Microdiscectomy (MD) is accepted nowadays as the operative method of choice for lumbar disc herniation, but it is not rare for neurosurgeons to opt for standard discectomy (SD), which does not entail the use of operating microscope. In our study, differences in disc herniation recurrence and clinical outcome of surgical treatment of lumbar disc herniation with and without the use of operating microscope were assessed. Our study included 167 patients undergoing lumbar disc surgery during a three-year period (SD, n=111 and MD, n=56). Clinical outcome assessments were recorded by patients via questionnaire forms filled out by patients at three time points. Operation duration, length of hospital stay and revision surgeries were also recorded. According to study results, after one-year follow up there was no statistically significant difference between the SD and MD groups in functional outcome. However, we recorded a statistically significant difference in leg pain reduction in favor of the MD group. According to the frequency of reoperations with the mean follow up period of 33.4 months, there was a statistically significant difference in favor of the MD group (SD 6.3% vs. MD 3.2%). There appears to be no particular advantage of either technique in terms of functional outcome since both result in good overall outcome. However, we choose MD over SD because it includes significantly lower recurrent disc herniation rate and higher reduction of leg pain.

We present a patient with blunt abdominal trauma with severe acute right limb ischemia and clinical signs of diffuse peritonitis. Computed tomography angiography showed circumferential dissection of the infrarenal aorta with occlusion of the right common iliac artery. We opted for simultaneous abdomen exploration and open repair of injured aorta. Critical weakening of the aortic wall with imminent rupture was identified intraoperatively. Aortotomy cranially from bifurcation showed circumferential intimomedial dissection. The fixation of fragile intimomedial flap of aortic dissection was achieved with reinforcement using an anterior longitudinal ligament. The long aortoiliac arteriotomy was repaired using a great saphenous vein patch. Patient had uneventful postoperative course and was discharged after 7 days. In patients with abdominal polytrauma with peritonitis, and no available endovascular tools, open surgery for circumferential aortic dissection is possible and successful. Described reinforcement of the posterior aortic wall to the anterior longitudinal ligament should be added to the armamentarium of aortic injury treatment.

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Introduction. Tibial plateau fractures are complex injuries that, in most cases, require surgical treatment in order to prevent far-reaching consequences for the functionality and quality of life of the patient. While numerous surgical techniques have been described, it is evident that the technique of arthroscopically assisted repositioning (reduction) and internal fixation has the potential to take the lead in the management of these types of injuries. Case report. We present the case of a 36-year-old patient injured in a traffic accident with a fracture of the left tibial plateau, type III by Schatzker classification. After the diagnostic procedures and preparation, the patient was operated on using arthroscopically assisted repositioning (reduction) and internal fixation, with the filling of the bone defect with a combination of allogenic and synthetic bone graft. No other intra-articular injuries were diagnosed intraoperatively. The postoperative recovery went without complications, and after a period of 10 weeks of non-weight bearing and functional rehabilitation, the fracture healed completely, while the patient regained full range of motion in the knee. Conclusion. Although this type of injury has traditionally been treated with open surgery, we believe that minimally invasive surgery is the future, when it comes to tibial plateau fractures Schatzker types I-III. There is still not enough data in the literature regarding the long-term outcomes of this type of treatment, but the early postoperative results are extremely encouraging since this surgical technique enables faster recovery and fewer postoperative complications.

Tanycytic ependymoma is a very rare spindle-cell variant of ependymoma derived from tanycytes, which are part of the primitive nervous system. This paper is presenting 48-year old woman who presented with low back and right-sided leg pain of moderate intensity. MRI showed spinal intradural tumor at the level of the L1 vertebral body. Right-sided L1 hemilaminectomy and en bloc tumor resection were performed. Neuroradiological and intraoperative diagnosis of schwannoma was revised to tanycytic ependymoma after careful immunohistochemical analysis. Six months post-operativly, MRI did not show tumor recurrence. Tanycytic ependymoma at the region of filum terminale is extremely uncommon and only three cases have been described in the literature. The low incidence of this tumor and atypical histological image, which is distinct from the typical features of commonly encountered ependymomas, can present a challenge in terms of making an accurate diagnosis. Awareness of this transitional form of ependymoma among neurosurgeons and pathologists may avoid incorrect surgical approaches and postoperative treatment course.