Radiological and clinical cerebral vasospasm (CV) is defined either as a delayed narrowing of cerebral arteries after aneurysmal subarachnoid hemorrhage (aSAH) or/and occurrence of new neurological...

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disorder, with a lifetime prevalence estimated at approximately 10%. This narrative review explores the historical evolution, current management strategies, and emerging trends in CTS diagnosis and treatment. Early recognition of CTS led to the development of conservative interventions, including splinting, corticosteroid injections, and physical therapy, aimed at alleviating median nerve compression and associated symptoms. The advent of open carpal tunnel release established surgery as the definitive treatment for moderate-to-severe CTS, with subsequent refinements—such as mini-open and endoscopic techniques—focused on minimizing tissue trauma and expediting recovery. Comparative studies demonstrate similar long-term efficacy between surgical modalities, though endoscopic approaches often provide faster short-term recovery. Advances in diagnostic imaging, including high-resolution ultrasound, have improved early detection and dynamic assessment of median nerve compression. Emerging therapies, such as regenerative biologics, neuromobilization, and minimally invasive surgical innovations, offer promising adjuncts to current care. Despite substantial progress, further research is needed to clarify optimal patient selection, refine minimally invasive techniques, and explore regenerative interventions. This review underscores the importance of individualized, evidence-based, and patient-centered approaches to CTS management, integrating both established and emerging strategies to optimize functional outcomes and quality of life.

Introduction. The treatment of patients with lumbar disc herniation can be conservative or surgical, depending on the patient’s characteristics, the disease, and treatment possibilities. This study aims to compare the intensity of pain, the presence of Lasègue’s sign, and the degree of neurological deficits in patients with lumbar disc herniation before and after the operation. Additionally, the degree of intervertebral disc degeneration, evaluated by magnetic resonance imaging findings on the outcome will be determined. Material and Methods. A retrospective study involved 50 patients aged 18 to 45 who underwent microdiscectomy procedure. Parameters including pain intensity on the visual-analog scale, Lasègue’s nerve stretching test, sensory deficits, motor deficits, and the degree of intervertebral disc degeneration according to the Pfirrmann grading system were assessed preoperatively and in the early postoperative period. Results. Intervertebral disc herniation most commonly occurred at the L4-5 and L5-S1 levels in our patients. Pain intensity significantly decreased from a preoperative score of 7.6 to 2.4 postoperatively. There was also a significant decrease in the number of patients with positive Lasègue’s sign. According to the Pfirrmann grading system, 38% of patients had mild degenerative changes in the intervertebral disc, while 62% had severe degenerative changes. Conclusion. Microdiscectomy is the gold standard in surgical treatment of lumbar disc herniation. In the early postoperative period, patients experience a significant reduction in pain intensity with subsequent improvement of sensory and motor deficits. Surgical treatment of lumbar disc herniation, when indicated appropriately, carries a high success rate.

Background/Aim. In an era of rapid technological innovation and growing patient expectations, healthcare systems worldwide face the need for continuous improvement in service quality. The Service Quality model (SERVQUAL) is a validated instrument for measuring service quality, based on comparing patients? expectations with their perceptions of the service provided. The difference (gap) between these two measures is assessed using a five-point Likert scale across five dimensions: tangibility, reliability, responsiveness, assurance, and empathy. The aim of this study was to measure and compare expectations and perceptions of patients undergoing neurosurgical services, and to examine whether the size of the gap differs between SERVQUAL dimensions. Methods. The study included a total of 60 patients who underwent surgery for degenerative lumbar and cervical spine diseases at the Clinic for Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia, between June and September 2024. A modified SERVQUAL questionnaire was used for data collection. Data were collected on admission and before the patients? discharge. Data were analyzed using descriptive statistics, paired t-tests to compare expectations and perceptions, and analysis of variance to examine differences across sociodemographic groups. Results. Patients had positive perceptions of the provided services. The results indicated the existence of a gap between patients? expectations and their perceptions of the services received. Mean expectations were high across dimensions (overall 4.85; range 4.79?4.88), as were perceptions (overall 4.90; range 4.85?4.94). All gaps were positive (perceptions > expectations). Dimension-specific gaps were as follows: tangibility 0.06 (p = 0.196), reliability 0.05 (p = 0.132), responsiveness 0.04 (p = 0.249), assurance 0.06 (p = 0.107), empathy 0.06 (p = 0.039). Only the empathy dimension reached statistical significance. No significant differences emerged across sociodemographic subgroups. Conclusion. The SERVQUAL method provided clear insights into patients? perceptions of the quality of neurosurgical services. The findings from this study can contribute to improving service quality and increasing patient satisfaction, positively influencing clinical outcomes and the healthcare system as a whole.

Introduction: Mild traumatic brain injury (mTBI) in older adults (≥65 years) is often underestimated, despite being associated with significant morbidity. Age-related vulnerability, comorbidities, and medication use may exacerbate outcomes. This study aimed to identify predictors of brain health and functional recovery in older adults following mTBI, focusing on acute symptoms, CT imaging findings, and sociodemographic factors. Methods: We analyzed a cohort of 93 older adult patients with mTBI (GCS 13–15) who were prospectively enrolled at a tertiary neurosurgical center. All patients underwent baseline CT, structured clinical assessment, and follow-up at six months with standardized instruments (Glasgow Outcome Scale–Extended-GOSE, 12-Item Short Form Health Survey (quality-of-life measure)-SF-12, Rivermead Post-Concussion Symptoms Questionnaire-RPQ, Patient Health Questionnaire-9 (depression measure)-PHQ-9, PTSD (Post Traumatics Stress Disorder) Checklist for DSM (Diagnostic and Statistical Manual for Mental Disorders)-PCL-5, Timed up and Go Test (mobility measure-TUG test). Multivariate regression was performed to identify independent predictors of recovery. Results: At six months, 94.9% of older adults achieved functional independence (GOSE ≥ 5), though only 43% attained complete recovery (GOSE = 8). Patients with acute intracranial lesions on CT had worse physical outcomes, including slower mobility (mean TUG 17.6 vs. 16.3 s, p = 0.012). Severe acute headache independently predicted poorer recovery (lower GOSE and SF-12 PCS). Lower educational attainment correlated with worse functional and quality-of-life outcomes, consistent with reduced cognitive reserve. Psychological outcomes (PTSD and depression rates) were not associated with CT findings but were influenced by social support and sex. Prompt anticoagulation reversal in patients on anticoagulants markedly reduced hemorrhagic complications. Discussion: Older adults with mTBI generally maintain independence but experience reduced physical health and mobility compared to younger patients. Predictors of poorer outcomes include severe acute symptoms, CT-detected lesions, advanced age, and lower educational levels. Psychosocial support mitigated mental health complications. Conclusions: mTBI in older adults is not benign. Clinical, imaging, and sociodemographic factors collectively shape recovery. Early identification of high-risk patients and targeted interventions are essential to preserve brain health and independence in this growing population.