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.

Mild traumatic brain injury (mTBI) in adults is extremely common worldwide, but only a small fraction of these patients harbor clinically significant intracranial injuries. Computed tomography (CT) of the head is the standard diagnostic tool to detect traumatic brain hemorrhages or lesions, yet indiscriminate CT scanning of all mTBI patients is inefficient, costly, and exposes patients to ionizing radiation. To optimize patient care, numerous clinical decision rules and guidelines have been developed internationally to identify which adult patients with mTBI should undergo head CT. This review provides a global perspective on the indications for head CT in adult mTBI, comparing key decision rules including the Canadian CT Head Rule, New Orleans Criteria, UK NICE Head Injury Guidelines, and others. Methods: We conducted a comprehensive analysis of major international guidelines and decision rules for head CT in adult mTBI, focusing on their inclusion criteria, risk factors, and diagnostic performance. Results: All the examined rules prioritize near-100% sensitivity for identifying patients who need neurosurgical intervention, but they differ greatly in specificity and recommended CT utilization rates. North American rules such as the New Orleans Criteria tend to favor higher sensitivity, scanning almost all patients with any symptom, whereas the Canadian CT Head Rule and certain European guidelines (NICE, Scandinavian) are more selective, significantly reducing CT usage while maintaining safety. Discussion: We discuss how these variations reflect different healthcare settings and risk tolerances, and we examine the implications for neurosurgical practice. We also highlight challenges in guideline implementation, the impact on global CT utilization, and emerging approaches (such as biomarker-assisted triage) that may further refine decision-making. In conclusion, appropriate use of clinical decision rules for head CT in mTBI can safely minimize unnecessary imaging, but local adaptation and clinician judgment remain crucial to ensure that no significant injuries are missed while avoiding over-scanning.

Introduction. Symptomatic pineal cysts are rare, and their optimal management remains controversial and not clearly defined. Case Report. We present a case of a 45-year-old female who presented with several weeks of headache and acute-onset vertigo beginning the night prior to admission. Her medical history included an asymptomatic pineal cyst incidentally identified on magnetic resonance imaging two years earlier. Current imaging demonstrated marked enlargement of the pineal cyst with compression of the Sylvian aqueduct, resulting in obstructive hydrocephalus. The patient underwent a single-session combined endoscopic procedure with neuronavigation guidance. An endoscopic third ventriculostomy was first performed via a right frontal burr hole (Kocher?s point) to restore cerebrospinal fluid circulation. Through a second frontal burr hole, the pineal cyst wall was fenestrated and a biopsy was obtained. Both procedures were performed with the patient in the supine position and neutral head alignment. No intraoperative or postoperative complications were observed. Postoperative computed tomography confirmed ventriculostomy patency and reduction in ventricular size. At three-month follow-up, the patient remained asymptomatic. Conclusion. A combined minimally invasive endoscopic approach can effectively addressed both obstructive hydrocephalus and symptomatic pineal cyst in a single surgical session.

Introduction. Anterior cervical discectomy and fusion is the standard surgical treatment for cervical discopathy and myelopathy caused by degenerative disc disease and osteophyte formation. The primary goal of the procedure is decompression of neural structures within the spinal canal by removing compressive pathology. Although neurological recovery after the procedure has been widely studied, data on neurological status in the immediate postoperative period remain limited. This retrospective study analyzed the association between clinical and radiological characteristics and early postoperative neurological recovery following the surgery. Material and Methods. The study included 66 patients who underwent the procedure at the Clinical Center of Vojvodina between 2022 and 2023. Statistical analysis using the ?2 test and Fisher?s exact test (p<0.05) evaluated the influence of neurological deficit type, number of operated levels, presence of spondylosis, and type of disc pathology on early postoperative neurological outcome. Results. Overall neurological improvement was observed in 82.5% of patients, with 42.8% showing significant improvement and 39.7% mild improvement. Statistically significant difference in early neurological recovery was found between single-level and two-level procedures (p=0.005), as well as between patients with disc protrusion and those with disc extrusion (p=0.035). No significant association was identified between early neurological recovery and neurological deficit type or the presence of spondylosis. Conclusion. Disc protrusion and a lower number of operated levels are positive predictors of early neurological improvement after the procedure, whereas spondylosis and neurological deficit type do not significantly affect early outcomes. Early postoperative neurological assessment may provide valuable insight into overall functional recovery.

Background and Objectives: Endoscopic biopsy of brain lesions plays an important role in the management of intra- and periventricular lesions. While the diagnostic yield of this technique has been reported with varying success across studies, its outcome is likely influenced by specific technical nuances of the procedure. However, the relationship between these technical factors and diagnostic accuracy remains understudied in the current literature. We aim to describe the procedural rationale, key anatomical considerations, and technical nuances of the endoscopic biopsy of intra- and paraventricular brain lesions, comparing standard tissue forceps with a side-cutting biopsy needle technique. Materials and Methods: We conducted a ten-year single-center, retrospective study of patients who underwent endoscopic biopsy for intra- and paraventricular brain lesions between January 2014 and December 2024. Patients were divided based on the biopsy technique used: the first group of 11 patients was treated using a side-cutting biopsy needle from the center of the lesion, while the second group of five patients underwent tissue sampling with standard endoscopic tissue cup forceps. The study evaluates and compares both approaches in terms of safety and diagnostic accuracy. Results: Endoscopic visualization enabled direct assessment of the biopsy site in both groups. Histopathological diagnoses were successfully obtained in all cases with a side-cutting biopsy needle (11/11, 100.0%), and in almost all cases with the cup forceps technique (4/5, 80.0%). In patients with obstructive hydrocephalus, an endoscopic third ventriculostomy (ETV) was performed as the first and therapeutic step in all procedures and two patients required a shunt procedure. Conclusions: Endoscopic biopsies utilizing a side-cutting biopsy needle strategy offer a promising adjunctive approach for selected intra- and paraventricular brain lesions. This method allows for direct visualization of the intraventricular surface, while the use of a needle biopsy can enhance the likelihood of obtaining diagnostically representative tissue with a high degree of reliability.

Introduction. Traumatic brain injury affects over 50 million people worldwide annually, with mild traumatic brain injury accounting for approximately 80%. The number of elderly patients sustaining such injuries is increasing. This study aimed to compare differences in consciousness impairment and computed tomography findings among mild traumatic brain injury patients of different age groups upon hospital admission. Material and Methods. This retrospective study included 150 patients with mild traumatic brain injury hospitalized at the Neurosurgery Clinic of the Clinical Center of Vojvodina between January 1, 2020 and July 1, 2021. Patients were categorized into three age groups and compared based on the level of consciousness impairment, assessed using the Glasgow Coma Scale, and computed tomography findings evaluated using the Rotterdam score. Results. Statistical analysis revealed that the mean Rotterdam score was 1.6 in patients aged 18-30 years, 1.64 in those aged 31-65 years, and 2.36 in patients over 65 years. The difference between the mean Rotterdam scores between the oldest group and other two groups was highly statistically significant. Conclusion. The findings indicate a significant correlation between age and injury severity, with older patients exhibiting more severe computed tomography findings. However, impairment of consciousness at admission remained comparable across all age groups.