Case Report of a Congenital Subglottic Cyst.

This article presents the case of a full-term newborn who underwent tracheal intubation after birth due to rapid breathing and cyanosis of the lips. Ultrasonography, computer tomography (CT), and magnetic resonance imaging revealed the presence of a subglottic cyst. The patient underwent cyst marsupialization via endoscopy under general anesthesia, with successful extubation on the second postoperative day. In the later follow-up, it was shown that the cyst recurred quickly. However, the special feature of this case is that during the follow-up, the size of the cyst remained unchanged, but suddenly disappeared spontaneously in the third year. As for the reason for the disappearance of the cyst, we can only make theoretical speculations. Whether other recurrent cases will also resolve spontaneously, there are currently no relevant reports.

Spinal neurenteric cysts: experience with 9 cases via an anterior cervical approach.

OBJECTIVE: Intraspinal cysts are uncommon, and the success rate of complete resection is still low for spinal neurenteric cysts (NCs). The aim of this study was to evaluate the efficacies of an anterior microscopic surgical approach in the treatment of ventral and ventrolateral subaxial cervical NCs (SCNCs). METHODS: Between 2019 and 2022, 9 patients with NCs of the subaxial spine underwent an anterior microsurgical approach. Their clinical presentations, radiological features, operative findings, and follow-up data were retrospectively reviewed and analyzed. RESULTS: All spinal cysts were intradural and extramedullary in origin. Five patients were first-time cases while 4 patients with recurrence underwent revision surgery. The most common clinical manifestation was pain (77.78%). One patient was found to have a concomitant disorder of Klippel-Feil syndrome. Microscopically confirmed gross-total resection was achieved in 8 patients (88.89%) based on clinical comparisons between pre- and postoperative MRI and intraoperative video. One patient had symptom recurrence 1 year after subtotal resection, while there was no evidence of recurrence during follow-up for the other patients. Dense adhesions within the spinal cord were observed in 8 patients (88.89%) intraoperatively. Most importantly, the surgical outcome was significantly improved in all patients, and the mean (± SE) Japanese Orthopaedic Association score increased from 11.33 ± 0.91 preoperatively to 16.22 ± 0.32 postoperatively (p = 0.008). CONCLUSIONS: An anterior surgical approach was proven to be both safe and effective in treating the ventral or ventrolateral SCNCs. The authors believe that an anterior microsurgical approach should be considered as a useful approach especially in patients with ventral recurrent SCNCs. Its clinical efficacy compared with a posterior approach in ventral spinal cyst may be better as most of the neurenteric cysts are ventrally or ventrolaterally located.

Hepatic Hydatid Cyst Presenting as Right-Sided Heart Failure: A Case Report.

Cystic echinococcosis is a parasitic disease caused by Echinococcus granulosus. The transmission of the parasite to dogs occurs when organs of animals that harbor hydatid cysts are consumed. We present the case of a patient presented in the cardiology outpatient clinic with the signs and symptoms of predominant right-sided heart failure. Upon evaluation, a large hepatic septated cyst was revealed, which was compressing the right chambers of the heart, altering diastolic filling, and causing right-sided heart failure. CT scan confirmed the presence of a hydatid cyst measuring 115 mm × 90 mm. The patient underwent surgical excision of the cyst with immediate relief of the symptoms. Two weeks later, the patient presented again with the same symptoms and was diagnosed with a recurrence of the hydatid cyst. He underwent surgical resection and removal of the cyst again. The patient remained asymptomatic and free of recurrence on further follow-up evaluations. Cardiac echinococcosis typically features intra-myocardial cysts, while our case presented an extracardiac location. Extrinsic compression of the heart's right chambers from a hydatid cyst has been rarely reported. The surgical excision of the cyst brings immediate and full resolution of the symptoms. The recurrence of hydatid cysts is also an important clinical feature that should not be underestimated.

A Rare Recurrence of a Thyroglossal Duct Cyst Accompanied by Several Postoperative Complications in an Eight-Year-Old Boy: A Case Report.

