Mirza Pojskic - Academia.edu (original) (raw)

Papers by Mirza Pojskic

Acta Clinica Croatica, 2018

Spinal dumbbell tumors are defi ned by a narrowing at the point where they penetrate the interver... more Spinal dumbbell tumors are defi ned by a narrowing at the point where they penetrate the intervertebral foramina or dura mater, assuming an hourglass or dumbbell shape. Dumbbell-shaped spinal hemangiomas are extremely rare. We describe a dumbbell spinal tumor (epidural cavernous hemangioma) resected by a 2-stage single-sitting combined approach. We also conduct a substantial literature review of the subject. We present a case of a 78-year-old male who was found to have a homogeneously enhancing, dumbbell-shaped, intraspinal, extradural tumor mass extending into the left chest cavity. Th e tumor was resected with a single-sitting 2-stage posterior technique: a microsurgical approach, followed by endoscopic resection via a thoracoscopic approach. Th ere are several reports in the literature on the combined approach for dumbbell tumors of the spinal cord. Our case is the fi rst to describe 2-stage combined surgery in 1 sitting for dumbbell hemangioma with the patient in the lateral decubitus position for the thoracoscopic part of the surgery; and the use of a fat pad, which was applied in the neuroforamen via the posterior route, as a marker for resection during the transthoracic procedure.

Brain Sciences, 2021

Background. Lateral approaches to the spine have gained increased popularity due to enabling mini... more Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodisc...

Bosnian Journal of Basic Medical Sciences, 2020

In this video, we highlight the anatomy involved with microsurgical resection of a giant T11/T12 ... more In this video, we highlight the anatomy involved with microsurgical resection of a giant T11/T12 conus cauda equina schwannoma. Spinal schwannoma remains the third most common intradural spinal tumor. Tumors undergoing gross total resection usually do not recur. To our knowledge, this is the first video case report of giant cauda equina schwannoma resection. A 55-year-old female presented with paraparesis and urinary retention. Lumbar spine MRI revealed a contrast-enhancing intradural extramedullary tumor at the T11/T12 level. Surgery was performed in the prone position with intraoperative neurophysiology monitoring (somatosensory and motor evoked potentials—SSEPs and MEPs). T11/T12 laminectomies were performed. After opening the dura and arachnoid, the tumor was found covered with cauda equina nerve roots. We delineated the inferior pole of the tumor, followed by opening of the capsule and debulking the tumor. Subsequently, the cranial pole was dissected from the corresponding caud...

Acta Clinica Croatica, 2020

SUMMARY Astrocytoma is the second most common intramedullary tumor of predominantly low-grade mal... more SUMMARY Astrocytoma is the second most common intramedullary tumor of predominantly low-grade malignancy in adult patients. Adult astrocytomas have better-quality prognosis compared with astrocytomas in children. Although a standardized surgical management protocol for spinal cord glioma is currently unavailable, surgery of low-grade astrocytoma should be aimed at gross total resection to preserve neurological function and to improve the outcome. Herein, we present a personal case series of four consecutive adult spinal cord astrocytoma patients who were operated on during the last few years. Tumor resection was performed in all patients utilizing microsurgical technique and intraoperative neurophysiologic monitoring. We also provide a literature review of the treatment of intramedullary astrocytoma in adults and discuss contemporary surgical management and prognosis.

Stereotactic and Functional Neurosurgery, 2020

Objective: The aim of this work was to compare fiducial-based and intraoperative computed tomogra... more Objective: The aim of this work was to compare fiducial-based and intraoperative computed tomography (iCT)-based registration for frameless stereotactic brain biopsy. Methods: Of 50 frameless stereotactic biopsies with the VarioGuide, 30 cases were registered as iCT based and 20 as fiducial based. Statistical analysis of the target registration error (TRE), dose length product, effective radiation dose (ED), operation time, and diagnostic yield was performed. Results: The mean TRE was significantly lower using iCT-based registration (mean ± SD: 0.70 ± 0.32 vs. 2.43 ± 0.73 mm, p < 0.0001). The ED was significantly lower when using iCT-based registration compared to standard navigational CT (mean ± SD: 0.10 ± 0.13 vs. 2.23 ± 0.34 mSv, p < 0.0001). Post-biopsy iCT was associated with a significant lower (p < 0.0001) ED compared to standard CT (mean ± SD: 1.04 ± 0.18 vs. 1.65 ± 0.26 mSv). The mean surgical time was shorter using iCT-based registration, although the mean total o...

