Treatment of supratentorial primary arachnoid cysts

Summary Twenty-four cases of supratentorial primary arachnoid cysts operated with different techniques are reviewed: both cyst shunting or extirpation may lead to a good early clinical result, but the former is less dangerous and more indicated in a particular group of patients; late results are better in the shunted patients. CT scan is almost always diagnostic and is mandatory postoperatively to assess the late results.     

Surgical treatment of patients with midline arachnoid cysts

Usually, arachnoid cysts are found in the Sylvian fissure (about 85%); midline arachnoid cysts are rare. Typical clinical symptoms are increased intracranial pressure, caused by a concomitant hydrocephalus, as well as visual and/or endocrinological disturbances.Six patients were examined, treated with one of two different surgical methods (cyst shunting or open treatment, either craniotomy/cyst membrane resection or laser endoscopy).Better results were observed following open treatment methods.     

Quality of life in adult patients with primary intracranial arachnoid cysts

Summary Background. Primary arachnoid cysts are benign developmental lesions of arachnoid mater. Arachnoid cysts may be detected due to various neurological symptoms, or they may be encountered as incidental findings of neuroimaging. Consequently, a significant share of the patients seems asymptomatic. There are diverging opinions about the clinical importance of cyst sizes, cyst location and degree of volume reduction after surgery, hence contributing to controversies regarding indications for surgical treatment. We present the first study assessing internationally established parameters of quality of life and mental health in a clinical-outcome analysis of adult patients with arachnoid cysts. Method. Ninety-two adult patients with arachnoid cysts who had been referred to our department over the last 16 years were included. Forty-seven patients had undergone surgery and 45 patients had not been operated on. Data for analysis was based on both medical records and questionnaires sent out by mail. Quality of life was assessed by the Short Form 36 Health Survey (SF-36), and mental health was further evaluated by the Hospital Anxiety and Depression Scale (HADS). Seventy-one percent of patients responded to our questionnaires. Findings. There was a great variation in the presenting symptoms, seemingly without any relation to cyst localisation. Patients with arachnoid cysts seem to have a reduced quality of life and a very high prevalence of anxiety compared to a healthy normal population. Men presented lower outcome scores than women. Subjects with symptoms, that we retrospectively labeled biologically comprehensible, tended to have higher quality of life, less anxiety and better subjective symptom relief after surgery. Conclusion. Our arachnoid cyst population had a low employment status, decreased quality of life scores and prevalent symptoms of anxiety. We argue that the arachnoid cysts are, in most cases, not directly related to these studied parameters. We speculate that our findings may reflect the demographic characteristics of adults likely of being diagnosed with incidental cysts. A better clinical outcome for patients with biologically plausible symptoms supports a neurobiological approach in the selection of patients suited for surgery.     

骶管内蛛网膜囊肿的MRI表现及诊断价值

目的 探讨骶管内蛛网膜囊肿的MRI特点及其诊断价值.方法 28例骶管内蛛网膜囊肿经手术病理证实.其中其中男19例,女9例,年龄16～70岁,平均41.6岁.所有病例均行MR检查.结果 囊肿位于骶管内,呈卵圆形、不规则形、串珠形.囊肿境界清楚,囊壁薄,囊液信号与脑脊液信号相似,T1WI囊液呈低信号,T2WI囊液呈高信号,其中4例囊肿内可见细条状神经根影,6例增强扫描囊液、囊壁无强化.结论 MRI是最好的影像学诊断方法;骶管内蛛网膜囊肿的发生,主要是先天的硬膜缺陷所致.     

先天性胆总管囊肿手术治疗经验

目的：总结先天性胆总管囊肿的手术治疗经验。方法：对194例先天性胆总管囊肿的手术治疗经验进行回顾性分析。结果：194例均行囊肿切除,胆道重建术：（1）肝管十二指肠吻合术4例;（2）间置空肠肝管十二指肠吻合术（人工乳头）15例;（3）间置胆囊肝管十二指肠吻合术4例;（4）肝管空肠Roux-en-Y型吻合术171例。本组190例术后恢复顺利,手术死亡4例（2．06％）。结论：囊肿可使胆汁流入胰管内并发胰腺炎,囊肿易癌变,囊肿可形成盲袋和死腔易形成结石,故囊肿切除胆道重建术是治疗先天性胆总管囊肿的最佳选择。尽管胆道建术式较多,但以肝总管空肠Roux-en-Y型吻合术是胆道重建术的一种理想手术。     

