The Therapeutic Use of Endoscopic Ultrasonography in Pediatric Patients is Safe: A Case Series

Background/Aim:Despite the safety and high diagnostic yield of endoscopic ultrasound guided fine needle aspiration (EUS FNA) for the evaluation of gastrointestinal diseases in adults, literature discussing the therapeutic use of EUS FNA in pediatrics remains limited. This study reports our experience with the use of EUS in children with pancreaticobiliary disorders.Results:A total of 6 therapeutic EUS procedures were performed in 5 children (3 F/2 M). The mean age was 13 years (range 6–17) with a mean body mass index of 28.2 (range 18.5–38.8). The indications for EUS procedures were abdominal pain with chronic pancreatitis (3) and management of symptomatic pancreaticobiliary cysts/pseudocysts observed on previous imaging (3). All procedures were performed under general anesthesia. The 6 therapeutic procedures performed were celiac plexus block (3), cyst gastrostomy with stents placement (2), and cyst aspiration using EUS FNA (1). A celiac plexus block effectively relieved abdominal pain in 2 patients with chronic pancreatitis. Cyst gastrostomy successfully resulted in pseudocyst resolution in the follow up imaging of 2 patients (up to 6 months after the procedure). Cyst aspiration with EUS guided FNA resulted in cyst resolution and confirmation of the benign nature of the cyst in 1 patient. All the procedures were successfully completed with no reported complications.Conclusion:The therapeutic use of endoscopic ultrasound in the pediatric population is safe and has a high success rate.     

Laparoscopic treatment of a giant seminal vesicle cyst with hemorrhage: A case report

Rationale:A seminal vesicle cyst is a benign lesion of the seminal vesicle that is usually asymptomatic. However, when a giant seminal vesicle cyst ruptures and bleeds, it can cause obvious clinical symptoms. To our knowledge, no single giant seminal vesicle cyst with hemorrhage has been reported in current studies, and surgery is the primary method to treat seminal vesicle hemorrhage with obvious symptoms.Patient concerns:A 31-year-old man presented with urination pain but without obvious urination frequency and urgency, dysuria, and discomfort. Rectal palpation in the chest-knee position revealed a hard mass palpable in the upper right with a smooth surface and mild tenderness, and the upper edge of the mass could not be palpated.Diagnosis:The results of the B-mode ultrasound indicated a mixed echogenic lump between the bladder and prostate, with a size of 81 × 76 mm. The computer tomography scan showed an “S” tubular lump in the right side of the pelvic cavity. The mass has a computer tomography value of 58 to 70 HU, and uneven reinforcement can be observed. On the basis of the results of the magnetic resonance imaging of the urinary bladder, the lump has T1 and T2 signals of equal lengths.Interventions:The patient was diagnosed with a huge right seminal vesicle cyst with hemorrhage and was treated via laparoscopic surgery.Outcomes:The patient recovered quickly after the operation, and the symptoms of urination pain were significantly improved.Lessons:Seminal vesicle hemorrhage is clinically rare, and laparoscopic treatment is an effective and safe surgical method for the treatment of seminal vesicle cysts.     

Variable virulence of isolates of Giardia lamblia in mice

Groups of inbred mice were inoculated intraoesophageally with Giardia lamblia cysts isolated from the stools of 15 patients with various clinical conditions: symptomatic diarrhoeic, symptomatic non-diarrhoeic and asymptomatic cyst carriers. The virulence of these isolates was studied in terms of two-hour cyst excretion rate and trophozoite counts in the duodenum. The basic pattern of the cyst excretion was similar in all the groups: cysts appeared in the stools by Day 3 +/- 1, reaching a maximum by Day 11 +/- 2. There was then a gradual decline until Day 23 +/- 2, with a low output until Day 31 post-inoculation. However, statistically significantly higher numbers of cysts were excreted by animals which had received cysts isolated from symptomatic diarrhoeic patients than by mice which received cysts from symptomatic non-diarrhoeic or asymptomatic cases. Identical results were obtained with the trophozoite counts. Haemagglutinating (HA) antibodies appeared after Day 11 post-inoculation in each group regardless of different cyst isolates, and the HA titre increased until Day 31 post-inoculation. The results indicate that variable symptomatology in patients could be due to variation in the virulence of the parasite.     

