Long-term outcome of surgical treatment for idiopathic spinal arachnoid web: A case series

ObjectiveSpinal arachnoid web (SAW) is a rare condition of the spine with limited long-term follow-up data in the literature. The longest reported follow-up period was an average  3.2 years. The objective of this study is to report our long-term results of patients who underwent surgical treatment for symptomatic idiopathic SAW.MethodsWe conducted a retrospective review of cases of idiopathic SAW that were operated between 2005–2020. We collected preoperative and last follow-up (LFU) data on motor force, sensory loss, pain, upper motor neuron (UMN) sign, gait disorder, sphincter dysfunction, syringomyelia, hyperintensity on T2-MRI, appearance of newer symptoms and number of reoperations.ResultsOur study included 9 patients with a mean follow-up period of 3.6 years (range 2–9.1 years). The surgical intervention involved a standard centered laminectomy, durotomy and arachnoid lysis. At presentation, motor weakness was present in 77.8% of patients, sensory loss in 66.7%, pain in 88.9%, sphincter dysfunction in 33.3%, UMN sign in 22%, gait disorder 55.6%, syringomyelia in 55.6% and MRI T2 hyperintensity in 55.6% of patients. At LFU, there was an improvement in all symptoms and signs to varying degrees. No new neurological symptoms appeared postoperatively, and there was no recurrence during the follow-up period.ConclusionOur results demonstrate that the reported immediate and short-term favorable outcomes following arachnoid lysis for symptomatic SAW persist over a long-term period and the risk of readhesion-correlated neurological deterioration following conventional surgical intervention is low.     

Prenatal diagnosis of pyriform sinus fistula using ultrasonography by detecting the communication to the pharynx

ObjectivePyriform sinus fistula (PSF) is a congenital anomaly which originates from the pharyngeal pouch. PSF is initially recognized as a cyst around the fetal neck, but accurate prenatal diagnosis of the disease is challenging. We aimed to report the key findings and tips in accurately distinguishing PSF from other differential diagnosis by which enables detection of the communication of the nuchal cyst and the pharynx.Case reportWe report a case in which we were able to diagnose PSF as early as 18 weeks of gestation with ultrasonography. We used epiglottis as a landmark, and detected an unilobular cyst arising from the pharynx.ConclusionUltrasonography is a powerful tool in prenatal diagnosis of PSF especially at early stage of pregnancy. By detecting the epiglottis, it can locate the communication of the nuchal cyst and the pharynx, and thereby enables an accurate diagnosis of PSF.     

Symptomatic perineural cyst after spontaneous subarachnoid hemorrhage: A case report

Rationale:Tarlov or perineurial cysts are nerve root lesions often found in the sacral region. Most perineural cysts (PCs) remain asymptomatic throughout a patient''s life. While their pathogenesis is still unclear, trauma resulting in hemorrhaging into subarachnoid space has been put forward as a possible cause of these cysts. Recently, we worked with a patient experiencing symptomatic PCs after spontaneous subarachnoid hemorrhage.Patient concerns:A 45-year-old man had a coil embolization procedure performed after being diagnosed with a subarachnoid hemorrhage from a ruptured anterior communicating artery. His symptoms were relieved after the procedure, but 7 days later he reported worsening pain in the left perineal area. The pain was intermittent at its onset and exacerbated by sitting, walking, and coughing.Diagnoses:Two weeks after the embolization procedure, a lumbar spine MRI revealed 2 PCs at the S1 and S2 level affecting the left S2 root with high signal intensity in T2 and T1 images, suggestive of bleeding within the cyst.Interventions:We operated using a posterior approach. Cyst fenestration was done after S1 laminectomy. We aspirated approximately 1 cc of old blood.Outcomes:His pain was relieved immediately after cyst removal and no neurologic deterioration occurred during the postoperative period.Lessons:Subarachnoid hemorrhage can be the source of the development of pain from asymptomatic PCs, making them symptomatic. Surgical extirpation is 1 treatment option for these symptomatic PCs.     

A rare case of a periorbital respiratory (choristomatous) cyst

Respiratory cysts are benign lesions lined by normal respiratory epithelium. There are few reported cases localized to the orbit, while those of the eyelid are exceedingly rare. Respiratory cysts usually arise either from a non‐hereditary congenital malformation, where they are distinguished as choristomatous, or from trauma. Here, we report a case of a 53‐year‐old man who presented with a large right lower eyelid cyst that was histopathologically diagnosed as a respiratory cyst.     

Islanded facial artery osteomyomucosal/osseous flap in head and neck reconstruction

A local pedicled vascularized bone flap can prevent the morbidity and cost of free bone flap surgery in small segmental bone defects or long cartilaginous defects of the head and neck. Such flaps can also be useful in patients who are high risk for surgery. The periosteal vascularity of the mandible can be used to design islanded facial artery-based bone flaps, which can be utilized to that extent. Two patients with a small segmental mandibulectomy defect and one patient with a long cricotracheal resection defect underwent reconstruction using three different designs of islanded facial artery osteomyomucosal/osseous flap (iFOMM). The patients had a minimum follow-up period of 18 months. All flaps were successful, with satisfactory healing and without any functional deficit or disease at last follow-up.     

Odontogenic cysts: classification,histological features and a practical approach to common diagnostic problems

The epithelial remnants of tooth development give rise to an impressive range of cystic lesions, termed odontogenic cysts. They are classified based on their distinct clinical, radiological and histological features, a process that has not been without controversy. We will attempt to explain the basis of the debate behind the changing classification of odontogenic cysts, describing their aetiology, clinical and histological features, along with common pitfalls that can confuse the diagnostic process. More common diagnostic challenges, such as the effects of inflammation and mucous change, will be explored in detail. An attempt will be made to distil the diagnostic process into simple algorithmic steps to narrow down the differential diagnoses of this fascinating group of lesions. We will demonstrate the importance of careful consideration of the clinical and radiological features that can help prevent misclassification, ensuring appropriate management and follow-up for this diverse group of lesions.     

达芬奇机器人在胆总管囊肿手术切除中的应用

目的评估达芬奇机器人手术系统辅助胆总管囊肿切除术的安全性及疗效，总结手术经验。 方法回顾性分析2016年3月至2018年12月于中山大学附属第一医院胆胰外科接受达芬奇机器人辅助胆总管囊肿切除术的12例患者临床资料，分析其相关的临床数据，评估手术的安全性及近期疗效。 结果12例均顺利完成机器人辅助下胆总管囊肿及胆囊切除、肝管空肠改良襻式吻合术；手术中位时间为385 min（280~420 min），术中出血量中位数为30 ml（30~100 ml）。3例有腹腔手术史患者术后进食时间、住院时间与无手术史的患者比较，差异无统计学意义。术后1例患者发生腹腔感染，经保守治疗后痊愈；术后平均住院（7.7±1.4）d，无一例30 d内再入院。 结论达芬奇机器人辅助胆总管囊肿切除手术安全、可靠，操作更精准灵活、舒适，具有微创、术中出血少、术后恢复快的优势。