Mirchevski, Vladimir

Preferred name

Official Name

Mirchevski, Vladimir

Main Affiliation

vladimir.mircevski@medf.ukim.edu.mk

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Surgical treatment of scalp skin cancer with endocranial invasion
(Macedonian Association of Orthopedics and Traumatology, 2016)
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Aneurysm of the anterior communicating artery.
(Macedonian Association of Anatomists and Morphologists, 2016)
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Aneurysms represent local pathological enlargement of the brain blood vessels that occur in 5% of the population. Intracranial aneurysms in 30 to 37% of the population are localized on the anterior communicating artery. Rupture of aneurysms of the anterior communicating artery lead to subarachnoid hemorrhage characterized by a high rate of morbidity and mortality. There are a number of open issues that are debated in the scientific community for aneurysms the anterior communicating artery. The purpose of this paper was to analyze clinical features, diagnostic and therapeutic modalities of aneurysms of the anterior communicating artery. All patients in this study were treated operatively and aneurysm was excluded from circulation by placing permanent clip to the neck of the aneurysm. Morphological analysis and topographical characteristics of the aneurysms of the anterior communicating artery is very important to decide the treatment of the aneurysm. Use of microneurosurgical clipping is an effective method for the treatment of aneurysms of the anterior communicating artery.
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Thymectomy for myasthenia gravis and anesthetic implications - a retrospective study
(League Against Epilepsy of the Republic of Macedonia = Лига против епилепсија на Република Македонија, 2017)
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Mojsova Maja
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Our experience in treatment of pressure ulcers by using local cutaneous flaps
(Macedonian Academy of Sciences and Arts, 2008-07)
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Agai, Ljuljzim
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Pressure ulcers appear in very ill patients and in states of prolonged immobilization. They are quite frequent in intensive care units and in paraplegic individuals. The expenses for their sanation are huge, due to the complicity of the long-lasting treatment. Shallow and superficial pressure ulcers are treated conservatively. Deep ones, with expressive underlying bone prominence in which no regression is on-going, are better to be treated operatively, if possible. Thus the hospitalisation period and the need for frequent dressings are shortened, preventing enormous scars (sanatio per secundam intentionem of the wound) and the risk of subsequent infection. What is also important for the treatment of the prime disease is that the patient can rehabilitate earlier. There are many methods of excision of the ulcer, ablation of the bone prominence and coverage of the defect with different types of flaps afterwards. Although muscle flaps can be utilized, we assume that their use additionally influences the general condition of the patient (malnutrition and anaemia always co-exist). Thus we find our way of treatment less traumatising and better, if pliable, for decubital ulcers. The objective of the study was to evaluate the clinical results after an operative treatment of deep decubital ulcers (III and IV grade) with local dermal flaps and to promote the method of their closure. We paid special attention to ablation of the bone prominence. We used local pivotal adipose-cutaneous flaps in order to cover the cleansed tissue defect. The types of flaps employed were unilateral and bilateral rotation flaps, transposition and bipedicular flaps. Our series covered 23 patients who were operated on in the last 10 years, of whom 16 (69.6%) had a spinal cord injury (paraplegic). Pressure ulcers in the sacral region dominated with 12 cases (52.2%). The operative techniques that we used were as follows: unilateral rotation flaps (in 7 patients), bilateral rotation flap (in 1 patient), transposition flaps (in 10 patients), bipedicular flaps (in 2 patients), free skin Thiersch auto-transplant (in 2 patients) and direct closure of the defect (in 1 patient). The results advocate the justification of these ways of treatment of pressure ulcers, with few early and late complications.
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CARPENTER SYNDROME - CASE REPORT AND TREATMENT
(Македонско лекарско друштво = Macedonian Medical Association, 2016)
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Zogovska E
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Agai Lj