Pancreatic cyst characterization: maximum axial diameter does not measure up

BackgroundUnidimensional size is commonly used to risk stratify pancreatic cysts (PCs) despite inconsistent performance. The current study aimed to determine if unidimensional size, demonstrated by maximum axial diameter (MAD), is an appropriate surrogate measurement for volume and surface area.MethodsPatients with cross-sectional imaging of PCs from 2012 to 2013 were identified. Cyst MAD, volume, and surface area were measured using quantitative imaging software. Non-pseudocystic PCs >1 cm were selected for inclusion to assess MAD correlation with volume and surface area. Cysts imaged twice >1 year apart were selected to evaluate volumetric growth rate.ResultsIn total, 195 cysts were included. Overall, MAD was strongly correlated with volume (r = 0.83) and surface area (r = 0.93). However, cysts 1–2 cm and 2–3 cm were weakly correlated with volume and surface area: r = 0.78, 0.57 and 0.82, 0.61, respectively. Cyst volumes and surface areas varied widely within unidimensional size groups with 51% and 40% of volumes and surface areas overlapping unidimensional size groups, respectively. Estimated changes in volume poorly predicted measured changes in volume with 42% of cysts having >100% absolute percent difference.ConclusionsPancreatic cyst volume and surface area may be useful adjunct measurements to risk stratify patients and surveil cyst changes and deserves further study.     

Fine needle sclerotherapy as a new effective therapeutic approach for nonparasitic splenic cysts: A case series

BackgroundNonparasitic splenic cysts are rare. Until now, surgical intervention has been the standard therapy of symptomatic splenic cysts.AimsWe herein present a retrospective analysis of an approach using percutaneous ultrasound-guided fine needle aspiration and sclerotherapy.MethodsOut of 88,151 ultrasound reports, we identified 138 patients who presented with splenic cysts. A single splenic cyst was found in 88% (mean size 28.9 mm). Twelve patients underwent percutaneous therapy of symptomatic splenic cysts. They were younger, had larger splenic cysts and more often cyst internal echoes than the 126 untreated patients (all p < 0.0001).ResultsInitial sclerotherapy was performed with polidocanol 1% in 9 patients and with NaCl 10% in 2 patients. One hemorrhagic cyst was only purged. Serious adverse events were not noted. Eight patients had to undergo 1–11 further percutaneous cyst therapies. 15 of these 30 reinterventions were cyst aspiration therapies, only, and 11 of them were sclerotherapies with NaCl 10%. Four patients were readmitted to hospital for cyst retreatment. After 57 ± 43 months of follow-up, cyst size significantly decreased (p < 0.0001). Only two patients had a complicated course of cyst therapy.ConclusionsPercutaneous ultrasound-guided sclerotherapy is a new approach for symptomatic splenic cysts. In most patients, cyst size and symptoms can be significantly reduced during one hospital stay.     

Lymphoepithelial cyst of the pancreas

Summary Conclusion Lymphoepithelial cyst of the pancreas (LC) is a very rare benign lesion and preoperative diagnosis is difficult. Conservative surgery seems to be the appropriate therapy in symptomatic patients or when a precise preoperative diagnosis is not achieved. The benign behavior of all reported cases suggests that the asymptomatic patients with a certain morphological preoperative diagnosis might be clinically followed up. The histogenesis of LC remains to be elucidated. Background LC of the pancreas is a cyst that is histologically characterized by a fibrous tissue, a lymphoid component and a lining squamous epithelium. Methods Clinical and pathological findings of two personal cases are reported with review of the literature. Results A 56-yr-old man, complaining of epigastric pain, and a 47-yr-old man, with a history of alcohol abuse, were admitted to hospital. In both cases the lesion was detected with abdominal ultrasound but a certain diagnosis was obtained only after histological examination of the resected cysts.     

