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.

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 Role of fibreoptic bronchoscopy and CT guided FNAC in diagnostic evaluation of Non resolving Pneumonia with special emphasis on clinical outcome

2014 ◽  
Vol 6 (3) ◽  
pp. 66-71
Author(s):  
Bhupendra Kumar Jain ◽  
Pooja Sharma ◽  
Ashok Bajpai ◽  
Satish Motiwale ◽  
Nikhilesh Pasari ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Symptoms ◽  
Major Complication ◽  
Needle Aspiration ◽  
Fibreoptic Bronchoscopy ◽  
Diagnostic Efficacy ◽  
Adequate Treatment ◽  
Ct Guided ◽  
Medical College

Background: Nonresolving pneumonia is a pneumonia with a delayed or slow resolution of radiographic infiltrates or clinical symptoms despite adequate treatment with antibiotics for a minimum period of 10 days. Fibreoptic bronchoscopy (FOB) and CT guided FNAC has a specific role in diagnosis of Non resolving pneumonia. Aims and Objectives: To assess the diagnostic efficacy of fibreoptic bronchoscopy (FOB) and computed tomography (CT)- guided fi ne needle aspiration cytology (FNAC) in evaluation of non-resolving or slowly resolving pneumonia with special emphasis on clinical outcome. Material and Methods: The study was designed as a prospective observational study. We reviewed FOB in Sixty-five consecutive patients of Non-resolving pneumonia admitted under Respiratory Medicine unit of Sri aurobindo medical college and PG Institute Indore from June 2012 to May 2014. We also reviewed role of CT guided FNAC in selected case where FOB result was inconclusive. Result: Out of total Sixty-five case of non resolving pneumonia, Fifty-two patient (81%) were diagnosed with the help of FOB and Eleven patients (91%) were diagnosed with help of CT guided FNAC out of Twelve patient subjected for procedure. Conclusion: FOB should be the first option before CT-guided FNAC in evaluating non-resolving pneumonia. Both the procedures were safe and no major complication was observed. DOI: http://dx.doi.org/10.3126/ajms.v6i3.10727  Asian Journal of Medical Sciences Vol.6(3) 2015 66-71

scholarly journals Glue That Pain: A Case Report and Review of Literature

2021 ◽  
Vol 24 (4) ◽  
pp. 387-392
Author(s):  
Umar Farooq ◽  
Asad Abbas ◽  
Asfand Baig Mirza ◽  
Faiza Nazir ◽  
Hiten Mehta ◽  
...  
Keyword(s):  
Symptomatic Relief ◽  
Needle Aspiration ◽  
Review Of Literature ◽  
First Line ◽  
Ct Guided ◽  
Tarlov Cyst ◽  
Root Sheath ◽  
Tarlov Cysts ◽  
Surgical Options ◽  
Csf Diversion

Tarlov cysts are cystic lesions of the nerve root sheath in the lower spine. With a reported incidence ranging from 1 to 5%, these lesions are fairly rare, benign and often asymptomatic. When they cause neural compression they may become symptomatic with sensory, motor, bowel/bladder and sexual dysfunction. The treatment of symptomatic Tarlov cysts is a controversial issue, ranging from conservative management and local steroid injections to a bewildering assortment of surgical options including CSF diversion procedures and advance microsurgical approaches with various ways of cyst manipulation. All these surgical modalities carry a high risk of serious complications, recurrence with need of a redo operation and a very variable rate of symptomatic relief ranging from 38 – 100 % in different series. Developing from the CT guided needle aspiration of the cyst which suffered disappointment in the form of re accumulation and heralded by earlier reports of aseptic meningitis, CT guided aspiration and subsequent filling of the cyst with fibrin glue has now emerged as a safe, highly effective and first line of treatment for symptomatic Tarlov cyst.

scholarly journals Askin’s Tumor - A Rare Case Report and Literature Review

2013 ◽  
Vol 14 (1) ◽  
pp. 94-97
Author(s):  
Aparna Das ◽  
Ahmed Hossain ◽  
Maruf H. Chowdhury ◽  
H.M. Mustafijur Rahman ◽  
Shumona Zahid
Keyword(s):  
Chest Wall ◽  
Soft Tissues ◽  
Clinical Symptoms ◽  
Neuron Specific Enolase ◽  
Needle Aspiration ◽  
Childhood And Adolescence ◽  
Specific Marker ◽  
Positive Staining ◽  
Term Survival ◽  
Ct Guided