A thyroglossal duct cyst (TGDC) is a fluid-filled mass in the neck resulting from the persistence of a duct from fetal development that typically regresses spontaneously. When it persists, it is most often removed in a surgical procedure known as a Sistrunk operation. This case study presents the intriguing case of an eight-year-old boy who presented to an otolaryngology clinic with both a recurrence of his TGDC, as well as several postoperative complications, after the Sistrunk operation was performed. After the initial procedure resulted in an incomplete removal of the TGDC, the patient was referred to Interventional Radiology for sclerotherapy. After several rounds of this treatment technique the cyst remnants still persisted along with their associated symptoms. Due to the very low likelihood of a recurrence being observed after surgical removal with subsequent sclerotherapy, the reappearance of the cyst raised several clinical questions. This report underscores the significance of a thorough evaluation and consideration of unique presentations when confronted with recurrent TGDCs.

Modified Nasoseptal Flap Technique to Prevent the Recurrence of Rathke's Cleft Cyst.

Background: Rathke's cleft cysts (RCCs) are benign epithelial lesions arising from the Rathke's pouch remnants that fail to regress during embryogenesis. Some RCCs become symptomatic and require treatment. Cyst fenestration and drainage of its contents is the preferred procedure to treat symptomatic cases but carries a risk of recurrence. We propose the use of a novel modified nasoseptal flap technique to partially line the cyst wall to avoid recurrence. Methods: This was a prospective, observational study that included all RCC patients admitted to the Department of Neurosurgery, Aster Medcity, from April 2015 to May 2018. The modified nasoseptal flap technique was performed in all patients. They underwent preoperative and postoperative ophthalmological, endocrine, endoscopic, and MRI evaluations to look for recurrence. Results: Ten patients underwent the modified nasoseptal flap technique. The median follow-up was 36 months. Postoperatively, all patients were relieved from headaches. Moreover, their visual fields and pituitary functions normalized. None of the patients developed recurrence of RCC on follow-up brain MRI. On endoscopic examination, all patients had retained patency of the fenestra. The longest follow-up was 72 months. Conclusions: The modified nasoseptal flap technique maintains patency and avoids recurrence of RCCs on long-term follow-up.

Pineal region neuroenteric cyst in a 13-year-old girl: A rare localization with postoperative recurrence and local dissemination.

Background: Neuroenteric cysts are rare cystic benign neoplasms of the central nervous system most often located in the spinal cord and rarely, intracranially. The nonspecific neuroimaging features make management planning potentially challenging. We present a case of a radiologically misdiagnosed neurenteric cyst with a complicated course. Case Description: A 13-year-old girl presented with a 6-month history of headache, tinnitus, and dizziness. Initial magnetic resonance images (MRIs) were indistinguishable from a pineal arachnoid cyst with aqueductal stenosis and hydrocephalus. Cyst fenestration was performed through an infratentorial supracerebellar approach. Histology revealed a neurenteric cyst. On day 10 postoperatively, she deteriorated with acute hydrocephalus and cyst enlargement. An external ventricular drain was inserted. She remained asymptomatic thereafter. At 1-year postoperative, the patient remains asymptomatic despite the MRI showing cyst enlargement and local dissemination in the form of multiple cystic lesions in the cerebellum along the operative corridor. The patient was managed conservatively considering adhesion noted intraoperatively. Conclusion: Neuroimaging features of brain cystic lesions may be nonspecific. Special attention should be awarded to posterior fossa and paramedian cystic lesions. Rarer lesions like neurenteric cysts should also be considered. When in doubt, we recommend using the following methods to prevent the free outflow of the cyst contents into the subarachnoid space: lining the cyst and operative corridor with cotton wool and puncture opening and suctioning of fluid. However, the "gold standard" remains surgical treatment with radical excision of the endodermal cyst capsule. It is necessary to preassess the possibility of total or subtotal resection.

Is Hydatid Cyst with Musculoskeletal Involvement a Problem that Causes Morbidity? Long-Term Follow-Up and Functional Results.