先天性胆总管囊肿的外科治疗

目的 比较先天性胆总管囊肿不同术式的治疗效果。方法 对1985年1月-1998年12月57例先天性胆总管囊肿的术式及疗效进行分析。结果 以I型为主(44例)占77．2％。B超确诊率为84．2％。57例中,囊肿切除、肝总管空肠Roux—Y吻合37例,囊肿大部切除,胆管与空肠Roux—Y吻合12例。其中有14例行囊肿引流术后再次行囊肿切除术。囊肿切除术明显降低胆管炎的复发,术后随访治疗效果优良占89．1％。结论 囊肿切除、胆管与空肠Roux-y吻合术应作为胆总管囊肿的首选术式,囊肿切除困难时应尽量大部分切除,并行大口胆管肠吻合。     

Suprasellar arachnoid cysts in children report of three cases

Summary Three cases of suprasellar arachnoid cysts in children are reported. Incidence, aetiology, pathogenesis, symptomatology, diagnosis, treatment, and other problems of these uncommon lesions are discussed.Communication presented at the XXXIst Meeting of the Portuguese-Spanish Neurosurgical Society. Santiago de Compostela, Spain. May 1979.     

症状性骶管内囊肿的诊断与治疗

目的：探讨症状性骶管内蛛网膜囊肿的诊断与治疗方法.方法：对12例以骶管内神经受压表现为主,如腰骶部疼痛、下肢痛、会阴部疼痛,鞍区麻木不适,大小便障碍,下肢无力患者,行MRI检查.结合临床症状、体征及MRI表现明确诊断为症状性骶管内囊肿后行手术治疗.手术均在显微镜下操作.对未见明显交通孔的7例中5例行囊壁大部切除后残存囊壁修补缝扎,2例因硬脊膜缺如,无法修补而行囊肿部分切除旷置;5例有交通孔的患者中,2例囊肿大部切除后用肌肉填塞交通孔,2例因交通孔处理困难未作特殊处理,1例囊肿大部切除后,切开交通孔处硬脊膜以扩大交通孔至脑脊液通畅流出,消除交通孔的单向阀门作用.严密缝合切口,术后采取头低臀高俯卧位.结果：骶管内囊肿在MRI上表现为骶管内单发或多发类圆形或椭圆形的软组织影,呈长T1、长T2表现,信号与脑脊液相同.术后2例出现少量皮下积液,加压包扎2～3个月后自行吸收,无1例脑脊液漏.随访3个月～4年6个月,平均18.3个月,症状完全缓解8例,部分缓解3例,1例3个月后症状复发,MRI检查示囊肿较术前轻微扩大,未再次手术.结论：MRI检查是正确诊断骶管内蛛网膜囊肿的有力手段,伴有临床症状、体征者应考虑手术治疗.对囊肿的处理以囊肿大部切除为主,严密缝合切口各层及术后合理体位可以有效防止并发症的发生.     

Cost-effective and time-saving surgical treatment of pulmonary hydatid cysts with multiple localization

Abstract. Purpose: The most frequent anatomic locations of hydatid cysts are the liver and lungs. Because there is no effective medical therapy against this parasitic disease, surgery is the treatment of choice. The aim of this retrospective study was to compare the cost and effect of a one-stage operation with those of two- or three-stage operations in the treatment of lung hydatid cysts with multiple localizations. Methods: We evaluated 364 patients who underwent surgical treatment for hydatid cysts, all of whom had multiple localizations. To avoid two- or three-staged operations, we performed median sternotomy, simultaneous bilateral thoracotomy and unilateral thoracotomy with a transdiaphragmatic approach. Results: For the treatment of 460 hydatid cyst localizations in 364 patients, a collective 381 operations were performed. The number of operations and periods of hospitalization were reduced. Conclusion: A one-stage surgical procedure for bilateral lung and liver hydatid cysts is superior to the traditional two- and three-stage operations because it reduces morbidity, hospital stay, and cost. Received: June 4, 2001 / Accepted: January 8, 2002     

Avoidable factors that contribute to complications in the surgical treatment of chronic subdural haematoma