Introduction. Carpenter syndrome is a polymorphic disorder transmitted by autosomal recessive inheritance, caused by mutations in the RAB23 gene [1]. These gene- tic disorders are reflected on the biogenesis of intracra- nial structures. This syndrome was described for the first time in 1900 by the British doctor George Carpenter. It may include congenital heart diseases, mental retarda- tion, hypogonadism, obesity, umbilical hernia, develop- mental disorder, bone anomalies and frequent respiratory infections. Carpenter syndrome has two main features: craniosynostosis and more than five fingers or toes (2-4]. Aim. To present our experience in treatment of an in- fant with Carpenter syndrome including trigonocephaly and polydactyly. Case report. In May 2003, an eleven-month-old male infant with Carpenter syndrome was hospitalized in the Pediatric Department of the University Clinic of Neuro- surgery in Skopje, Republic of Macedonia. The infant was referred to our Department from the University Pediatric Clinic because of trigonocephaly and poly- dactyly with two thumbs on his right hand. The infant had already been twice hospitalized at the University Pediatric Clinic for two recurrent lung infections su- ggestive of Carpenter syndrome. The diagnosis of tri- gonocephaly and polydactyly with two thumbs on the right hand was made by physical examination, X-ray of the right infant's hand and computed tomography of the head. According to Oi and Matsumoto classification from 1986 [5], the infant had a severe form of trigonocephaly. Surgical procedure. Under general endotracheal anesthe- sia, the infant was placed supine on the operating table, a bifrontal skin incision was made and the scalp flap was created. The bifrontal craniotomy was realized into one bony piece succeeded by a modified Di Rocco's "shell" procedure including frontal translation and trans- Correspondence to: Vladimir Mirchevski, University Clinic for Neurosurgery, Clinical Center "Mother Teresa" Skopje, Macedonia, E- mail: neurosurgery skopje @yahoo. position rotating the flap for 180 degrees without /touching the orbital rims. Results. The postoperative period was uneventful ex- cept for the expected forehead swelling. The infant was discharged from the hospital on the 7 postoperative day, neurologically intact. Three months after surgery, the head had excellent esthetic appearance, with regular psychomotor development in line with the age of the patient. Six months after the first surgery the patient underwent a second plastic and reconstructive surgery in order to reduce the number of fingers. Conclusion. The early recognition and multidisciplinary approach could prevent new disabled individuals in the society. Our technique shortens the entire surgical procedure, diminishes the time under anesthesia and its complications, especially in departments where blood saving devices are not available
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Metastatic ductal breast carcinoma in meningioma: A case report
(Springer, 2017-09)
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Noveska Petrovska, B
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Kocmanovska Petreska, S
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Stojkovski, V
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Objective: Meningiomas and breast cancers statistically are very common tumours among women. However, metastasis from breast carcinoma into an intracranial meningioma is extremely rare. We present a case of 66-years-old female patient diagnosed with breast tumour on physical exam 2 years prior, but refusing further treatment at that time. Method: After incidental fall from height the patient was admitted with vertigo and headaches. CT and MRI was performed which revealed temporoparietal extra-axial brain tumour measuring 7,4x6,3x4,8 cm and small diffuse post-contrast lesions suspicious for sarcoidosis. Surgery with fragmented excision and brain biopsy was performed. Gross examination showed hard white tumour parts with uniform cut surface. Standard procedure for histology and immunohistochemistry was made. Results: Microscopically the tumour was composed of spindle-shaped fibroblastoid cells with small areas of edema. On one sample from totally fifteen taken and on the samples from the brain biopsy, micro-metastatic foci resembling ductal breast carcinoma were detected. Immunohistochemical positivity for CK7, E-cadherin, ER, PR and strong HER with high Ki-67, confirmed the diagnosis. Conclusion: Tissue sampling plays great role in macroscopically undetectable lesions and patients without desire for cooperation. It is important to avoid overlooking the diagnosis of metastatic disease, taking into consideration the requirements for specific treatment strategy.
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Dandy Walker and extreme macrocephaly caused by by enormous occipital encaphalocele
(Македонско лекарско друштво = Macedonian Medical Association, 2016)