Background: The aim of study is to evaluate the involvement characteristics of hydatid cysts, which are rarely involved the musculoskeletal system, and the results of recurrence, morbidity, and functional and mental scoring. Methods: We retrospectively investigated 18 patients with skeletal hydatid disease. Patients were categorized as those with bone or skeletal muscle involvement. Pre- and post-operative physical component scores (PCS) and mental component scores (MCS) on the functional Short Form 12-item Survey were recorded in these patients.We compared the functional scores, number of recurrences, and lesion volumes between patients with hydatid cyst of bone (HCOB) and those with hydatid cyst of soft tissue (HCOST). Results: This study included 11 women and 7 men with bone hydatid cysts. Patients' mean age was 38 years (range 22-70 years). Patients were followed up for a mean of 118.16 months (range 49-230 months). The mean lesion volume was 447.39 cm3 (36-1260 cm3). The 12th and 48th month PCS, the PCS was lower in the HCOB group during both periods (p = 0.04 and p = 0.001, respectively). The 48th month MCS was lower in the HCOB group (p = 0.04). Postoperative residual cysts were detected in five patients who underwent surgical treatment for bone c; all residual lesions were located in the pelvis. Conclusions: Bone hydatid cysts are associated with high recurrence rates, and treatment is challenging. In view of the low functional results and high infection and recurrence rates observed in patients over long-term follow-up, particularly in those with pelvic hydatid cysts, we conclude that this disease is associated with significant morbidity.

Short- and Long-Term Complications of Intraoperative Benign Ovarian Cyst Spillage: A Systematic Review and Meta-analysis.

OBJECTIVE: To review short- and long-term complications associated with intraoperative rupture of benign ovarian cysts. DATA SOURCES: The Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched using the following terms and their combinations: "spillage," "rupture," "leakage," "ovarian cyst," "teratoma," "dermoid," "operative," "surgery," "outcome." METHODS OF STUDY SELECTION: Randomized controlled and observational studies evaluating the operative outcomes of surgical treatment of ovarian cysts with intraoperative spillage compared with those of surgical treatment of ovarian cysts without spillage were included. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. TABULATION, INTEGRATION, AND RESULTS: A total of 28 studies were included in the qualitative analysis and 12 in the quantitative analysis. Ovarian cyst diameter was not found to be associated with the risk for spillage (relative risk [RR] 0.75; 95% confidence interval [CI], -0.33 to 1.82). Intraoperative benign ovarian cyst rupture was not associated with adverse short- and long-term outcomes such as reoperation (RR 1.16; 95% CI, 0.39-3.48), infertility (RR 0.73; 95% CI, 0.15-3.63), transient fever (RR 3.22; 95% CI, 0.83-12.51), and readmission (RR 1.00; 95% CI, 0.33-2.98). However, intraoperative spillage was found to be associated with increased risk for benign recurrence (RR 3.1; 95% CI, 1.05-9.14). A subgroup analysis of the studies that included only dermoid cysts showed an association between intraoperative cyst rupture and postoperative chemical peritonitis (RR 9.36; 95% CI, 1.20-73.28). CONCLUSION: Intraoperative ovarian cyst spillage of a benign cyst is associated with limited adverse clinical outcomes. Although the surgical approach (minimally invasive vs open) should not be affected by the concern regarding an intraoperative cyst rupture, maximal efforts should be made to prevent intra-abdominal spillage.

Utility of Interval Imaging During Focused Radiation Therapy for Residual Cystic Craniopharyngiomas.

