Sclerotherapy of Symptomatic Nonparasitic Splenic Cysts: Excellent Long-Term Treatment Response'

Background Splenic cysts are rare and occur in 0.5 to 2% of the population. They are usually asymptomatic and do not require therapy. In case of symptomatic nonparasitic splenic cysts, potential therapy includes partial splenectomy or laparoscopic cyst de-roofing as well as ultrasound-guided sclerotherapy with 1% polidocanol or 10% sodium chloride (NaCl) as an interventional alternative. So far, single-session sclerotherapy of symptomatic nonparasitic cysts is recommended only if clear-transparent cyst fluid is aspirated. Materials and Methods We report a case series of 17 patients with symptomatic macroscopically turbid nonparasitic splenic cyst fluid who underwent ultrasound-guided fine needle sclerotherapy with either polidocanol ± 10% NaCl (n = 12) or 10% NaCl alone (n = 5) and a follow-up of a maximum of 12 years after first intervention. Clinical, sonographic, and laboratory chemistry data were recorded at baseline and during the follow-up. Results The mean follow-up time was 43.65 ± 40.18 months. At the end of the follow-up, a 79% reduction of cyst size was achieved. The maximum size reduction in the polidocanol group was 76 ± 18% and 84 ± 21% in the sodium chloride group (p >0.05). At the end of follow-up, 15 out of the 17 patients did not have any further symptoms. Despite the cystic fluid being turbid, it was hardly possible to detect a microbiological superinfection. Conclusion Sclerotherapy of splenic cysts leads to a significant size regression in all patients, independent of the sclerotherapy agent used with fewer systemic toxic side effects of polidocanol treatment. It was shown that in a tertiary care center with significant experience, sclerotherapy of splenic cysts is also safe and successful and can lead to a drastic regression of cyst size and symptoms. This shows that interventional therapy is a good alternative to surgical procedures.

Surgical treatment of symptomatic pineal cysts without hydrocephalus—meta-analysis of the published literature

Background To examine published data and assess evidence relating to safety and efficacy of surgical management of symptomatic pineal cysts without hydrocephalus (nhSPC), we performed a systematic review of the literature and meta-analysis. Methods Following the PRISMA guidelines, we searched Pubmed and SCOPUS for all reports with the query ‘Pineal Cyst’ AND ‘Surgery’ as of March 2021, without constraints on study design, publication year or status (PROSPERO_CRD:42,021,242,517). Assessment of 1537 hits identified 26 reports that met inclusion and exclusion criteria. Results All 26 input studies were either case reports or single-centre retrospective cohorts. The majority of outcome data were derived from routine physician-recorded notes. A total of 294 patients with surgically managed nhSPC were identified. Demographics: Mean age was 29 (range: 4–63) with 77% females. Mean cyst size was 15 mm (5–35). Supracerebellar-infratentorial approach was adopted in 90% of cases, occipital-transtentorial in 9%, and was not reported in 1%. Most patients were managed by cyst resection (96%), and the remainder by fenestration. Mean post-operative follow-up was 35 months (0–228). Presentation: Headache was the commonest symptom (87%), followed by visual (54%), nausea/vomit (34%) and vertigo/dizziness (31%). Other symptoms included focal neurology (25%), sleep disturbance (17%), cognitive impairment (16%), loss of consciousness (11%), gait disturbance (11%), fatigue (10%), ‘psychiatric’ (2%) and seizures (1%). Mean number of symptoms reported at presentation was 3 (0–9). Outcomes: Improvement rate was 93% (to minimise reporting bias only consecutive cases from cohort studies were considered, N = 280) and was independent of presentation. Predictors of better outcomes were large cyst size (OR = 5.76; 95% CI: 1.74–19.02) and resection over fenestration (OR = 12.64; 3.07–52.01). Age predicted worse outcomes (OR = 0.95; 0.91–0.99). Overall complication rate was 17% and this was independent of any patient characteristics. Complications with long-term consequences occurred in 10 cases (3.6%): visual disturbance (3), chronic incisional pain (2), sensory disturbance (1), fatigue (1), cervicalgia (1), cerebellar stroke (1) and mortality due to myocardial infarction (1). Conclusions Although the results support the role of surgery in the management of nhSPCs, they have to be interpreted with a great deal of caution as the current evidence is limited, consisting only of case reports and retrospective surgical series. Inherent to such studies are inhomogeneity and incompleteness of data, selection bias and bias related to assessment of outcome carried out by the treating surgeon in the majority of cases. Prospective studies with patient-reported and objective outcome assessment are needed to provide higher level of evidence.

Diagnosis, Management, and Therapy of Fetal Ovarian Cysts Detected by Prenatal Ultrasonography: A Report of 36 Cases and Literature Review

Background: Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. Methods: We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥ 40 mm was performed. Results: We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter < 40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to < 35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥ 40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. Conclusions: IUA is a promising therapy for preserving ovaries with simple cysts ≥ 40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.

