Use of Tubular Retractor for Resection of Colloid Cysts: Single Surgeon Experience and Review of the Literature

2018 ◽  
Vol 16 (5) ◽  
pp. 571-579 ◽  
Author(s):  
Daniel G Eichberg ◽  
Simon S Buttrick ◽  
Jake M Sharaf ◽  
Brian M Snelling ◽  
Ashish H Shah ◽  
...  
Keyword(s):  
Literature Review ◽  
Safety Profile ◽  
Case Series ◽  
Colloid Cyst ◽  
Neurologic Deficit ◽  
Surgical Approaches ◽  
Surgical Morbidity ◽  
Average Hospital ◽  
Surgeon Experience ◽  
Colloid Cysts

Abstract BACKGROUND Colloid cysts are challenging lesions to access. Various surgical approaches are utilized which all require brain retraction, creating focal pressure, local trauma, and potentially surgical morbidity. Recently, tubular retractors have been developed that reduce retraction pressure by distributing it radially. Such retractors may be beneficial in colloid cyst resection. OBJECTIVE To retrospectively review a single neurosurgeon's case series, as well as the literature, to determine the efficacy and safety profile of transtubular colloid cyst resections. We also aim to describe our operative technique for this approach. METHODS We conducted a retrospective review of colloid cyst resections using either ViewSite Brain Access System (Vycor Medical, Boca Raton, Florida) or BrainPath (NICO, Indianapolis, Indiana) tubular retractors performed by a single neurosurgeon from 2015 to 2017 (n = 10). A literature review was performed to find all published cases of transtubular colloid cyst resections. RESULTS Gross total resection was achieved in all patients. Early neurologic deficit rate was 10% (n = 1), and permanent neurologic deficit rate was 0%. There were no postoperative seizures or venous injuries. Average hospital stay was 2.0 d. There was no evidence of recurrence at average follow-up length of 13.6 mo. A literature review demonstrated nine studies (n = 77) with an overall complication rate of 7.8%. CONCLUSION Tubular retractors offer an attractive surgical corridor for colloid cyst resections, avoiding much of the morbidity of interhemispheric approaches, while minimizing damage to normal cortex. There were no permanent complications in our series of ten cases, and a literature review found a similarly benign safety profile.

COLLOID CYSTS OF THE THIRD VENTRICLE: A REVIEW OF SIXTEEN CASES

2021 ◽  
pp. 62-64
Author(s):  
Y Srinivas Rao ◽  
Hemal Chheda ◽  
Ch Surendra ◽  
M V Vijayasekhar ◽  
K Satya Varaprasad
Keyword(s):  
Benign Lesion ◽  
Third Ventricle ◽  
Clinical Manifestations ◽  
Colloid Cyst ◽  
Surgical Approaches ◽  
Imaging Features ◽  
Complete Excision ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Colloid Cysts

BACKGROUND : Colloid cysts are one of the rare brain tumours and are mostly located in the anterosuperior portion of the third ventricle, between the fornix and surround of Foramen of Monroe. OBJECTIVES: Ÿ 1.To review the demographic information & analyse clinical manifestations of patients presenting with colloid cyst of third ventricle. Ÿ 2.To analyze the advantages and disadvantages of various surgical approaches Ÿ 3.To assess the surgical outcome in colloid cyst patients operated by any method. MATERIALS AND METHODS: A retrospective study was performed on 16 patients who presented with a colloid cyst and underwent surgery at the Department of Neurosurgery, King George Hospital, Andhra Medical College between 2013-2018. They were evaluated based on clinical ndings and imaging features, surgical approaches used for resection and their outcomes. RESULTS: Sixteen cases of colloid cyst of the third ventricle were operated upon between 2013-2018. There were seven male and nine female patients with their ages varying between 9 and 62 years old. Nine patients were operated on by using a transcortical trans-ventricular approach, four using the anterior trans-callosal approach and, three patients by using an endoscopic approach. In all patients, complete excision of the lesions was achieved. CONCLUSION: Colloid cysts, though benign, present surgical challenges because of its deep midline location. Complete excision of the colloid cyst carries an excellent prognosis. Surgery is a safe and effective treatment option for this benign lesion.

scholarly journals Primitive Isolated Hydatid Cyst of the Spleen: Total Splenectomy Versus Spleen Saving Surgical Modalities