BACKGROUND: In the present study, we investigated the changes in cyst volume detected on interval computed tomography (CT) in patients undergoing radiation therapy (RT) for residual cystic craniopharyngioma after surgery. METHODS: We performed a retrospective analysis of CT scans performed halfway during the course of RT for residual cystic craniopharyngioma from January 2005 to January 2018 to assess the incidence of cyst expansion requiring additional intervention. The possible risk factors for cyst expansion during RT were also analyzed. RESULTS: A total of 33 patients (23 males) with a median age of 15 years (interquartile range 8-21 years) who had undergone surgical excision (n = 30) or aspiration (n = 3) of cystic craniopharyngiomas, followed by stereotactic (n = 25) or conformal (n = 8) RT were included. The extent of reduction in tumor volume after surgery was 66.5% ± 17.9% (range, 20.6%-88.9%). Of the 33 patients, 6 (18.2%) experienced a median increase in cyst volume of 11.1 mL (interquartile range, 9.1-12.1 mL; range, 6.3-40 mL) that was beyond the initial planned target volume (PTV) and necessitated additional intervention. Of the 6 patients in whom the cyst showed an increase in volume, 4 underwent cyst aspiration followed by repeat planning of RT and 2 underwent repeat planning of RT alone without additional surgical intervention. In 5 of these 6 patients, the increase in cyst volume was asymptomatic. Younger age (P = 0.002) and a larger residual cyst wall (P = 0.009) were risk factors for early cyst expansion. CONCLUSIONS: Cyst expansion will occur in nearly one fifth of patients with cystic craniopharyngioma during the course of RT. As nearly all these expansions are asymptomatic, interval CT scans midway through RT are essential to avoid geographic miss of the tumor.

What's up with my neck? Ultrasound and surgical findings in cervical midline tumors. / ¿Qué tengo en el cuello? Hallazgos ecográficos y quirúrgicos en tumoraciones de línea media cervical.

OBJECTIVE: Evaluate ultrasound (US) sensitivity and specificity in suspected thyroglossal duct cysts (TGDC) undergoing surgery in our hospital, and their correlation with surgical findings. MATERIAL AND METHODS: Retrospective study of 150 patients undergoing surgery for midline neck mass suggestive of TGDC (2008-2018). We analyzed epidemiological variables and compared the correlation between diagnostic ultrasound imaging and surgical findings, considering previous episodes of local infection. RESULTS: Mean age at surgery was 3.96 years (0.75-12.58 years). Of the 150 patients, 81 were male and 69 were female. Following ultrasound examination, 110 were suspected to have TGDC, and diagnosis was confirmed after surgery in 80 cases. Of the remaining 40 cases without TGDC-compatible US examination, TGDC was confirmed in 15 cases. The rest were diagnosed with dermoid cyst (49), lymphadenopathy (4), and vascular malformation (2). US sensitivity was 84%, while specificity was 45%, with a positive predictive value of 73%, and a negative predictive value of 62%. In 62.1% (59) of TGDCs, a previous infection episode had been described, with 16.7% of cases requiring surgical drainage. 13.6% had recurrence after Sistrunk technique. There was no statistically significant relationship between previous infection episodes and postsurgical recurrence, or between surgical or spontaneous drainage and cyst recurrence. CONCLUSIONS: Even though US role in eutopic thyroid gland identification cannot be doubted, it provides with low specificity in the study of midline neck masses. Therefore, the physician's opinion should be prioritized.

OBJETIVO: Evaluar la sensibilidad y especificidad de la ecografía en las sospechas de quistes del conducto tirogloso (QCT) intervenidas en nuestro centro y su correlación con los hallazgos quirúrgicos. MATERIAL Y METODOS: Estudio retrospectivo de 150 pacientes intervenidos por nódulo en línea media cervical sugestivo de QCT (2008-2018). Recogida de variables epidemiológicas y comparación de la correlación de imagen ecográfica con hallazgos quirúrgicos, considerando la presencia de episodios de sobreinfección previos. RESULTADOS: La edad media de intervención fue de 3,96 años (0,75-12,58 años), siendo 69 mujeres y 81 hombres. De 150 pacientes, 110 presentaron ecografía compatible con QCT, confirmándose el diagnóstico por anatomía patológica en 80 casos. De los 40 pacientes con ecografía no compatible, en 15 se confirmó diagnóstico de QCT. En 95 pacientes del total se identificó QCT. El resto fueron diagnosticados de quiste dermoide (49), adenopatía (4) y malformación vascular (2). La sensibilidad ecográfica fue del 84% y la especificidad del 45%, el valor predictivo positivo del 73% y valor predictivo negativo del 62%. El 62,1% (59) de los QCT tuvo episodio de sobreinfección, precisando drenaje quirúrgico 16,7%. El 13,6% presentó recidiva tras técnica de Sistrunk. No se encontró relación estadísticamente significativa entre episodios previos de infección y recidiva postquirúrgica, ni entre drenaje (espontáneo o quirúrgico) y recidiva del quiste. CONCLUSIONES: A pesar de la importancia de la ecografía para valorar tiroides eutópico en sospechas de QCT, su resultado en el estudio de quistes cervicales tiene baja especificidad, debiendo primar el criterio del facultativo.

