Rathke cleft cysts: a review of clinical and surgical management

2011 ◽  
Vol 31 (1) ◽  
pp. E1 ◽  
Author(s):  
Gabriel Zada
Keyword(s):  
Cyst Wall ◽  
Clinical Symptoms ◽  
Management Strategies ◽  
Field Testing ◽  
Csf Leak ◽  
Recurrence Rates ◽  
Alcohol Injection ◽  
Nonsurgical Management ◽  
Relationship Of ◽  
Sellar Floor

The aim of this paper is to provide a comprehensive review of clinical, imaging, and histopathological features, as well as operative and nonoperative management strategies in patients with Rathke cleft cysts (RCCs). A literature review was performed to identify previous articles that reported surgical and nonsurgical management of RCCs. Rathke cleft cysts are often incidental lesions found in the sellar and suprasellar regions and do not require surgical intervention in the majority of cases. In symptomatic RCCs, the typical clinical presentation includes headache, visual loss, and/or endocrine dysfunction. Visual field testing and endocrine laboratory studies may reveal more subtle deficiencies associated with RCCs. When indicated, the transsphenoidal approach typically offers the least invasive and safest method for treating these lesions. Various surgical strategies including cyst wall resection, intralesional alcohol injection, and sellar floor reconstruction are discussed. Although headache and visual symptoms frequently improve after surgical drainage of RCCs, hypopituitarism and diabetes insipidus are less likely to do so. A subset of more aggressive, atypical RCCs associated with pronounced clinical symptoms and higher recurrence rates is discussed, as well as the possible relationship of these lesions to craniopharyngiomas. Rathke cleft cysts are typically benign, asymptomatic lesions that can be monitored. In selected patients, transsphenoidal surgery provides excellent rates of improvement in clinical symptoms and long-term cyst resolution. Complete cyst wall resection, intraoperative alcohol cauterization, and sellar floor reconstruction in the absence of a CSF leak are not routinely recommended.

scholarly journals Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report

2021 ◽  
Vol 3 (10) ◽  
Author(s):  
Brendan Ryu ◽  
Deepak Khatri ◽  
Avraham Zlochower ◽  
Stephen Maslak ◽  
Randy S. D’Amico
Keyword(s):  
Brain Abscess ◽  
Clinical Symptoms ◽  
Sella Turcica ◽  
Csf Leak ◽  
Case Presentation ◽  
Brain Abscesses ◽  
Pituitary Enlargement ◽  
Operative Recovery ◽  
Sellar Floor

Introduction. Brain abscesses can lead to a diverse array of complications, especially when they are polymicrobial in nature. Multiple underlying pathogens may present with a unique set of clinical symptoms which require an early identification and treatment. Skull base osteomyelitis with sellar floor erosion and pituitary involvement with SIADH are such rare complications of brain abscesses which have never been reported previously in the literature. Case Presentation. We report the case of an immunocompetent 38-year-old male with altered mental sensorium and left hemiparesis due to polymicrobial brain abscess which required surgical evacuation. The post-operative recovery was complicated by severe hyponatremia secondary to SIADH which was treated uneventfully. Radiological imaging demonstrated pituitary enlargement with herniation through an eroded sella turcica without active CSF leak. Patient responded well to the antibiotic therapy based on microbiological susceptibility testing with a complete resolution of the pituitary enlargement on radiological follow-up. Conclusion. Conservative treatment with targeted antibiotics can lead to the resolution of pituitary enlargement secondary to a brain abscess. However, a close clinical follow-up is required to look for a CSF leak considering the sellar floor erosion due to osteomyelitis.

Tarlov cysts: a controversial lesion of the sacral spine

2011 ◽  
Vol 31 (6) ◽  
pp. E14 ◽  
Author(s):  
Corrado Lucantoni ◽  
Khoi D. Than ◽  
Anthony C. Wang ◽  
Juan M. Valdivia-Valdivia ◽  
Cormac O. Maher ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Management Strategies ◽  
Great Majority ◽  
Needle Aspiration ◽  
Radicular Pain ◽  
Lumbosacral Spine ◽  
Ct Guided ◽  
Nonsurgical Management ◽  
Tarlov Cysts ◽  
Leg Weakness

The primary aim of our study was to provide a comprehensive review of the clinical, imaging, and histopathological features of Tarlov cysts (TCs) and to report operative and nonoperative management strategies in patients with sacral TCs. A literature review was performed to identify articles that reported surgical and nonsurgical management of TCs over the last 10 years. Tarlov cysts are often incidental lesions found in the spine and do not require surgical intervention in the great majority of cases. When TCs are symptomatic, the typical clinical presentation includes back pain, coccyx pain, low radicular pain, bowel/bladder dysfunction, leg weakness, and sexual dysfunction. Tarlov cysts may be revealed by MR and CT imaging of the lumbosacral spine and must be meticulously differentiated from other overlapping spinal pathological entities. They are typically benign, asymptomatic lesions that can simply be monitored. To date, no consensus exists about the best surgical strategy to use when indicated. The authors report and discuss various surgical strategies including posterior decompression, cyst wall resection, CT-guided needle aspiration with intralesional fibrin injection, and shunting. In operative patients, the rates of short-term and long-term improvement in clinical symptoms are not clear. Although neurological deficit frequently improves after surgical treatment of TC, pain is less likely to do so.