2020 ◽  
Author(s):  
Atef Mejri ◽  
khaoula Arfaoui ◽  
Mohamed Firas Ayadi ◽  
Badreddine Aloui ◽  
Jasser Yaakoubi
Keyword(s):  
Hydatid Cyst ◽  
Hospital Stay ◽  
Surgical Techniques ◽  
Case Series ◽  
Surgical Approaches ◽  
Average Hospital ◽  
Spleen Preserving ◽  
Operative Complications ◽  
Total Splenectomy ◽  
Post Operative Complications

Abstract BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

Endoscopic resection of incidental colloid cysts

2014 ◽  
Vol 120 (6) ◽  
pp. 1259-1267 ◽  
Author(s):  
Konstantinos Margetis ◽  
Paul J. Christos ◽  
Mark Souweidane
Keyword(s):  
Endoscopic Resection ◽  
Colloid Cyst ◽  
Surgical Removal ◽  
Surgical Morbidity ◽  
Operative Results ◽  
Symptomatic Group ◽  
Surveillance Imaging ◽  
Incidental Group ◽  
Colloid Cysts ◽  
The Mean

Object Incidental colloid cysts are frequently managed with surveillance imaging rather than surgical excision. This approach is born out of their purported indolent growth pattern and the surgical morbidity associated with microsurgical removal. The advent of endoscopic colloid cyst removal may offer renewed assessment of these patients who carry a risk of acute neurological deterioration. An evidence-based recommendation should weigh the risks of operative treatment. Thus far, there has been no concentrated assessment of cyst removal in patients with incidental colloid cysts. The major objective in this study was to define the risks associated with the endoscopic surgical removal of incidentally diagnosed colloid cysts Methods A retrospective review of the medical records was performed to search for patients evaluated for a colloid cyst between the years 1996 and 2012. Eighty-seven patients underwent colloid cyst resection, and 34 were managed with nonoperative surveillance imaging. Microsurgical resections, endoscopic resections of residual or recurrent colloid cysts, and cases with unknown preoperative symptomatic status were excluded from further analysis. Seventy-seven cases of primary endoscopic resections were identified. Twenty resections were performed in patients with an incidental diagnosis and 57 in symptomatic individuals. Presenting characteristics and surgical outcomes were compared between the incidental and symptomatic groups. Results The mean age at surgery was 39.65 years for the incidental and 43.31 years for the symptomatic group (p = 0.36). The median maximal cyst diameter was 9.7 mm (range 3–31 mm) for the incidental and 12 mm (range 5–34 mm) for the symptomatic group. The mean frontal and occipital horn ratio was 0.3928 for the incidental and 0.4445 for the symptomatic group (p = 0.002). Total resection was achieved in 90% of the incidental and 82.3% of the symptomatic cases (p = 0.49). The median hospital stay was 1 day for incidental and 2 days for symptomatic cases (p = 0.006). There were no deaths. There was one case of aseptic meningitis in the incidental group. In the symptomatic group there were 3 complications: one patient with subjective memory impairment, one with transient short-term memory deterioration, and another with a superficial wound infection treated with operative debridement. Two patients from the symptomatic group needed a CSF diversion procedure, and no shunting was needed in the incidental group. There were two recurrences in the symptomatic group (78 and 133 months postoperatively) and none in the incidental group (p = 1). Conclusions Age and cyst diameter were not correlated with the absence or presence of symptoms in patients with a colloid cyst of the third ventricle. Operative results were highly favorable in both groups and did not reveal a higher risk of morbidity in the patient presenting with an incidental lesion. The results support endoscopic resection as a legitimate therapeutic option for patients with incidental colloid cysts. Generalization of the operative results should be cautiously made, since this is a limited series and the results may depend on the degree of neuroendoscopic experience.

scholarly journals Endoscopic resection of colloid cyst: long-term followup with 65 patients

2015 ◽  
Vol 42 (S1) ◽  
pp. S20-S20
Author(s):  
MG Hamilton ◽  
A Isaacs ◽  
G Urbaneja ◽  
W Hader ◽  
H Yong
Keyword(s):  
Surgical Treatment ◽  
Endoscopic Treatment ◽  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Colloid Cyst ◽  
Surgical Approaches ◽  
Consecutive Series ◽  
Endoscopic Removal ◽  
The Third ◽  
Colloid Cysts