Comparison of Laparoscopic Single-Incision Surgery with Hangt-Port Approach and Multiport Approach for Ovary Mature Cystic Teratoma

Objective To compare the safety and clinical outcomes of transumbilical laparoscopic single-incision Hangt-port approach with multiport approach surgery for mature cystic teratoma of ovary. Methods A total of 94 patients with unilateral ovarian maturity cystic teratoma underwent cystectomy in our hospital from February 2018 to December 2019 were retrospectively analysed. All the patients were treated with single incision surgery by Hangt-port approach (n = 45) and multiport approach (n = 49). Baseline characteristics were presented, and perioperative outcomes were followed-up and compared. Primary outcome measures were incision related complications. Results Baseline characteristics were comparable within the groups. During 1 year follow-up, the incidence of incision related complications of Hangt-port approach were more than that in the multiport group ( 8/45 v.s.1/49, P = 0.013). A total of 2 cases suffered postoperative umbilical hernia and 7 case was delayed incision wound healing. Compared with multiport group, post-operative VAS scores during 12 hours were significantly increased in Hangt-port group (3.62 ± 0.91 v.s. 2.92 ± 1.13, P = 0.001). Also, the Hangt-port group had significantly shorter operative time for patients with cyst size > 6cm (77.77 ± 16.31 v.s. 92.33 ± 25.65, P = 0.031), while showed significantly prolonged post-operative hospital stay for patients with cyst size ≤ 6cm (4.13 ± 1.01 v.s. 3.32 ± 0.82, P = 0.003). Conclusions Both multiport and Hangt-port approach were safe in laparoscopic single incision surgery. Hangt-port approach was likely to be recommended for patients with cyst size > 6 cm, but incision-related follow-up complications should be concerned.while this finding still need to be explored by further large-scale study.

Predicting outcomes in Dandy-Walker malformation: a retrospective cohort study

OBJECTIVE Dandy-Walker malformation (DWM) is a disorder that most neurologists and neurosurgeons will manage at some point during their careers. It is characterized by partial or complete dysgenesis of the cerebellar vermis. Outcomes are highly variable and range from functionally normal to severely disabled. Predicting these outcomes has classically been focused on the radiological findings that constitute DWM. Other anomalies that can be commonly found in these patients are potentially more indicative of outcome than the tenet markers of DWM. Furthermore, hydrocephalus is an ever-present danger in these patients, many of whom will be admitted to the hospital due to this condition. This study aims to identify these items as potential predictors of outcome. METHODS All referrals from antenatal anatomy scans between 1992 and 2013 that were suspicious for DWM were reviewed. Neurosurgery archives were reviewed for outpatient letters and other correspondence. The number of DWM diagnoses was quantified. Outcomes were judged based on patient status, ranging from death to attending normal school. The presence of any other anomalies was quantified and measured against patient outcomes. RESULTS Cyst size and the presence of another CNS anomaly were shown to portend worse outcomes. Non-CNS anomalies and hydrocephalus were not predictive of worse outcomes. Furthermore, of all the treatments assessed, ventriculoperitoneal shunts were shown to be the most effective in this data set. CONCLUSIONS Results from this study suggest a pivot in how prognoses in DWM should be established and how parents should be counseled, along with a view of hydrocephalus and its treatment that challenges the current literature.

Functional Ovarian cysts: Expectant management versus Oral contraceptives

Background: Ovarian cyst is a common problem in females of reproductive age group. Objective: To compare the expectant management and use of oral contraceptives for the management of ovarian cysts. Methodology: This was a comparative study, conducted in the department of Obstetrics and Gynecology, Sheikh Zayed Medical College, Rahim Yar Khan, from January 2017 to December 2018. A total of 870 females were included through non-probability, purposive sampling. Informed verbal consent was obtained. Ultrasound was performed to measure the cyst size, site, and characteristics. The lottery method was used to divide the patients into two groups. Patients in group E received expectant treatment (placebo) and in group OC, patients were prescribed hormonal treatment with combined oral contraceptive (COCP) having ethinyl estradiol 0.03mg and levonorgestril 0.15mg. Then patients were counseled and followed up for one month. After one month, USG was performed again to measure success as cyst resolution. The collected data was analyzed into SPSS 16. Both groups were compared for success by using the chi-square test, taking p-value <0.05 as significant. Results: Mean age of females was 26.42±7.59 years. There were 488 (56%) married females while 382 (44%) were unmarried. Mean cyst size was 3.93±1.28cm. was achieved in 605 (69.5%) females, out of which 259 (59.5%) had expectant management while 346 (79.5%) had oral contraception. Success (Cyst resolution) was achieved in 605 (69.5%) females, out of which 259 (59.5%) had expectant management while 346 (79.5%) had oral contraception. (p=0.00). Conclusion: It was concluded that oral contraceptives are more effective and successful in the resolution of ovarian cysts as compared to expectant management.