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Zogovska E
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Kostov M
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Micunovic M
Introduction. Dandy-Walker syndrome is a congenital brain malformation involving cerebellum with partial and complete vermian agenesis, enlargement of the fourth ventricle and surrounding fluid spaces, cyst formation in posterior cranial fosse pushing tentorium upward [1,2). Hydrocephalus or an increase in the pressure of the fluid spaces may also be present or other malformation as corpus calosum hypoplasia or agenesia, occipital encephalocele, malformation of the heart, face, limbs fingers and toes [3-5]. The symptoms often occur in early infancy and include slow motor development and progressive enlargement of the skull. The diagnostic is done by ultrasound, CT and MRI [6-11]. The treatment of this syndrome may be complex and sometimes includes various experts such as pediatrician, pediatric neurosurgeon, physiatrist, psychologist, sociolo- gist or others. The treatment consists of treating the asso- ciated problems such as hydrocephaly [12-15]. Prog- nosis of Dandy-Walker syndrome is variable and the morbidity and mortality depends on severity of the syndrome and associated malformations [16]. Aim. The aim of this paper was to demonstrate how se- vere spontaneous evolution of Dandy-Walker syndrome may be expressed and the problems and dilemmas which may appear related to its treatment. Case report. A six-year-old boy was referred to the neurosurgeon because of the excessive growth of the skull in anteroposterior axis caused by a wide base occipital encephalocele. Although the psychological de- velopment was near the low limit of the 1Q, the enor- mous head had not allowed verticalization of the child and further progress of his psychomotor development. The head was so heavy that could not be supported by Correspondence to: Vladimir Mirchevski, University Clinic for Neuưosurgey, Clinical Center "Mother Teresa" Skopje, Macedonia: E- mail: neurosurgery.skopje@yaho0.com the child's neck. Surgical procedure. We performed a cranial skull re- duction with primary cranioplasty assisted by a plastic surgeon and Pudentz shunt procedure. Result. The follow-up period lasted two years. The child started to walk, hypotonia and Babinski signs disappeared, communication and his IQ improved. The esthetic results are quite acceptable allowing him better development. Conclusion. The early recognition of anomalies such as Dandy-Walker syndrome with occipital encephalocele using ultrasound may suggest interruption of the preg- nancy on time [6-9). However, the right diagnostic pro- cedure for detecting deformities of the newborn and infant's head at birth is MRI, and the adequate surgical treatment can prevent abnormal and excessive growth of the skull and disorders in the psychomotor develop- ment during child's growth. A multidisciplinary approach may prevent new disabled individuals in the society.
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ANATOMICAL AND MORPHOLOGICAL CHARACTERISTICS OF CUTENEOUS FLAPS USED FOR LARGER BODY TISSUE DEFECTS
(MACEDONIAN ASSOCIATION OF ANATOMISTS AND MORPHOLOGISTS, 2008)
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Jovchevska, Jasmina
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Cutaneous and subcutaneous fat tissue defects are caused by various pathological and trauma conditions. Their coverage can be done with cutaneous flaps or free skin grafts. Anatomical and morphological characteristics of the skin flaps are those which make them versatile and widely applicable for soft tissue defects coverage, even when bare tendon or bone is present on the wound bed bottom. Cur study comprises 645 patients with soft tissue defects, treated on the Clinic for Plastic and Reconstructive Surgery, Skopjе, in a period of 5 years (2002 —2007). Males and females with defects on different body regions are admitted to the study. All defects were treated with skin flaps. We present the results of this reconstructive method. Postoperatively, we examined flap's color, flap's depression/elevation, functional specifics of the flaps and finally, the aesthetic value of the flaps. Hospitalization time was also examined. The conclusion is that in patients where skin flaps were used, better aesthetic and functional effects were achieved; at the same time, the hospital stay was shorter.
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SURGICAL TREATMENT OF SPINAL DYSRAPHISM. A 25 YEARS SINGLE CENTRE EXPERIENCE
(2019)
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Surgical procedures in patients with single level cervical and lumbar disc herniation, treated at PHI University clinic for neurosurgery Skopje
(2021-12)
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Mirchevski, Vladimir

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