Introduction: Colloid cysts of the third ventricle are rare, histologically benign lesions that can be associated with obstructive hydrocephalus. Endoscopic removal developed as an alternative to microsurgical craniotomy as a less invasive surgical treatment. This review examines the endoscopic surgical experience for a consecutive series of patients with colloid cyst of the third ventricle. Methods: Patients with a diagnosis of “colloid cyst of the third ventricle” who were treated in Calgary between January 1994 and July 2014 were reviewed using a clinic database and registry. Results: 95 patients were identified. 30 patients without hydrocephalus underwent serial MRI and clinical observation with one patient developing hydrocephalus leading to surgical treatment. 65 patients underwent endoscopic treatment of their colloid cyst (male=34; female=31). The mean age at diagnosis was 45.5 years. 3 patients had been previously treated with other surgical approaches. All surgically treated patients had hydrocephalus and hydrocephalus resolved in all 65 patients. 1 patient sustained an injury to the internal capsule with transient hemiparesis. Mean followup was 8.2 years (range 0.1-19.3 years). 3 patients experienced colloid cyst recurrence treated with a second endoscopic removal. Conclusion: Endoscopic treatment of third ventricle colloid cysts can be performed with low risk as an alternative to microsurgical resection.

scholarly journals The “Flip-Flap” Technique for Laparoscopic Port-Site Closure—Description of a Novel, Cost-Effective Technique with Review of Literature

2021 ◽  
Vol 07 (03) ◽  
pp. e168-e171
Author(s):  
Ajaz Ahmed Wani ◽  
Suhail Khuroo ◽  
Saurabh Kumar Jain ◽  
Vikas Kumar Heer ◽  
Deepak Rajput ◽  
...  
Keyword(s):  
Safety Profile ◽  
Subcutaneous Tissue ◽  
Case Series ◽  
Laparoscopic Approach ◽  
Surgical Care ◽  
Cost Effective ◽  
Port Site ◽  
Reverse Direction ◽  
Surgical Morbidity ◽  
Trocar Site

Abstract Overview Laparoscopic approach has changed the face of surgical care offered to patients. Almost all surgical procedures across specialties are now undertaken by the laparoscopic approach. Closure of port sites to prevent trocar-site hernias (TSHs) forms an integral part of the laparoscopic procedure. TSH is an area of preventable surgical morbidity. We hereby report our technique that is easily applicable, simple, safe, and highly cost-effective. It requires no additional instruments or retractors, is easy to learn, and has a very favorable safety profile. Materials and Methods This prospective case series enrolled a total of 454 port-site closures in 255 patients undergoing different laparoscopic procedures over a period of 2 years. The intraperitoneal tissue forceps were used in the reverse direction to lift the fascia up and a right-angled retractor was used to retract back the skin and subcutaneous tissue. The port-site closure is done under vision and no adverse events were reported. Results This technique was used in 454 port sites in 255 patients. No intraoperative incidents were noted. There is no requirement of any specialized instruments or retractors. No additional tissue trauma or dissection is required. There is no extension of operative time. The technique is simple to learn and easy to teach. No bowel injuries or TSHs were reported during a follow-up of 26 months. Conclusion The described technique is easy, simple, cost-effective, and has a good safety profile.

scholarly journals Intraventricular meningiomas: A case series and literature review.

2021 ◽  
Vol 28 (11) ◽  
pp. 1633-1639
Author(s):  
Urooj Fatimah Siddiqui ◽  
Muhammad Faiq Ali ◽  
Muhammad Asim Khan Rehmani ◽  
Atiq Ahmed Khan ◽  
Sheeraz ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Residual Tumor ◽  
Surgical Approaches ◽  
Cognitive Changes ◽  
Rare Type ◽  
Who Grade ◽  
Lateral Ventricles ◽  
Csf Leakage ◽  
Biopsy Report

Objective: Intraventricular meningiomas (IVMs) are rare type of meningiomas. Majority of IVMs are located in lateral ventricles. Study Design: Case Series. Setting: Civil Hospital Karachi. Period: January 2013 to January 2018. Material & Methods: 15 patients were assessed with histologically verified IVMs, clinical features, radiological findings, surgical approaches, outcome and literature review. Results: The most common presentations included raised intracranial pressure (66.7%), visual deficits (40%), cognitive changes and dysphasia. All lesions arose in the lateral ventricles. Preoperative diagnosis was confirmed on MRI. Excision was performed using the posterior parietal and parieto-temporal approach for lateral ventricle tumors. Total excision was done in 13 out of 15 patients and two patients with residual tumor underwent stereotactic radiosurgery. Biopsy report showed WHO grade-I lesion in all cases. Postoperative complications included CSF leakage, transient hemiparesis and dysphasia. Glasgow Outcome Score of 5 was found in majority of cases (87%) on follow-up. Conclusion: These results depict that IVMs can be excised completely with minimum postoperative morbidity. However, resection requires planning to avoid eloquent cortical damage.