Journal of Personalized Medicine, 2022

Glioblastoma, as the most aggressive brain tumor, is associated with a poor prognosis and outcome... more Glioblastoma, as the most aggressive brain tumor, is associated with a poor prognosis and outcome. To optimize prognosis and clinical therapy decisions, there is an urgent need to stratify patients with increased risk for recurrent tumors and low therapeutic success to optimize individual treatment. Radiogenomics establishes a link between radiological and pathological information. This review provides a state-of-the-art picture illustrating the latest developments in the use of radiogenomic markers regarding prognosis and their potential for monitoring recurrence. Databases PubMed, Google Scholar, and Cochrane Library were searched. Inclusion criteria were defined as diagnosis of glioblastoma with histopathological and radiological follow-up. Out of 321 reviewed articles, 43 articles met these inclusion criteria. Included studies were analyzed for the frequency of radiological and molecular tumor markers whereby radiogenomic associations were analyzed. Six main associations were de...

Healthcare

Background: The coronavirus 2019 (COVID-19) pandemic forced students and teachers to rapidly adop... more Background: The coronavirus 2019 (COVID-19) pandemic forced students and teachers to rapidly adopt digital education methods. Proper guidance for and refinement of such methods is continuously required. Here, we report on the educational experience students and academic staff at the neurosurgical department of a German university hospital made with digital teaching modules (DTMs) that were newly developed due to the transition to digital teaching during the first year of the COVID-19 pandemic and on the insights gained therefrom. Methods: Nine newly created DTMs provided students the option to anonymously evaluate each module by assigning a score from 0 (worst value) to 5 (best value) to it. Access count, evaluation count, average evaluation, number of included (interactive) figures, number of presented cases, number of linked publications, and number of included multiple-choice questions for each DTM were recorded retrospectively. For each DTM, we aimed to correlate access count, e...

Brain Sciences

Surgical treatment of spondylodiscitis allows for rapid mobilization and shortens hospital stays,... more Surgical treatment of spondylodiscitis allows for rapid mobilization and shortens hospital stays, which makes surgical treatment the first-line therapy. We aim to describe our experiences with operative treatment on spondylodiscitis and to determine the parameters that are important in the prediction of outcomes. A retrospective review identified 237 patients who were operatively treated for spondylodiscitis in our institution between January 2010 and December 2018. Clinical data were collected through review of electronic records and relevant imaging. In all cases, contrast-enhancing MRI from the infected region of the spine was obtained. Leukocyte count and C-reactive protein concentrations (CRP) were determined in all the patients. We included 237 patients in the study, 87 female (36.7%) and 150 male (63.3%), with a mean age of 71.4 years. Mean follow-up was 31.6 months. Forty-five patients had spondylodiscitis of the cervical, 73 of the thoracic, and 119 of the lumbosacral spine...

Frontiers in Oncology

BackgroundIn glioma surgery, the patient’s outcome is dramatically influenced by the extent of re... more BackgroundIn glioma surgery, the patient’s outcome is dramatically influenced by the extent of resection and residual tumor volume. To facilitate safe resection, neuronavigational systems are routinely used. However, due to brain shift, accuracy decreases with the course of the surgery. Intraoperative ultrasound has proved to provide excellent live imaging, which may be integrated into the navigational procedure. Here we describe the visualization of vascular landmarks and their shift during tumor resection using intraoperative navigated 3D color Doppler ultrasound (3D iUS color Doppler).MethodsSix patients suffering from glial tumors located in the temporal lobe were included in this study. Intraoperative computed tomography was used for registration. Datasets of 3D iUS color Doppler were generated before dural opening and after tumor resection, and the vascular tree was segmented manually. In each dataset, one to four landmarks were identified, compared to the preoperative MRI, an...

Global Spine Journal

Study Design: A prospective, case-based, observational study. Objectives: To investigate how micr... more Study Design: A prospective, case-based, observational study. Objectives: To investigate how microscope-based augmented reality (AR) support can be utilized in various types of spine surgery. Methods: In 42 spinal procedures (12 intra- and 8 extradural tumors, 7 other intradural lesions, 11 degenerative cases, 2 infections, and 2 deformities) AR was implemented using operating microscope head-up displays (HUDs). Intraoperative low-dose computed tomography was used for automatic registration. Nonlinear image registration was applied to integrate multimodality preoperative images. Target and risk structures displayed by AR were defined in preoperative images by automatic anatomical mapping and additional manual segmentation. Results: AR could be successfully applied in all 42 cases. Low-dose protocols ensured a low radiation exposure for registration scanning (effective dose cervical 0.29 ± 0.17 mSv, thoracic 3.40 ± 2.38 mSv, lumbar 3.05 ± 0.89 mSv). A low registration error (0.87 ± 0...