Portal Hypertension as a Complication of Cystic Echinococcosis: A 20-Year Cohort Analysis

Cystic echinococcosis (CE) is a parasitic disease caused by the larval forms of species of the tapeworm Echinococcus. The most common location is the liver. To assess the frequency and clinical characteristics of portal hypertension (PH) and the risk factors for PH development, we performed a retrospective observational study of inpatients diagnosed with hepatic CE and PH from January 1998 to December 2018, at Complejo Asistencial Universitario de Salamanca, Spain. Of 362 patients analyzed with hepatic CE, 15 inpatients (4.1%) had a portal vein diameter ≥14 mm, and the mean diameter of the portal vein was 16.9 (standard deviation [SD] ±2.1) mm. Twelve patients were men. The mean age was 59.5 years (SD ± 17.8 years). Four patients had ascites (26.6%), four had collateral circulation (26.6%), 14 had hepatosplenomegaly (93.3%), five had esophageal varices (33.3%), four had hematemesis, and three had jaundice. Other causes of PH included hepatitis B virus (1 patient) and hepatitis C virus (1 patient) infections and alcohol abuse (1 patient). The host variables associated with PH development were male sex (odds ratio, 4.6; 95% confidence interval, 1.1–20.9; P = 0.030) and larger cyst size (10.8 ± 6.3 versus 7.6 ± 4.1; P = 0.004). Hepatic CE is an infrequent cause of PH that usually occurs without indications of liver failure. Larger cyst size and male sex were the main risk factors associated with this complication. Mortality was higher for patients with hepatic CE with PH than for patients with hepatic CE without PH.

Thyroglossal Duct Cyst - An Observational Study from Visakhapatnam, Andhra Pradesh

BACKGROUND Thyroglossal duct cyst is a developmental cyst that occurs in 7 % of the population. These cysts are most commonly seen in paediatric patients. They occur due to failure of thyroglossal duct to involute and atrophy. Majority of them are found in infrahyoid region. The purpose of this research was to summarise our three years of clinical experience in different features of thyroglossal cysts and their surgical results, with an emphasis on the naked eye extent of a patent thyroglossal duct if present. METHODS This observational study was carried out in the Department of ENT, GVP IHC & MT – Visakhapatnam district, Andhra Pradesh for a period of three years from January 2016 to 2019. In our study, twenty patients were enrolled. Patients with cysts were initially diagnosed based on medical history, clinical examination, and ultrasound sonography (USG) reports. RESULTS Patients' clinical and surgical data, including cyst size and position, presence or absence of the thyroglossal duct, and so on, were analysed. The average age was 11 years. The majority (73.5 percent) were under the age of 15. Males accounted for 75 percent of the population, while females accounted for 25 %. Midline neck swelling was found in most of the patients (95 %). Majority (84.5 %) of cysts were located in the sub-hyoid region. Erythema over swelling was seen in 14.5 % of patients. Thyroglossal ducts were found to be patent at various lengths and areas. Majority of patients (75 %) had tract that began from cyst and ended at superior border of hyoid body while two patients (10 %) had patent thyroglossal duct from the cyst to the vallecular mucosa. Majority (70 %) cysts had size between 1.6 cm and 3 cm. Intraoperatively 15 % of cyst got ruptured. Most of them were present with visible midline neck swelling. None of the cysts had malignant characteristics in our study. CONCLUSIONS In most cases, a patent duct just disappeared at the superior border of body of hyoid. Complete patent thyroglossal duct from cyst to tongue musculature was rare. None of the cysts had malignant characteristics in our study. KEYWORDS Thyroglossal Cyst, Neck Swelling, Thyroglossal Duct

Percutaneous Transhepatic and Translumbar Sclerotherapy of a Thoracic Duct Cyst: A Case Report

A 58-year-old male presented with chronic abdominal pain lasting 5 years and a 15 × 6-cm multicystic thoracic duct cyst with three compartments, located in the right retrocrural and retrocardiac regions from T5/T6 to T12/L1. A transhepatic route was selected to sclerose the middle and lower compartments. Subsequent contrast injection showed minimal contrast passage into the upper compartment through a narrow neck, but the guidewire could not pass into this compartment. The contrast-filled upper compartment was punctured with a 22-g Chiba needle using a translumbar approach under cone-beam computed tomography (CT) guidance and ethanol sclerotherapy was performed. Six-month follow-up CT revealed decreased thoracic duct cyst size (5×3 cm) and no pain. This case illustrates successful percutaneous transhepatic and translumbar sclerotherapy for retrocardiac and retrocrural thoracic duct cysts, which are very difficult to remove surgically.