Long-Term Outcomes of Endoscopic Third Ventricle Colloid Cyst Resection: Case Series With a Proposed Grading System

2020 ◽  
Vol 19 (2) ◽  
pp. 134-142
Author(s):  
Albert M Isaacs ◽  
Yarema B Bezchlibnyk ◽  
Jarred Dronyk ◽  
Geberth Urbaneja ◽  
Heather Yong ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Third Ventricle ◽  
Case Series ◽  
Surgical Approaches ◽  
Grading System ◽  
Long Term Outcomes ◽  
Initial Surgery ◽  
Colloid Cysts

Abstract BACKGROUND Endoscopic resection of colloid cysts has gained recent widespread practice. However, reported complication and recurrence rates are variable, possibly, in part, because of a lack of consistency with reporting of the extent of cyst capsule removal. OBJECTIVE To present the long-term outcomes of endoscopic resection of third ventricle colloid cysts without complete capsule removal and propose a grading system to allow consistent description of surgical outcomes. METHODS A retrospective review of 74 patients who underwent endoscopic resection of symptomatic third ventricle colloid cysts between 1995 and 2018 was performed. Kaplan-Meier analyses were used to assess recurrence-free survival rates. RESULTS Median patient age and cyst diameter were 48.0 (13.0-80.0) yr and 12.0 (5.0-27.0) mm, respectively. Complete emptying of cyst contents with capsule coagulation was achieved in 73 (98.6%) patients. All patients improved or remained stable postoperatively, with a median follow-up duration of 10.3 (0.3-23.7) yr. Radiographic recurrence occurred in 6 (8.1%) patients after their initial surgery, 5 (6.8%) of whom underwent redo endoscopic resection. No major complications or mortality was encountered at primary or recurrence surgery. CONCLUSION Endoscopic resection of third ventricle colloid cysts without emphasizing complete capsule removal is a viable option for successfully treating colloid cysts of the third ventricle. Long-term follow-up demonstrates that it is associated with low risks of complications, morbidity, mortality, and recurrence. The proposed extent of the resection grading scheme will permit comparison between the different surgical approaches and facilitate the establishment of treatment guidelines for colloid cysts.

Colloid Cysts: Experience with the Management of 84 Cases Since the Introduction of Computed Tomography

Neurosurgery ◽  
1989 ◽  
Vol 24 (5) ◽  
pp. 693-700 ◽  
Author(s):  
Arturo Camacho ◽  
Chad D. Abernathey ◽  
Patrick J. Kelly ◽  
Edward R. Laws
Keyword(s):  
Imaging Techniques ◽  
Visual Disturbance ◽  
Treated Group ◽  
Colloid Cyst ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Computer Assisted ◽  
Stereotactic Aspiration ◽  
Presenting Symptoms ◽  
Colloid Cysts

ABSTRACT A retrospective review of colloid cysts diagnosed from 1974 to 1986 emphasizes the presenting symptoms of these lesions, their surgical management, and the contribution of modern imaging techniques to their diagnosis and therapy. In this 12-year period, 84 patients (45 men and 39 women) had a colloid cyst diagnosed. The patients' mean age was 46 years (range, 7-82 years). Surgery was performed in 55 patients, 7 of whom had undergone prior surgery elsewhere. The surgical approaches used were transfrontal-transventricular, transcallosal, computer-assisted stereotactic aspiration and resection by stereotactic craniotomy, and shunting of cerebrospinal fluid without removal of the lesion. There was no operative mortality, but complications occurred in 15 patients (27%). Preoperative imaging showed hydrocephalus in 93% of the patients: severe in 43%, moderate in 36%, and mild in 14%. In the surgically treated group, the most common presenting symptoms were headache, change in mental status, ataxia, nausea and vomiting, visual disturbance, emotional lability/inappropriate affect, depersonalization, and hypersomnolence. Twenty-four patients for whom surgery was not recommended are being followed up closely. Most of these patients had normal ventricles. The symptoms in this group included headache, anxiety/nervousness, ataxia, memory impairment, visual disturbance, and seizures. Five autopsy cases of patients with colloid cysts were available during this period and were reviewed. Direct removal of colloid cysts can be accomplished with low morbidity and mortality, avoiding the frequent revisions and complications related to shunt procedures. There is a subgroup of colloid cysts that can be operated upon electively or followed up closely with serial imaging studies.

scholarly journals Primitive isolated hydatid cyst of the spleen: total splenectomy versus spleen saving surgical modalities