Pneumonia,pleurisy, mediastinitis,and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration: A case report

Introduction:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen).Patient concerns:A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed.Diagnosis:The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid.Interventions:Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed.Outcomes:Seven days after the treatments, the patient''s symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic.Conclusions:EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.     

Lumbar laminotomy and replantation for the treatment of lumbar spinal epidural lipomatosis: A case report

Rationale:Lumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by excessive overgrowth of extradural fat within the lumbar spinal canal. Surgical decompression is commonly performed to treat symptomatic SELs. Fenestration or laminectomy with epidural fat debulking was a routine surgical procedure according to the literature, that may be causing postoperative lumbar instability. In the present study, we presented a brief report of lumbar SEL and introduced another surgical approach.Patient concerns:A 55-year-old man complained of severe low back pain and right leg radicular pain for a year, accompanied by neurogenic intermittent claudication. He received a variety of conservative treatments, including non-steroidal anti-inflammatory drugs, acupuncture, and physical therapy. However, his pain did not diminish. Finally, a posterior epidural mass in the dorsal spine extending from the L3 to L5 level, which caused dural sac compression was found on lumbar magnetic resonance imaging. This mass was homogeneously hyperintense in both T1W1 and T2W1 images, suggestive of epidural fat accumulation.Diagnoses:Lumbar SEL.Interventions:The patient underwent lumbar laminectomy, epidural fat debulking, and spinous process-vertebral plate in situ replantations.Outcomes:The patient presented with complete recovery of radiculopathy and low back pain after surgery. Postoperative magnetic resonance imaging showed that the increased adipose tissue disappeared, and the dural sac compression was relieved. A computed tomography scan revealed the lumbar lamina in situ. He was able to walk normally and remained relatively asymptomatic for 12 months after the operation at the last follow-up visit.Lessons:Lumbar laminotomy and replantation provide an ideal option to treat lumbar SEL because it can achieve sufficient and effective decompression, simultaneously reconstruct the anatomy of the spinal canal, and reduce the risk of iatrogenic lumbar instability.     

Rescue balloon-assisted remodeling technique for protrusion of coil loop: A case report

Rationale:Among the possible complications during endovascular embolization of intracranial aneurysms, coil protrusion into the parent artery is associated with parent artery occlusion or thromboembolic of the distal arteries. There is no clearly established management strategy for coil protrusion. This report demonstrates our experience with balloon-assisted remodeling to reposition a protruded coil loop.Patient concerns:A 53-year-old man was admitted to our hospital with severe bursting headache, nausea, and vomiting. Computed tomography showed subarachnoid hemorrhage and digital subtraction angiography revealed an anterior communicating artery aneurysm. We decided to obliterate the aneurysm with endovascular embolization using detachable coilsDiagnosis:A small loop protruded into the parent artery during the removal of the microcatheter.Interventions:We performed successful repositioning of the protruded coil loop using balloon inflation.Conclusion:The rescue balloon-assisted remodeling technique was useful in the management of protrusion of a small coil loop into the parent artery during endovascular coil embolization of an intracranial aneurysm. The procedure was associated with minimal complications.     

Systematic review on percutaneous aspiration and sclerotherapy versus surgery in symptomatic simple hepatic cysts

BackgroundSimple hepatic cysts (SHC) may cause pain and bloating and thus impair quality of life. Whereas current guidelines recommend laparoscopic cyst deroofing, percutaneous aspiration and sclerotherapy (PAS) may be used as a less invasive alternative. This review aimed to assess the efficacy of PAS and surgical management in patients with symptomatic SHC.MethodsA systematic search in PubMed and Embase was performed according to PRISMA-guidelines. Studies reporting symptoms were included. Methodological quality was assessed by the MINORS-tool. Primary outcomes were symptom relief, symptomatic recurrence and quality of life, for which a meta-analysis of proportions was performed.ResultsIn total, 736 patients from 34 studies were included of whom 265 (36%) underwent PAS, 348 (47%) laparoscopic cyst deroofing, and 123 (17%) open surgical management. During weighted mean follow-up of 26.1, 38.2 and 21.3 months, symptoms persisted in 3.5%, 2.1%, 4.2%, for PAS, laparoscopic and open surgical management, respectively. Major complication rates were 0.8%, 1.7%, and 2.4% and cyst recurrence rates were 0.0%, 5.6%, and 7.7%, respectively.ConclusionOutcomes of PAS for symptomatic SHC appear to be excellent. Studies including a step-up approach which reserves laparoscopic cyst deroofing for symptomatic recurrence after one or two PAS procedures are needed.     

