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INTRODUCTION: Among children who sustain mild traumatic brain injury (mTBI), 10-30% develop a cluster of cognitive, physical, and emotional symptoms commonly referred to as post-concussion syndrome (PCS). Symptoms typically resolve within 7-10 days, but a minority of patients report symptoms that persist for months or even years. The aim of our study was to identify a neurobiochemical marker after mTBI that can predict the presence of post-concussion syndrome three months after head injury in paediatric patients. MATERIALS AND METHODS: Children between 7 and 16 years of age who had head trauma and no other complaints were included. Three months after the initial visit, participants or parents/guardians were interviewed in person about the children's PCS symptoms using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). RESULTS: The mean value of S100B protein in serum in 38 patients without signs of PCS was 0.266 µg L-1, with a 95% confidence interval (CI) of 0.221 - 0.310 µg L-1. Among the 22 patients with signs of PCS, the mean value of S100B protein in serum was 0.845 µg L-1, with a 95% CI of 0.745-0.945 µg L-1. Patients with signs of PCS had higher S100B protein levels than those without signs of PCS (p < 0.0001). CONCLUSIONS: Our prospective study showed that S100B protein is a useful neurobiomarker for detecting paediatric patients at risk for post-concussion syndrome. We found that the biomarker S100B correlated with the severity of traumatic brain injury (number of lesions on CT) and the presence of post-concussion syndrome.

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INTRODUCTION: Traumatic brain injuries (TBIs) are very common in paediatric populations, in which they are also a leading cause of death. Computed tomography (CT) overuse in these populations results in ionization radiation exposure, which can lead to lethal malignancies. The aims of this study were to investigate the accuracy of serum S100B levels with respect to the detection of cranial injury in children with mild TBI and to determine whether decisions regarding the performance of CT can be made based on biomarker levels alone. MATERIALS AND METHODS: This was a single-center prospective cohort study that was carried out from December 2016 to December 2017. A total of 80 children with mild TBI who met the inclusion criteria were included in the study. The patients were between 2 and 16 years of age. We determined S100B protein levels and performed head CTs in all the patients. RESULTS: Patients with cranial injury, as detected by CT, had higher S100B protein levels than those without cranial injury (p < 0.0001). We found that patients with cranial injury (head CT+) had higher mean S100B protein levels (0.527 µg L-1, 95% confidence interval (CI) 0.447-0.607 µg L-1) than did patients without cranial injury (head CT-) (0.145 µg L-1, 95% CI 0.138-0.152 µg L-1). Receiver operating characteristic (ROC) curve analysis clearly showed that S100B protein levels differed between patients with and without cranial injury at 3 hours after TBI (AUC = 0.893, 95% CI 0.786-0.987, p = 0.0001). CONCLUSION: Serum S100B levels cannot replace clinical examinations or CT as tools for identifying paediatric patients with mild head injury; however, serum S100B levels can be used to identify low-risk patients to prevent such patients from being exposed to radiation unnecessarily.

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BACKGROUND: The study is to show the advantages of preservation of a calvarial bone flap in the abdominal pocket after decompressive craniotomy. Decompressive craniectomy is an option in the surgical management of refractory hypertension when maximal medical treatment (sedation, drainage of cerebrospinal fluid, moderate cooling, etc) has failed to control refractory high intracranial pressure. METHODS: We have prospectively analyzed 82 consecutively operated cases decompressive craniotomies done at the University Neurosurgical Clinic in Prishtina/KOSOVA over a period of eight years (June 1999 to Aug 2008). Of the 75 who had their grafts replaced (7 patient died before replacement of bone graft), 62 patients had hemicraniectomy (fronto-parieto-temporal) 7 of them were bilateral. RESULTS: In 66 out of 75 patients was achieved a satisfactory and cosmetically reconstruction, in 9 cases was required augmentation with methyl methacrylate to achieve cosmetic needs. Two patients had infection and the bone was removed; 6 months later these patients had cranioplasty with methyl methacrylate. The duration of storage of calvarial bone in abdominal pouch before reimplantation was 14 - 232 days (range 56 days). CONCLUSION: We think that storage of the patients own bone flap in the abdominal pocket is a safe, easy, cheap, sterile, histocompatible, and better cosmetic results.

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INTRODUCTION: In the present study we report 36 cases of anterior encephaloceles treated at Clinic of Neurosurgery in the University Clinical Center of Kosova over a 24 year period. MATERIALS AND METHODS: All 36 children were included in this retrospective study (1986 through 2009). Their ages ranged from 1 day to 10 years (mean 13 months); 20 were boys and 16 were girls. The commonest type of anomaly seen was nasofrontal 17 patients, 12 nasoethmoidal, and 7 nasoorbital. The size of the lesion varied from 2.5 cm to 28 cm. Hypertelorism occurred in 12 patients. Hydrocephalus was present in 11 patients and in 8 of them was progressive. RESULTS: 1 patient died on 10th postoperative day due to fulminant meningitis. Cosmetic results were judged from parents as excellent in 16 patients, good in 12 patients, average in 6 patients and poor in 2 patients. None of patients were lost to follow-up. DISCUSSION: Histologic examination of the herniated tissue can vary between normal brain to fibrous atrophic nonviable tissue. No familial cases have been reported in the literature, we also have similar experience. In our study we have found that the prevalence is higher among patients coming from rural parts of our country with pore living conditions, malnutrition and so on. We have avoided surgery in very young children until body weight is around 5-6 kg because of complication from blood lose and hypothermia. CONCLUSION: The aim of treatment is early removal of the meningoencephalocele to allow normal growth forces to be re-established. In patients with hypertelorism, correction surgery is done in the same session. Ifhydrocephalus is not treated before corrective surgery for encephalocele, the risk of postoperative CSF is very high. With one stage surgery excellent results can be achieved.

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INTRODUCTION: We report a case of Rhabdoid meningioma in an eight-year-old child which is the fifth case in the world according to our knowledge. MATERIAL AND METHOD: An 8-year-old girl was seen in our University Clinic of Neurosurgery with one month history of increasing headaches, vomiting and increasing frequency of grand mal seizures (known history of epilepsy). Her past medical history was not significant, except the epilepsy. After opening the dura mater, an extra axial tumor was found. The neoplasm invaded the brain and was highly vascular. The lesion was totally excised and 2 cm of adjacent dura materwas excised--Simpson O. RESULTS: The postoperative course was without significant events. The patient was discharged home on the seventh postoperative day. Seizures were controlled with anticonvulsant therapy. Postoperative control head CT scan demonstrated total removal of the lesion. HP analysis: Paraffin-embedded tissue sections stained with H&E revealed meningothelial tumor with rhabdoid morphology characterized by sheets of tumor cells with eccentric nuclei, variably abundant eosinophilic cytoplasm and intracytoplasmic hyaline paranuclear inclusions. The number of mitoses was up to four in ten high-power fields, and the Ki-67 proliferation index was 4.4%. The histopathological diagnosis was rhabdoid meningioma (grade III). DISCUSSION: Radical surgery (Simpson grade 1) has been shown to significantly enhance prognosis in atypical and malignant meningiomas. CONCLUSION: Rhabdoid meningioma is an anaplastic, very rare subtype of malignant meningioma. The prognosis for rhabdoid meningioma depends on their proliferative activity and the possibility of radical removal.

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