Summary The results of a personal series of 44 consecutive patients undergoing burrhole evacuation and closed system suction drainage for chronic subdural haematoma are presented. 43 patients made a complete recovery and one was left with moderate disability. Contralateral weakness in one patient, recurrence of haematoma in another, and a new contralateral haematoma in a third were the only complications.The operative procedures responsible for the rather low complication rate in this series are described. It is concluded that to avoid complications following surgical treatment of chronic subdural haematoma, attention must be paid to the following factors: evacuation of the haematoma through two burrholes overlying the subdural collection; attention to ensure free communication through the subdural space between the two burrholes; identification and opening of additional loculations overlying the cortex; irrigation of the subdural space to ensure as complete an evacuation of the subdural collection as possible and the use of closed system suction drainage, nursing the patient flat, and intravenous hydration of the patient for three days. In addition, in patients with coagulopathy, correction of these disorders before surgery is most essential.     

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.     

Long-term results after surgical treatment of nonparasitic hepatic cysts

Background

Studies evaluating surgical success in patients with benign liver cysts focus on cyst recurrence. The aim of this study was to evaluate the efficacy of surgical treatment with regard to clinical complaints.

Materials and methods

Between 1995 and 2007, 99 patients (M:F 1:7.25) with symptomatic, benign, nonparasitic liver cysts (77 simple liver cysts [SLCs], 22 polycystic liver disease [PCLD]) underwent surgical treatment (77% laparoscopic surgery, 23% open surgery). Perioperative parameters (including morbidity) were evaluated. Moreover, a questionnaire was completed by 65 patients monitoring subjective complaints focusing on abdominal pain, vegetative symptoms, and dyspnea pre- and postoperatively (mean follow-up 76 months).

Results

Severe complications occurred in 7 patients. Abdominal pain, vegetative symptoms, and dyspnea were significantly improved in SLC patients. In PCLD patients abdominal pain and dyspnea were significantly decreased, whereas vegetative symptoms were unaffected by surgery. The symptom recurrence rate for SLC patients was significantly lower compared with PCLD patients (41% vs 66.6%).

Conclusion

Indications for surgical treatment of PCLD should be well considered and limited to a selected group of patients.     

Results of surgical treatment in multinodular goiter with an intrathoracic component

PURPOSE: (1) To determine the clinical profile of intrathoracic multinodular goiter (IMG); (2) to evaluate the results of surgery, and (3) to analyze the incidence of malignancy and its evolution. METHODS: Two hundred and forty-seven operated cases of IMG were reviewed. These cases of IMG had all been diagnosed according to Eschapse's definition (>3cm below the sternal manubrium). The morbidity and postoperative evolution were analyzed. A comparative study was carried out on a group of 425 cases of nonintrathoracic goiter. We applied the chi(2) test, Student's t-test, and a logistical regression analysis. RESULTS: Intrathoracic MG occurs in patients over 60 years of age, with goiter which has a long evolution time (>12 years), and more than 60% are symptomatic. Oral tracheal intubation was difficult in 10% (n = 24) of the cases, and 7 required the use of a fibrobronchoscope. In 8 cases (3%) a thoracic approach was necessary. Morbidity occurred in 24% (n = 59), most notably 29 recurring lesions (12%), of which 2 were definitive (0.8%), and 31 hypoparathyroidisms (13%), of which 1 was definitive (0.4%). No significant difference was found in the postsurgical morbidity between the intrathoracic MG and the nonintrathoracic cases. Regarding the remission of the symptoms, the results were excellent. In 14 cases (5.7%) thyroid carcinoma was related with, most of these being papillary microcarcinoma. In 10 of the 49 cases of partial surgery (20%) a relapse of the goiter was observed. CONCLUSIONS: Intrathoracic MG is usually asymptomatic and it occurs in goiter with a long time of evolution. Surgery is a good therapeutic option given that the goiter can be removed via the neck, with low morbidity, a remission of the symptoms, malignancy is ruled out, and recurrence can be avoided if a total thyroidectomy is performed.     