Relationship between Recurrence Rates of Rathke's Cleft Cysts and Surgical Approaches to Sellar Reconstruction

2020 ◽  
Author(s):  
Rebecca Limb ◽  
James King
Keyword(s):  
Recurrence Rate ◽  
Case Series ◽  
Redo Surgery ◽  
Rathke’S Cleft Cyst ◽  
Recurrence Rates ◽  
Rathke's Cleft Cyst ◽  
Study Objective ◽  
Cyst Recurrence ◽  
Rathke's Cleft ◽  
Sellar Floor

Abstract Study Objective The main purpose of this article is to address the question of whether reconstructing the sellar floor following Rathke's cleft cyst excision results in increased rates of recurrence. Methods and Design A retrospective case series was compiled from medical records and radiological investigations at a single institution over a time period spanning 25 years. Episodes of cyst recurrence were determined from magnetic resonance imaging scans and outpatient encounters. Details regarding surgical procedure and techniques were obtained from operation notes. Perioperative morbidity was also recorded. Results Twenty-three adult patients were treated surgically for a Rathke's cleft cyst at the study institution between 1992 and 2017. The overall cyst recurrence rate was 48%, with 39% of all patients requiring redo surgery within the timeframe of the study. The mean time to redo surgery for recurrence was 4 years. Cyst recurrence rates were 57% postmicroscopic procedures, and 26% postendoscopic procedures (p = 0.148). In the nonreconstructed group, the recurrence rate was 17%, and in the reconstructed group the recurrence rate was 41% (p = 0.3792). Complications arising after nonreconstructive procedures were delayed cerebrospinal fluid rhinorrhea, pneumocephaly, and multiple episodes of meningitis. All these patients required return to theater for secondary reconstruction of the pituitary fossa floor. Conclusion The results of this small study suggest that reconstruction of the sellar floor, and microscopic rather than endoscopic techniques, may be associated with a higher rate of Rathke's cleft cyst recurrence. However, these trends did not reach statistical significance. Patients undergoing nonreconstructive procedures may be more prone to certain postoperative complications.

Meningiomas Of the Internal Auditory Canal

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 119-128 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Sharham Mirzai ◽  
Cordula Matthies ◽  
Peter Vorkapic ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Clinical Symptoms ◽  
Management Strategies ◽  
Internal Auditory Canal ◽  
Signs And Symptoms ◽  
Vestibular Schwannomas ◽  
Additional Patient ◽  
Surgical Removal ◽  
Neurosurgical Department ◽  
Vestibulocochlear Nerve

Abstract OBJECTIVE: Meningiomas arising primarily within the internal auditory canal (IAC) are notably rare. By far the most common tumors that are encountered in this region are neuromas. We report a series of eight patients with meningiomas of the IAC, analyzing the clinical presentations, surgical management strategies, and clinical outcomes. METHODS: The charts of the patients, including histories and audiograms, imaging studies, surgical records, discharge letters, histological records, and follow-up records, were reviewed. RESULTS: One thousand eight hundred meningiomas were operated on between 1978 and 2002 at the Neurosurgical Department of Nordstadt Hospital. Among them, there were 421 cerebellopontine angle meningiomas; 7 of these (1.7% of cerebellopontine angle meningiomas) were limited to the IAC. One additional patient underwent surgery at the Neurosurgical Department of the International Neuroscience Institute, where a total of 21 cerebellopontine angle meningiomas were treated surgically from 2001 to 2003. As a comparison, the incidence of intrameatal vestibular schwannomas during the same period, 1978 to 2002, was 168 of 2400 (7%). There were five women and three men, and the mean age was 49.3 years (range, 27–59 yr). Most patients had signs and symptoms of vestibulocochlear nerve disturbance at presentation. One patient had sought treatment previously for total hearing loss before surgery. No patient had a facial paresis at presentation. The neuroradiological workup revealed a homogeneously contrast-enhancing tumor on magnetic resonance imaging in all patients with hypointense or isointense signal intensity on T1- and T2-weighted images. Some intrameatal meningiomas showed broad attachment, and some showed a dural tail at the porus. In all patients, the tumor was removed through the lateral suboccipital retrosigmoid approach with drilling of the posterior wall of the IAC. Total removal was achieved in all cases. Severe infiltration of the facial and vestibulocochlear nerve was encountered in two patients. There was no operative mortality. Hearing was preserved in five of seven patients; one patient was deaf before surgery. Postoperative facial weakness was encountered temporarily in one patient. CONCLUSION: Although intrameatal meningiomas are quite rare, they must be considered in the differential diagnosis of intrameatal mass lesions. The clinical symptoms are very similar to those of vestibular schwannomas. A radiological differentiation from vestibular schwannomas is not always possible. Surgical removal of intrameatal meningiomas should aim at wide excision, including involved dura and bone, to prevent recurrences. The variation in the anatomy of the faciocochlear nerve bundle in relation to the tumor has to be kept in mind, and preservation of these structures should be the goal in every case.