Askin’s Tumour (Synonym: Primitive Neuro-Ectodermal Tumor) is a rare neoplasm of the chest wall. In 1979 Askin and Rosai described an unique clinicopathological entity, characterised as a malignant small-cell tumour of the soft tissues of the chest wall in childhood and adolescence. We report on a case of a 30-year old male who had a massive tumour in the left thorax. The clinical symptoms were cough and increasing dyspnoea. The tumour was revealed as a Primitive Neuro-Ectodermal Tumor (PNET) compatible with ASKIN’s Tumor by CT-guided fine needle aspiration. Immunohistochemical studies showed positive staining for CD99. In our case , radiotherapy followed by chemotherapy was given. Microscopy and immunohistological stain of the specific marker—neuron-specific enolase—are essential. Multimodal treatment allows a long-term survival, but often the prognosis is variable.DOI: http://dx.doi.org/10.3329/jom.v14i1.14588 J MEDICINE 2013; 14 : 94-97

COMPUTED TOMOGRAPHY CORRELATION OF THORACIC LESIONS WITH TRANSTHORACIC FINE NEEDLE ASPIRATION CYTOLOGY AND BIOPSY

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Rajneesh Madhok ◽  
Ashish Gupta ◽  
Lalit Singh ◽  
Tanu Agarwal
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Ct Guided ◽  
Fine Needle ◽  
Malignant Lesions ◽  
Needle Aspiration Cytology ◽  
Adequate Tissue

INTRODUCTION: The study is an attempt to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, p Value and complications of CT guided thoracic interventions fine needle aspiration cytology and core biopsy which are used for diagnosing benign and malignant thoracic lesions. MATERIAL AND METHODS: Study included 102 Patients (87 males and 15 females) with age group ranged from 15 to 87 years.A total of 143 CT guided interventions (84 FNAC’s and 59 core biopsies) were performed in 102 patients. The tissue obtained was sent to the laboratory for histopathological and cytological analysis for a final diagnosis which would contribute to patient management. RESULTS: All( 59) core biopsies were successful in procuring adequate tissue for histopathological analysis and the yield of core biopsies was 100% .However out of 84 FNAC’s only 4 were unsuccessful in procuring adequate tissue with a failure rate of 4.8%. Post procedural biopsy complications were only three (2.1%) which were small pneumothorax. There were 75 malignant lesions and 23 benign lesions based on cytology and histopathology (4 were excluded due to inadequate sample). There was good agreement between benign and malignant lesions diagnosed on CT and that diagnosed by pathology. The most common benign and malignant lesions were granulomatous lesion and squamous cell carcinoma. CONCLUSION: Percutaneous CT guided interventions like core biopsy and fine needle aspirations cytology are simple minimal invasive procedures with good patient acceptance and low morbidity and almost negligible mortality. CT guided interventions should be performed early for diagnosis of thoracic lesions.

scholarly journals Clinical Value of CT-Guided Fine Needle Aspiration and Tissue-Core Biopsy of Thoracic Masses in the Dog and Cat

Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 883
Author(s):  
Massimo Vignoli ◽  
Roberto Tamburro ◽  
Andrea Felici ◽  
Francesca Del Signore ◽  
Annalisa Dettori ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Core Biopsy ◽  
Needle Aspiration ◽  
Clinical Value ◽  
Reliable Technique ◽  
Ct Guided ◽  
Fine Needle ◽  
Tissue Core ◽  
Histopathologic Diagnosis ◽  
Ct Guided Biopsy

Diagnosis of thoracic lesions on the basis of history and physical examination is often challenging. Diagnostic imaging is therefore of paramount importance in this field. Radiology has traditionally been considered the diagnostic procedure of choice for these diseases. Nevertheless, it is often not possible to differentiate inflammatory/infectious lesions from neoplastic diseases. A correct cytological and histopathologic diagnosis is therefore needed for an accurate diagnosis and subsequent prognostic and therapeutic approach. In human medicine, Computed Tomography (CT) and CT-guided biopsy are used in the presence of lesions which are not adequately diagnosed with other procedures. In the present study, thoracic lesions from 52 dogs and 10 cats of different sex, breed and size underwent both CT-guided fine-needle aspiration (FNAB) and tissue-core biopsy (TCB). Clinical examination, hematobiochemical analysis and chest radiography were performed on all animals. In this study, 59 of 62 histopathological samples were diagnostic (95.2%). Cytology was diagnostic in 43 of 62 samples (69.4%). General sensitivity, accuracy and PPV for FNAB and TCB were 67.7%, 67.7% and 100% and 96.7%, 95.2% and 98.3%, respectively. Combining the two techniques, the overall mean accuracy for diagnosis was 98.4%. Nineteen of 62 cases showed complications (30.6%). Mild pneumothorax was seen in 16 cases, whereas mild hemorrhage occurred in three cases. No major complications were encountered. CT-guided FNAB cytology can be considered a useful and reliable technique, especially for small lesions or lesions located close to vital organs and therefore dangerous to biopsy in other way.

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.

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