and orbitotomy was performed. Two aneurysms involving the M1 segment of the MCA were found in line, one giant, and the other large in size. The aneurysms were resected and treated with short radial artery interposition graft, which was narrower than the proximal or distal MCA. The child recovered normally, and the bypass was patent after 1 year. Large fusiform MCA aneurysms may be difficult to treat but there are treatment options that include a bypass procedure. Resection and short interposition radial artery graft is an excellent but rare treatment option in a very young child. This was very successful treatment in this child.
We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping... more We report an unusual case of complex giant and large fusiform aneurysms not amenable for clipping or coiling in a 4-year-old child managed with aneurysm resection and radial artery interposition graft. A 4-year-old child presented with repeated severe headache and vomiting. Computed tomography, magnetic resonance imaging, and magnetic resonance angiography and digital subtraction angiography showed a giant fusiform aneurysm on the right middle cerebral artery (MCA). Because of the complex shape, endovascular treatment or clip reconstruction was not possible, and a bypass procedure was planned. Right frontotemporal craniotomy and orbitotomy was performed. Two aneurysms involving the M1 segment of the MCA were found in line, 1 giant, and the other large in size. The aneurysms were resected and treated with short radial artery interposition graft, which was narrower than the proximal or distal MCA. The child recovered normally, and the bypass was patent after 1 year. Large fusiform MCA aneurysms may be difficult to treat, but there are treatment options that include a bypass procedure. Resection and short interposition radial artery graft is an excellent but rare treatment option in a very young child. This was a very successful treatment in this child.
Journal of Neurological Surgery Part B: Skull Base, 2012
We retrospectively reviewed the hospital charts of six members of a family affected with NF2, inc... more We retrospectively reviewed the hospital charts of six members of a family affected with NF2, including clinical and operative reports, radiology, and neuropathology findings. Follow-up data, including functional outcome, was conducted
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Papers by Goran Mrak