老年人动脉瘤性蛛网膜下腔出血早期介入治疗的临床研究

目的 探讨老年人动脉瘤性蛛网膜下腔出血早期介入栓塞治疗的安全性和可行性.方法 84例经CT明确的蛛网膜下腔出血的60岁以上的患者,Hunt & Hess分级为Ⅱ级26例,Ⅲ级31例,Ⅳ级25例,Ⅴ级2例.出血后6～72 h内,经全脑血管造影共发现89个动脉瘤,立即行介入栓塞治疗,根据动脉瘤结构,分别采用单纯弹簧圈栓塞、球囊辅助技术和支架结合技术栓塞.术后给予脱水、扩容、扩血管、腰穿及(或)间断腰大池引流,同时对并存疾病予以治疗.结果 89个动脉瘤,成功栓塞83个,技术成功率93.3%.术后3个月格拉斯哥预后评分(GOS)优良68例,中残7例,重残4例,死亡5例(与技术相关的死亡1例); 结论 老年动脉瘤性蛛网膜下腔出血患者,并存症多、全身状况较差,介入栓塞为一种安全、有效的治疗手段.     

Medial meniscal cyst of the knee detected by magnetic resonance imaging in a Moroccan patient: A case report and post-excision follow-up

IntroductionMeniscal cysts are rare and usually asymptomatic. They may cause various symptoms depending upon their size and site of origin. It may present as a palpable mass with or without pain and sometimes grows large enough to limit the patient’s activities of daily living. The magnetic resonance imaging (MRI) is the gold standard for their visualization. Excision is often guided by a careful study of the pre-operative MRI scans in multiple planes.Case reportWe report an unusual case of a medial meniscal cyst of the knee in a 40-year-old Moroccan patient with a progressively increasing swelling of his left knee for 1 year. There was no history of trauma. On examination there was a tender effusion. The range of motion of the knee was limited 0–110°. The MRI showed a meniscal cyst extending around the medial collateral ligament into the soft tissue. The lateral meniscus, anterior cruciate, posterior cruciate and collateral ligaments were normal in appearance. The well-circumscribed cyst was excised and the diagnosis confirmed by the histopathology. At 1-year follow up, he had full range of knee movement and remained asymptomatic, with no sign of recurrence.ConclusionMedial meniscal cysts should be considered in any patient presenting with persistent medial knee discomfort. Rigorous history and physical examination are essential to identify similar rare presentations. The use of MRI is important in confirming such anomalies and plan surgical intervention.     

Effectiveness of steroid therapy for pancreatic cysts complicating autoimmune pancreatitis and management strategy for cyst-related complications

Abstract

Objectives: Autoimmune pancreatitis (AIP) sometimes becomes complicated with pancreatic cysts, although their detailed characteristics and management strategy have not been fully determined. We aimed to clarify the efficiency of steroid therapy and the risk factors for cyst formation and cyst-related complications.

Methods: One hundred sixty-three AIP patients were retrospectively analyzed for relevant factors of cyst formation. We compared subjects with and without steroids to evaluate drug effectiveness on cyst size change and investigated the factors associated with cyst-related complications.

Results: Thirty-two patients (19.6%) had complicating pancreatic cyst formation, and 40 cystic lesions of ≥10?mm in size were detected. Multivariate analysis revealed a drinking habit, abdominal/back pain, and elevated serum amylase to be significantly associated with cyst formation. Steroid-treated cysts became significantly reduced in size in the short-term and disappeared significantly more frequently within 1-year as compared with non-treated ones, which was confirmed by multivariate analysis. Six of 40 cysts exhibited cyst-related complications significantly associated with multilocular morphology and larger size.