Virus Vector Relationship of Yellow Mosaic Virus and Whitefly, Bemisia tabaci (Gennadius) in Soybean

2021 ◽  
Author(s):  
M. Swathi ◽  
Neeta Gaur ◽  
Kamendra Singh
Keyword(s):  
Mosaic Virus ◽  
Virus Disease ◽  
Management Strategies ◽  
Virus Transmission ◽  
Virus Vector ◽  
Yellow Mosaic Virus ◽  
Starvation Period ◽  
Mungbean Yellow Mosaic Virus ◽  
Biological Relationship ◽  
Relationship Of

Background: Whitefly is one of the most destructive sucking pest in the tropical and subtropical regions of the world and causing significant crop losses directly by sucking sap from the plants and indirectly through the transmission of viral diseases specifically caused by the genus Begomovirus. The Begomovirus species viz., Mungbean yellow mosaic India virus (MYMIV) and Mungbean yellow mosaic virus (MYMV) are causing yellow mosaic virus disease in soybean, which is transmitted by whiteflies. The disease accounts to 30-70 per cent yield loss and increases up to 80 - 100 per cent during severe incidence. Hence, there is a need for development of integrated pest management strategies against disease and whiteflies, for this the knowledge on virus-vector relationship is required. But, the studies on biological relationship of yellow mosaic virus disease and whitefly in soybean are scarce. At this juncture, considering the importance of disease in soybean, the present investigation was carried out to know the virus -vector relationship of the YMV and whitefly in soybean.Methods: The experiment on virus-vector relationship of yellow mosaic virus and whitefly in soybean was conducted at Department of Entomology, College of Agriculture, G. B. Pant University of Agriculture and Technology, Pantnagar, Uttarakhand during 2016-17. The data on number of whiteflies per plant, acquisition and inoculation access feeding period and pre and post starvation period required for effective transmission of virus was recorded.Result: A single viruliferous whitefly was able to transmit virus and ten viruliferous whiteflies per plant were required for cent per cent transmission of virus. The minimum acquisition access and inoculation access feeding periods required for virus transmission was 0.25h (15 min) each; while the 100 per cent virus transmission was recorded with acquisition and inoculation period of 12h, each. The per cent transmission was increased with the increase of acquisition and inoculation periods. The rate of transmission was positively correlated with pre-acquisition starvation period and negatively correlated with post- acquisition starvation period.

scholarly journals Endoscopic Endonasal Resection of Symptomatic Rathke Cleft Cysts: Total Resection or Partial Resection

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiejun Zhang ◽  
Jihu Yang ◽  
Yan Huang ◽  
Yufei Liu ◽  
Lei Chen ◽  
...  
Keyword(s):  
Cyst Wall ◽  
Partial Resection ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Clinical Prognosis ◽  
Electrolyte Disturbance ◽  
Operative Complications ◽  
Post Operative Complications

Objective: Rathke cleft cysts (RCC) are benign sellar lesions, and endoscopic endonasal surgery (EES) for symptomatic RCC is becoming increasingly popular, but total resection or partial resection (TR or PR) of the cyst wall is still inconclusive. The aim of this study was to review the complications and clinical prognoses associated with total and partial resection of the cyst wall by EES.Methods: We retrospectively analyzed a series of 72 patients with symptomatic RCC treated by EES from -January 2011 to June 2019 at Shenzhen University First Affiliated Hospital. For these 72 cases, 30 were treated with TR and 42 were treated with PR. Intra- and post-operative complications and clinical prognosis were investigated.Results: All 72 patients underwent a pure EES. In the TR group, 10 patients (33.3%) had intraoperative cerebrospinal fluid leakage (CSF leak), three patients (10%) had postoperative CSF leak, eight patients (26.7%) had postoperative diabetes insipidus (DI), eight patients (26.7%) had postoperative electrolyte disturbance, and 12 patients (40%) had temporary hypopituitarism postoperatively. While in the PR group, three patients (7.1%) had intraoperative CSF leak, two patients (4.8%) had postoperative DI, three patients (7.1%) had postoperative electrolyte disturbance, four patients (9.5%) had temporary hypopituitarism postoperatively, and no cases experienced postoperative CSF leak. The intra- and post-operative complications were significantly higher in TR group then PR group (P IntraoperativeCSFleak = 0.004, P Post−operativeCSFleak =0.036, P TransientDI = 0.008, P Temporaryhypopituitarism = 0.002, P Permanenthypopituitarism = 0.036, P Electrolytedisturbance = 0.023). No significant differences in post-operative improvement and recurrence.Conclusions: EES is a safe and effective approach for the treatment of symptomatic RCC. Complete sucking out the cyst contents and partial resection of the cyst wall may be sufficient for treatment, and total resection of the cyst wall is associated with a higher incidence of complications.