Retrospective analysis of transvaginal ultrasound-guided aspiration of simple ovarian cysts.

BACKGROUND: The widespread availability of ultrasonography means that transvaginal ultrasonography has become a routine procedure during gynecological examinations, even in asymptomatic patients. Nowadays the imaging technology offered by ultrasonography and tumor biomarkers give us an opportunity to implement transvaginal ultrasound-guided aspiration as a less radical treatment of simple ovarian cysts (SOC). OBJECTIVES: The aim of the study was a retrospective evaluation of the diagnostic and therapeutic efficacy of transvaginal ultrasound-guided aspiration of SOC in postmenopausal and premenopausal patients. MATERIAL AND METHODS: A total of 84 women, divided into a premenopausal group (38/84) and a postmenopausal group (46/84), underwent transvaginal ultrasound-guided aspiration of small SOC (40-80 mm in diameter). Simple cysts were defined ultrasonographically according to the International Ovarian Tumor Analysis (IOTA) guidelines as cysts with negative risk of ovarian malignancy algorithm (ROMA) scores and CA125 levels. Simple ovarian cyst-related data was obtained from medical documentation (diagnostic tests, medical reproductive and surgical history, and clinical status during SOC aspiration). Follow-up data was collected by means of a telephone interview and medical database. The survey included questions focused on cyst recurrence during the 24-month period following the aspiration of SOC. RESULTS: We had 100% compatibility with ultrasound diagnosis and cytological examination of aspirated fluid. The cumulative rate of cyst recurrence among 84 patients was 20.2% (17/84). There was a higher percentage of cyst recurrence in the premenopausal group: 27% (10/38) vs 15.2% (7/46) in the postmenopausal group, but the difference was not statistically significant (hazard ratio (HR) = 1.89, 95% confidence interval (95% CI) = 0.72-4.97; p = 0.19). Recurrent cysts were treated with laparoscopic cystectomy, adnexectomy or a second aspiration in accordance with individual indications. CONCLUSIONS: Ultrasound-guided aspiration of small (<80 mm) adnexal SOC is a diagnostic and alternative therapeutic procedure, which allows cytological examination and may reduce the need for surgery, which is especially beneficial for women of reproductive age.

A randomized controlled trial of a new technique for laparoscopic management of ovarian endometriosis preventing recurrence and keeping ovarian reserve.

INTRODUCTION: Laparoscopic cystectomy provides more favourable outcomes as regards the recurrence and subsequent clinical pregnancy rates. It is associated with significant reduction in the ovarian reserve due to the inevitable removal of unaffected ovarian tissue. The aim of our study was to evaluate the efficiency of Surgicel in preventing recurrence of endometriomas after their laparoscopic conservative management (cystectomy or drainage). MATERIAL AND METHODS: A randomized controlled trial included two hundred women (candidate for conservative laparoscopic management of ovarian endometriomas). They were randomized into four groups; group D in which patients underwent laparoscopic drainage of the endometrioma, group C in which patients underwent laparoscopic cystectomy of the endometrioma, group DS in which patients underwent laparoscopic drainage followed by insertion of Surgicel inside the cyst cavity & group CS in which patients underwent laparoscopic cystectomy of the endometrioma followed by insertion of Surgicel inside the remaining ovarian tissues. All patients were followed up for 2 years & the primary outcome was the recurrence of endometriomas in the ipsilateral ovary & the postoperative ovarian reserve was reassessed as a secondary outcome. RESULTS: The Surgicel-treated groups had significantly lower hazard of recurrence compared to untreated groups (p = 0.004). Group CS had significantly lower hazard of recurrence compared to Group D & C (p = 0.014, 0.046 respectively). Group DS had significantly lower hazard of recurrence compared to Group D (p = 0.039) but it not significantly different from Group C (p = 0.112). Group DS had the lowest drop of AMH and was significantly lower than the other three groups. CONCLUSION: Surgicel reduces effectively the recurrence risk of endometriomas and its use during laparoscopic drainage is an effective alternative for traditional laparoscopic cystectomy with minimal affection of the patient ovarian reserve. TRIAL REGISTRATION: Name of the registry: clinicaltrials.gov. Trial registration number NCT02947724 . Date of registration October 28, 2016.

