Stolevski, Vlado

Preferred name
Stolevski, Vlado
Official Name
Stolevski, Vlado
Main Affiliation
Email
vlado.stolevski@medf.ukim.edu.mk

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    AWAKE BRAIN SURGERY IN A PATIENT WITH GLIOBLASTOMA
    (Department of Anaesthesia and Reanimation, Faculty of Medicine, “Ss. Cyril and Methodius” University in Skopje, R.N.Macedonia, 2024)
    Adramanova, Dona
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    Abbas, Nebil
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    Strezoska, Marija
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    The awake craniotomy, as a surgical procedure, facilitates maximal resection of brain tumors with minimal or no damage to eloquent brain areas. Conscious sedation and asleep-awake-asleep techniques are two anesthetic techniques employed. During the awake phase, the patient should be alert and cooperative, with adequate analgesia as an essential component of the anesthetic management while neurological testing is performed. Ensuring airway patency, proper oxygenation and ventilation, avoidance of hypoxia and hypercarbia, and maintaining stable systemic and cerebral hemodynamics are crucial. We present a case of a right-handed 56-years-old man with speech difficulties manifested as fluent dysphasia and magnetic resonance findings of intra-axial supratentorial left-sided temporoparietal lesions. The patient was scheduled for awake brain surgery according to the affected eloquent language brain area of the dominant hemisphere. Asleep-awake-asleep anesthetic technique was utilized. Short-acting sedative agents propofol and dexmedetomidine were used, along with remifentanil and fentanyl as analgesics. After awakening, neurological testing of sensory, motor and cognitive functions was performed, revealing no new neurological deficits and achieving maximally safe microsurgical tumor resection with stable hemodynamics and no respiratory or intracranial adverse events. With histopathological findings of glioblastoma (WHO Grade IV), chemotherapy and radiotherapy followed the surgery. The available literature demonstrates the importance of the extent of tumor resection for improved outcomes and survival benefits in glioma surgery, with maximal resection without excising functional brain tissue, being the primary goal of awake brain surgery.
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    Unveiling the neuropathology tumour landscape: 10-year statistical analysis with global comparison – Single centre experience
    (Macedonian Academy of Sciences and Arts, 2023-12)
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    Introduction: Central nervous system (CNS) tumours represent a significant public health issue worldwide, and their incidence and distribution vary across different populations. Although studies on CNS tumours have been conducted in various countries, there is a lack of information regarding their patterns in Macedonia. Therefore, this study is aimed at investigating the distribution, histopathological types and subtypes and demographic features of CNS tumours in our country. Materials and Methods: A cross sectional study was conducted using the electronic database of the Institute of Pathology – Medical Faculty, University “Ss. Cyril and Methodius” in Skopje which contains data from 3286 received and analysed surgical specimens, mainly from the University Clinic of Neurosurgery in Skopje, and a smaller number of surgical specimens from the University Surgical Centre “St. Naum Ohridski” in Skopje between 2012 and 2022. The collected and analysed data includes patient age, sex and histopathological types and subtypes of the tumours. Results: The majority of CNS tumours were diagnosed in adults aged between 50-70, with a male to female ratio of 1.5:1. The most common location of the tumours was the cerebrum, followed by the pituitary gland and cerebellum. The most frequent histological groups were gliomas, with glioblastoma as the most common diagnosis, followed by meningiomas. Conclusion: Following a detailed and thorough review of the CNS tumours in our study, we can conclude that the R. of Macedonia follows global statistics and trends regarding brain tumours.