scholarly journals Therapeutic and rehabilitation complex for the treatment of patients with chronic generalized periodontitis and bruxism

2020 ◽  
Vol 17 (5) ◽  
pp. 252-257
Author(s):  
Rasima R. Khaybullina ◽  
Larisa P. Gerasimova ◽  
Lira T. Gilmutdinova ◽  
Marina Yu. Gerasimenko
Keyword(s):  
High Efficiency ◽  
Clinical Symptoms ◽  
Blood Perfusion ◽  
Control Group ◽  
Bioelectric Activity ◽  
Temporal Muscle ◽  
Doppler Flowmetry ◽  
Flow Perfusion ◽  
Therapeutic Procedures ◽  
Relationship Of

Background. The article discusses modern concepts of the relationship of periodontal disease and bruxism. Aim: to study the efficiency of the proposed therapeutic and rehabilitation complex for patients with chronic generalized periodontitis and bruxism. Methods. 73 patients aged 3045 years with a diagnosis of chronic generalized periodontitis of moderate severity and bruxism were examined. The control group consisted of 15 apparently healthy individuals of the same age to clarify the functional parameters of the norm. To assess the effectiveness of the proposed therapeutic and rehabilitation complex, clinical, Doppler flowmetric and electromyographic research methods were used. Results. High efficiency of the therapeutic and rehabilitation complex in the treatment of chronic generalized moderate periodontitis and bruxism has been revealed. An analysis of changes in time of clinical symptoms revealed that when using this program, which includes basic therapy, laser phoresis, ozone irrigation of the gums, the intake of phyto-complex and local-mineral complexes, the use of dental pins with propolis and phytocomplex, physiotherapy exercises and fluctuorization, positive changes were pronounced. Under the influence of the course effect of therapeutic procedures, patients showed an increase in blood perfusion volume by 37.7% (p 0.05), blood flow perfusion rate by 58.2% (p 0.05) from the initial values. At the same time, a decrease by 51.82% (p 0.05) from the initial indices of bioelectric activity of the temporal muscle at rest was registered, as well as by 40.4% (p 0.05) with voluntary constriction, and a decrease in the bioelectric activity of the mastication muscle at rest by 47.4% (p 0.05), and with voluntary constriction by 35.12% (p 0.05). Conclusion. The data obtained based on electromyography and laser Doppler flowmetry indicate that the developed treatment and rehabilitation complex is an effective method for correcting the microcirculation of periodontal vessels, the functional activity of the maxillofacial muscles.

scholarly journals Recommendations for Effective and Sustainable Regulation of Biopesticides in Nigeria

2021 ◽  
Author(s):  
Christine Abey Ashaolu ◽  
Chibuzor Okonkwo ◽  
Elizabeth Njuguna ◽  
Dennis Ndolo
Keyword(s):  
Risk Assessment ◽  
Management Strategies ◽  
Field Testing ◽  
Key Factors ◽  
African Countries ◽  
Safety Standards ◽  
Natural Substances ◽  
Global Trend ◽  
Scientific Technical ◽  
Micro Organisms

The global trend towards increased demand for organic food, greener environments, and the integration of biological control agents into pest management strategies has greatly enhanced the need for biological pesticides (biopesticides). Biopesticides are generally environmentally friendly and are made from micro-organisms or other natural substances. Despite their great potential, relatively few have been registered and commercialised in Nigeria compared to other African countries such as South Africa and Kenya. Biological active agents are so diverse such that ap-plying the same safety standards or environmental conditions to all of them is almost impossible. A review of risk assessment processes and comparative assessments of Nigeria's biopesticide regulations with other developing African countries and developed regions was conducted. Prolonged field testing, lack of bridged risk assessments and technical checklists have been identified as key factors hampering the timely development and commercialisation of biopesti-cides in Nigeria. Recommendations on necessary changes to the existing Nigeria biopesticide regulations have been made. Risk assessment matrices for microbial and biochemical biopesti-cides and a scientific/technical checklist have also been developed. Harmonisation and data ex-change among other countries in the region will also enhance the advancement of scientific and technical knowledge for sustainable regulation and cross-border trade.

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