Applied Sciences

Background: Implementation of intraoperative 3D ultrasound (i3D US) into modern neuronavigational... more Background: Implementation of intraoperative 3D ultrasound (i3D US) into modern neuronavigational systems offers the possibility of live imaging and subsequent imaging updates. However, different modalities, image acquisition strategies, and timing of imaging influence object appearances. We analyzed the differences in object appearances in ultrasound (US) and magnetic resonance imaging (MRI) in 35 cases of brain metastasis, which were operated in a multimodal navigational setup after intraoperative computed tomography based (iCT) registration. Method: Registration accuracy was determined using the target registration error (TRE). Lesions segmented in preoperative magnetic resonance imaging (preMRI) and i3D US were compared focusing on object size, location, and similarity. Results: The mean and standard deviation (SD) of the TRE was 0.84 ± 0.36 mm. Objects were similar in size (mean ± SD in preMRI: 13.6 ± 16.0 cm3 vs. i3D US: 13.5 ± 16.0 cm3). The Dice coefficient was 0.68 ± 0.22 (...

Neurosurgical Focus

OBJECTIVELow registration errors are an important prerequisite for reliable navigation, independe... more OBJECTIVELow registration errors are an important prerequisite for reliable navigation, independent of its use in cranial or spinal surgery. Regardless of whether navigation is used for trajectory alignment in biopsy or implant procedures, or for sophisticated augmented reality applications, all depend on a correct registration of patient space and image space. In contrast to fiducial, landmark, or surface matching–based registration, the application of intraoperative imaging allows user-independent automatic patient registration, which is less error prone. The authors’ aim in this paper was to give an overview of their experience using intraoperative CT (iCT) scanning for automatic registration with a focus on registration accuracy and radiation exposure.METHODSA total of 645 patients underwent iCT scanning with a 32-slice movable CT scanner in combination with navigation for trajectory alignment in biopsy and implantation procedures (n = 222) and for augmented reality (n = 437) in...

International Journal of Computer Assisted Radiology and Surgery

Surgical Neurology International

Sažetak Tokom posljednjih decenija identificiran je niz citogenetičkih, molekularno-genetičkih i ... more Sažetak Tokom posljednjih decenija identificiran je niz citogenetičkih, molekularno-genetičkih i imunohistohemijskih faktora kod različitih humanih malignoma. To je omogućilo primjenu različitih terapijskih metoda koje su značajno unaprijedile tretman i ishod kod pacijenata sa malignim oboljenjima. Kada je riječ o glijalnim tumorima mozga za sada, promjene na molekularnom nivou imaju značaja u procjeni ishoda i izboru tretmana kod dva histološka oblika, oligodendroglioma i glioblastoma multiforme. Identifikacija mutacije 1p/19q kod oligodendroglioma direktno korespondira sa izborom tretmana i prognozom bolesti. Primjena hemioterapije kod glioblastoma multiforme je u direktnoj korelaciji sa ekspresijom enzima MGMT. Drugim riječima, prisustvo ovog enzima inaktivira hemioterapeutik i čini ga nedjelotvornim. U novije vrijeme istražuje se primjena antagonista EGFR III u liječenju GBM, posebno primarnih oblika kod kojih postoji visoka ekspresija ovog receptora. Ključne riječi: oligodendrogliom, glioblastoma multiforme, 1p/19q mutacija, MGMT, EGFR III. Uvod Gliomi su tumori porijeklom iz glijalnih ćelija. Shodno celularnom porijeklu, razlikuju se astrocitomi, oligodendrogliomi, ependimomi itd. Novija istraživanja ukazuju da primarni glioblastoma multiforme (GBM) vodi porijeklo iz neuronalnih stem ćelija koje se kod čovjeka mogu naći u svim fazama razvoja, počev od intrauterinog pa do duboke starosti (1,2).

Medicina

Background and objectives: Expandable cages are frequently used to reconstruct the anterior spina... more Background and objectives: Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. In this retrospective study, we evaluated the perioperative advantages and disadvantages of corpectomy reconstruction with an expandable cage. Materials and Methods: Eighty-six patients (45 male and 41 female patients, medium age of 61.3 years) were treated with an expandable titanium cage for a variety of indications from January 2012 to December 2019 and analyzed retrospectively. The mean follow-up was 30.7 months. Outcome was measured by clinical examination and visual analogue scale (VAS); myelopathy was classified according to the EMS (European Myelopathy Scale) and gait disturbances with the Nurick score. Radiographic analysis comprised measurement of fusion, subsidence and the C2–C7 angle. Results: Indications included spinal canal stenosis with myelopathy (46 or 53.5%), metastasis (24 or 27.9%), spondylodiscitis (12 or 14%), and fracture (4 or 4.6%). ...