Conclusions: Steroid therapy is an effective choice for cysts developing in AIP to promote the release of pancreatic juice stasis. Larger lesions with multilocular morphology should be monitored closely for cyst-related complications and be considered strong candidates for steroid therapy.     

对直径小于7mm的无症状颅内动脉瘤应该进行手术夹闭吗？

颅内动脉瘤破裂出血可导致危及生命的蛛网膜下腔出血。对于有症状颅内动脉瘤患者的治疗并无疑义,但对直径〈7mm的无症状颅内动脉瘤患者,究竟是采取保守治疗还是实施手术夹闭或血管内弹簧圈栓塞治疗,目前的意见尚不统一。文章就此进行了讨论。     

Alcohol ablation of pericardial cysts under pericardioscopical control

Pericardial cysts are rare. They are often asymptomatic mediastinal abnormalities, which are usually congenital. If symptomatic differential diagnosis can pose a diagnostic challenge since it has to consider the different causes of pericardial effusion including malignant forms. In 2 symptomatic female patients (aged 51 and 58 years) pericardiocentesis, pericardioscopy and pericardial fluid analysis confirmed the diagnosis of “spring water cysts.” Pericardioscopy excluded protrusions, petechial bleeding, neovascularization or inflammation. Application of contrast media into the cyst confirmed by radiological control that no communication to the true pericardial sac was present. So after aspiration of the entire fluid, subsequent instillation of 10 ml ethanol for a few minutes was carried out to prevent recurrence of the cystic formation. The aspiration of the residual fluid under moderate suction demonstrated and 24-h clinical observation at the ICU completed the short intervention. All symptoms were relieved immediately in both patients. Recurrence was not observed in the follow-up.     

Rare severe hypofibrinogenemia induced by tissue plasminogen activator in stroke patients: Case report

Rationale:Severe hypofibrinogenemia after intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is rare and easily overlooked, but hypofibrinogenemia increases the risk of major bleeding. However, it is unclear when hypofibrinogenemia reaches the peak and when hypofibrinogenemia is resolved.Patient concerns:Case 1 was of a 66-year-old man who was hospitalized due to sudden onset of vague speech and right hemiplegia for 4 hours. Case 2 was of an 84-year-old woman who was hospitalized for sudden onset of left hemiplegia and vague speech for 4 hours. In case 1, fibrinogen levels decreased from normal values to <0.25 g/L within 4.5 hours after commencing IVT and returned to normal at 35 hours later. In case 2, fibrinogen levels decreased from 1.1 to <0.25 g/L within 2 hours after commencing IVT and normalized 36.5 hours later.Diagnoses:Both patients were diagnosed with rt-PA-related hypofibrinogenemia.Interventions:No antiplatelet or symptomatic treatment was administered during the period of hypofibrinogenemia.Outcomes:Fibrinogen levels gradually recovered. In case 1, the patient did not experience cerebral hemorrhage during hypofibrinogenemia. His symptoms improved significantly within 1 week. In case 2, repeat computed tomography revealed minor cerebral hemorrhage, but no deterioration in her condition was noted until she was discharged.Lessons:Rapid, severe, and prolonged hypofibrinogenemia may occur after IVT with rt-PA, which may increase the risk of massive hemorrhage and affect the related therapy. Prompt diagnosis of hypofibrinogenemia is important for preventing complications. We recommend checking the fibrinogen levels routinely after IVT. Fibrinogen replacement therapy and platelet transfusion are the main management routes for rt-PA-related symptomatic intracranial hemorrhage.     

Spontaneous rupture of a renal artery pseudoaneurysm in a hemodialysis patient: A case report

Rationale:Renal artery pseudoaneurysm is a rare vascular lesion usually caused by trauma or percutaneous urological procedures. Spontaneous rupture of pseudoaneurysms without predisposing events, especially in hemodialysis patients, has rarely been reported.Patient concerns:A 25-year-old man receiving maintenance hemodialysis visited the emergency room because of sudden severe right flank pain. He had no history of trauma or urological procedures except for a left renal biopsy to diagnose Alport syndrome 10 years prior.Diagnosis:Contrast-enhanced computed tomography revealed a right perirenal hematoma with pseudoaneurysms.Interventions:On renal angiography, multiple pseudoaneurysms were observed in the right renal artery branches and embolization was performed.Outcomes:Post-angiography showed no pseudoaneurysms. His abdominal pain improved, and he was discharged 2 weeks after embolization.Lessons:When maintenance dialysis patients complain of severe abdominal pain, spontaneous rupture of a renal pseudoaneurysm should be considered as a differential diagnosis, even if the patient has no history of trauma or previous urological procedures.     