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Atef Mejri ◽  
Khaoula Arfaoui ◽  
Mohamed Firas Ayadi ◽  
Badreddine Aloui ◽  
Jasser Yaakoubi
Keyword(s):  
Hydatid Cyst ◽  
Hospital Stay ◽  
Surgical Techniques ◽  
Case Series ◽  
Surgical Approaches ◽  
Average Hospital ◽  
Spleen Preserving ◽  
Operative Complications ◽  
Total Splenectomy ◽  
Post Operative Complications

Abstract Background This study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease. Methods This is a descriptive retrospective study carried out over a period of 7 years extending from January 2013 to December 2019 reporting eight cases of isolated primitive splenic hydatid cysts. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy. Results The diagnosis was incidentally made in 50% of cases. The main other revealing complaints are pain in the left upper quadrant of abdomen in 25% of cases and a painless renitent mass in the same quadrant in only 12,5%. None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay (9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. Conclusions The current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures. It seems to be the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization (MAC-19 PRO): a case series

2020 ◽  
Vol 3 (3) ◽  
pp. 297-310 ◽  
Author(s):  
Rafael Ricafranca Castillo ◽  
Gino Rei A. Quizon ◽  
Mario Joselito M. Juco ◽  
Arthur Dessi E. Roman ◽  
Donnah G De Leon ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Hospital Stay ◽  
Clinical Improvement ◽  
Case Series ◽  
High Dose ◽  
Chest Imaging ◽  
Imaging Findings ◽  
Rt Pcr ◽  
Average Hospital ◽  
Sleeping Problems

 Treatment for coronavirus disease 2019 (COVID19) pneumonia remains empirical and the search for therapies that can improve outcomes continues. Melatonin has been shown to have anti-inflammatory, antioxidant, and immune-modulating effects that may address key pathophysiologic mechanisms in the development and progression of acute respiratory distress syndrome (ARDS), which has been implicated as the likely cause of death in COVID19. We aimed to describe the observable clinical outcomes and tolerability of high-dose melatonin (hdM) given as adjuvant therapy in patients admitted with COVID19 pneumonia. We conducted a retrospective descriptive case series of patients who: 1) were admitted to the Manila Doctors Hospital in Manila, Philippines, between March 5, 2020 and April 4, 2020; 2) presented with history of typical symptoms (fever, cough, sore throat, loss of smell and/or taste, myalgia, fatigue); 3) had admitting impression of atypical pneumonia; 4) had history and chest imaging findings highly suggestive of COVID19 pneumonia, and, 5) were given hdM as adjuvant therapy, in addition to standard and/or empirical therapy. One patient admitted to another hospital, who one of the authors helped co-manage, was included. He was the lone patient given hdM in that hospital during the treatment period. Main outcomes described were: time to clinical improvement, duration of hospital stay from hdM initiation, need for mechanical ventilation (MV) prior to cardiopulmonary resuscitation, and final outcome (death or recovery/discharge). Of 10 patients given hdM at doses of 36-72mg/day per os (p.o.) in 4 divided doses as adjuvant therapy, 7 were confirmed COVID19 positive (+) by reverse transcription polymerase chain reaction (RT-PCR) and 3 tested negative  (-), which was deemed to be false (-) considering the patients’ typical history, symptomatology, chest imaging findings and elevated bio-inflammatory parameters.  In all 10 patients given hdM, clinical stabilization and/or improvement was noted within 4-5 days after initiation of hdM. All hdM patients, including 3 with moderately severe ARDS and 1 with mild ARDS, survived; none required MV. The 7 COVID19(+) patients were discharged at an average of 8.6 days after initiation of hdM. The 3 highly probable COVID19 patients on hdM were discharged at an average of 7.3 days after hdM initiation. Average hospital stay of those not given hdM (non-hdM) COVID19(+) patients who were admitted during the same period and recovered was 13 days. To provide perspective, although the groups are not comparable, 12 of the 34 (35.3%) COVID19(+) non-hdM patients admitted during the same period died, 7/34 (20.6%) required MV; while 6 of 15 (40%) non-hdM (-) by RT-PCR but highly probable COVID19 pneumonia patients also died, 4/15  (26.7%) required MV. No significant side-effects were noted with hdM except for sleepiness, which was deemed favorable by all patients, most of whom had anxiety- and symptom-related sleeping problems previously. HdM may have a beneficial role in patients treated for COVID19 pneumonia, in terms of shorter time to clinical improvement, less need for MV, shorter hospital stay, and possibly lower mortality. HdM was well tolerated. This is the first report describing the benefits of hdM in patients being treated for COVID19 pneumonia.  Being a commonly available and inexpensive sleep-aid supplement worldwide, melatonin may play a role as adjuvant therapy in the global war against COVID19. 

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