Microsurgical resection of juxtafacet cysts without concomitant fusion-Long-term follow-up of 74 patients.

OBJECT: We report on our experience with treating juxtafacet cysts focusing on clinical outcome, rate of recurrence and secondary surgery, especially fusion. METHODS: This retrospective study evaluates patients who underwent surgical resection of juxtafacet cysts without concomitant fusion from 2002 to 2013 with a minimum follow-up of one year. RESULTS: Complete follow-up is available in 74 patients. Mean follow-up in all 74 patients was 69±34months (range, 14-140 months). Mean ODI was 14.9%. 68 patients (91.9%) were pleased with the results and would undergo surgery again. Three patients (4.1%) underwent secondary resection because of cyst recurrence at the same site. Four patients (5.4%) needed secondary fusion. CONCLUSIONS: In patients without evident clinical and radiological criteria of instability we regard surgical resection of juxtafacet cysts without concomitant fusion as adequate primary treatment due to good outcome and low incidence of secondary symptomatic instability.

Spontaneous Bone Regeneration After Enucleation of Large Jaw Cysts: A Digital Radiographic Analysis of 44 Consecutive Cases.

PURPOSE: This study evaluated the healing in cystic defect of the jaw to substantiate our understanding of spontaneous bone healing after enucleation of jaw cysts subjectively and with analysis of digital postoperative panoramic radiographs. MATERIALS AND METHODS: Fourty four consecutive patients reporting to the Department of Dental and Oral Surgery, during the period between 2008-2012 having maxillary and mandibular cysts treated by either surgical enucleation or by marsupialization followed by enucleation were evaluated for subsequent bone formation at the site of cystectomy defect by subjective clinical examination along with digital radiographic examination. Postoperative clinical and radiographic examinations were performed at 6,9,12, and 24 months. Bone regeneration was evaluated by reduction of the size of residual cavities at the cystectomy defect using digital orthopantomogram. RESULTS: Out of 44 patients 15 patients completed two years of follow-up with all the patients having 6 months follow-up. The maximum size of the cystic pathology was 150.40mm and minimum of 14.73mm at the time of presentation (average size of 58.16mm). Twenty patients were diagnosed with odontogenic keratocyst, with one patient having multiple OKC associated with Gorlin Goltz Syndrome, 17 patients had dentigerous cyst, 5 had Radicular cyst; solitary bone cyst and globulomaxillary cyst formed one each. Uneventful healing and spontaneous filling of the residual cavities were obtained in all cases. The digital analysis of the postoperative radiographs showed mean values of reduction in size of the residual cavity of 25.85% after 6 months, 57.13% after 9 months, 81.03% after one year and 100% after two year. CONCLUSION: Spontaneous bone regeneration can occur after surgical removal of jaw cysts without the aid of any graft materials even in large cystic cavity sufficiently surrounded by enough bony walls. This simplifies the surgical procedure, decreases the overall cost of surgery, and reduces the risk of postoperative complications associated with grafting.

Pearls and pitfalls in surgery for endometrioma.

Endometrioma surgery should be planned and executed very carefully as it is associated with risks that may hamper future reproductive potential. Symptoms, age, risk of malignancy, bilaterality, ovarian reserve, and desire to have children should all be taken into account prior to surgical intervention. Cyclic and noncyclic severe pain may be an indicator or deep infiltrating diseases. Laparoscopic surgery is the gold standard, however, the issue of resection versus ablation should be further studied.