Incidental finding of multiple pulmonary and cardiac hydatid cysts

BackgroundCardiac hydatid cyst is a rare parasitic disease. Since it may be associated with fatal complications, early diagnosis and treatment of a cardiac hydatid cyst is very important, however, it may stay asymptomatic for a long time, until they reveal themselves being perforated into cardiac chambers and/or pulmonary artery or systemic circulation.Case presentationWe report a case of a young asymptomatic boy, who underwent a routine chest x ray in a pre employment check up in whom we discovered a multiple pulmonary lesions and a right ventricle hydatid cyst. He then underwent a successful treatmentConclusionDue to the high risk of associated complications, cardiac hydatid cysts should be removed surgically, even in asymptomatic patients.     

Tamoxifen for the treatment of polycystic liver disease: A case report

Rationale:Polycystic liver disease is a rare disease characterized by the growth of numerous cysts in the liver. The liver function remains well preserved, but liver volumes can grow very large, and some patients ultimately need a liver transplantation. Other treatment options are limited and there is an unmet need for new therapeutic options.Patient concerns:We describe a 59-year-old patient with pain in the abdomen, especially when bending forward. Five years ago, she was diagnosed with breast cancer and as an incidental finding a couple of large liver cysts were diagnosed, explaining her abdominal pain.Diagnosis:Polycystic liver disease with several large liver cysts.Interventions:The patient was treated with tamoxifen, an estrogen receptor modulator, as treatment for her hormone receptor positive breast cancer. One of the liver cysts was aspirated.Outcomes:In the 4.6 years after the start of tamoxifen treatment, 20 mg once daily, the volume of her liver cysts decreased remarkably. There was a reduction of combined cyst volume from 311 mL to 22 mL without percutaneous drainage.Lessons:Epidemiological as well as experimental evidence supports a pivotal role for estrogens as a driver for growth of polycystic livers. Estrogen antagonism has often been proposed as a therapeutic target, but supporting evidence is lacking in the literature. We hypothesize that the decrease in cyst size in this patient was caused by tamoxifen therapy, suggesting an in vivo antagonistic effect on cystic cholangiocytes. This is an important finding because tamoxifen could be a promising new treatment option for polycystic liver disease.     

Treatment of popliteal cysts via arthroscopic enlargement of unidirectional valvular slits

Abstract

Objective. The aim of the present study was to investigate the efficacy of arthroscopic enlargement of unidirectional valvular slits for the treatment of popliteal cysts and to evaluate potential factors affecting the outcomes of our arthroscopic procedure.

Methods. Twenty-nine patients aged 43–77 years with popliteal cysts were treated with arthroscopic cyst decompression. Surgery was performed via two posterior portals after creating a transseptal portal. Rauschning and Lindgren clinical score, magnetic resonance images, and osteoarthritic grade were evaluated pre- and postoperatively, and cartilage degeneration class was confirmed via arthroscopy. The mean follow-up period was 22.9 ± 14.6 months (range, 9–60 months).

Results. Twelve cysts disappeared completely (group D), while 16 reduced and one enlarged (group R) in size by the final follow-up. Twenty-two (75.9%) of 29 popliteal cysts diminished to a volume that was less than 10% of the preoperative volume. Clinical scores improved in 93.1% of the patients, and more patients (68.8%) in group R had positive joint effusion at the final follow-up compared with group D (17.7%; p < 0.01).

Conclusions. Arthroscopic cyst decompression was effective in the treatment of symptomatic popliteal cysts. Intra-articular pathologies associated with joint effusion should be corrected simultaneously.