Spinal synovial cysts: pathogenesis,diagnosis and surgical treatment in a series of seven cases and literature review

This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing, the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven patients (age range 58–69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results of treatment were recorded. A follow-up of at least 6 months (range 6–48 months) was conducted and results were noted. All patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify issues under debate. An erratum to this article can be found at     

后腹腔镜一期手术治疗34例双侧肾囊肿的疗效观察

目的探讨后腹腔镜一期手术治疗双侧单纯性肾囊肿的临床价值。方法对34例后腹腔镜一期行双侧肾囊肿去顶减压患者临床资料进行回顾分析。其中男1例,女13例,年龄17～65岁(34±0.53),囊肿直径5.32±1.31cm,左侧囊肿43个,右侧48个。结果经后腹膜入路34例患者双侧肾囊肿顺利去顶,平均每侧手术时间37.28±0.45min,平均每侧术中出血量7.18±0.53ml,2例随访3～6个月无复发,术中出现单侧腹膜损伤,未伤及腹腔脏器。平均住院天数7.47±0.32d,平均术后住院天数4.10±0.27d。结论后腹腔镜一期行双侧肾囊肿去顶术是一种安全、可行的治疗方式。     

To shunt or to fenestrate: which is the best surgical treatment for arachnoid cysts in pediatric patients?

The treatment options for intracranial arachnoid cysts are either craniotomy and fenestration of the cyst into the cerebrospinal fluid spaces or shunting of the cyst contents extracranially. Fenestration may eliminate the need to shunt, but it is a major operative procedure and is not always successful. To determine which treatment provides the greatest benefit with the fewest complications, the records of 31 patients with 34 arachnoid cysts treated at the Children's Hospital of Los Angeles between 1976 and 1986 were reviewed. The mean age of the patients was 4.4 years, with a range of 0 to 15.5 years. The most common location was the middle fossa (14 cases), followed by the posterior fossa (7 cases), the suprasellar region (5 cases), and hemispheric (5 cases) and other locations (3 cases). Signs and symptoms were related to abnormally rapid head growth in infants and to increased intracranial pressure and seizures in older children. The initial treatment of 29 cysts was fenestration. Twenty-two (76%) procedures were successful, with no additional treatment needed for the cyst. The other 7 cysts required the subsequent placement of a cystoperitoneal shunt. In 5 cases, the cysts were treated initially with cystoperitoneal shunts. Of the total 12 cystoperitoneal shunts, 5 have required revisions on one or more occasions. No significant difference in morbidity was noted between the two treatment options. Because we consider shunt independence to be a major goal of therapy, we suggest that patients with arachnoid cysts be divided into two categories, those presenting with associated hydrocephalus and those without hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

卵巢子宫内膜异位囊肿术后盆腔囊性包块分析

目的 探讨卵巢子宫内膜异位囊肿术后异位囊肿的复发和盆腔包裹积液发生的规律,以及合理有效的治疗方案.方法 比较两者发生的时间、手术范围,与年龄、服药、CA125的关系,以及影像学的特征.采用阴道超声引导下穿刺治疗,并就其囊液进行分析.结果 术后1～6月内,盆腔包裹积液发生率为41.7%（10/24）,没有发生卵巢子宫内膜异位囊肿复发,两者相比（P〈0.001）差异有统计学意义.术后18月以上出现的囊肿中,卵巢子宫内膜异位囊肿居多,发生率为40%（12/30）两者的发生率相比（P〈0.05）,差异有统计学意义.结论 子宫内膜异位症术后盆腔包裹积液出现一般早于卵巢子宫内膜异位囊肿的复发,且这种囊肿可以通过阴道超声进行介入治疗.     

不同手术方式处理卵巢子宫内膜异位囊肿对体外受精-胚胎移植妊娠结局的影响

目的探讨卵巢子宫内膜异位囊肿剔除术和经阴道穿刺抽吸术对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法选择2010年1月至2016年3月在我院行IVF-ET助孕治疗的98例卵巢子宫内膜异位囊肿患者为研究对象,根据助孕前处理不同分组:52例曾在外院接受囊肿剔除术的患者为囊肿剔除组,46例促排卵前行经阴道行囊肿穿刺抽吸术的患者为穿刺组;并选择同期来我院就诊因单纯输卵管因素不孕的55例患者为参照组。比较不同手术组的促排卵情况及妊娠结局,以及与本中心一般IVF患者的临床结局差异。结果穿刺组窦卵泡数显著低于参照组[(10.41±4.69)vs.(13.68±7.78)个](P0.05)。囊肿剔除组和穿刺组的HCG日E_2水平[分别为(15 746.24±7 821.86)、(16 704.57±7 860.99)pmol/L]显著低于参照组[(21 082.45±10 316.09)pmol/L](P0.05)。囊肿剔除组和穿刺组的获卵数[分别为(11.37±5.98)、(10.84±6.01)个]显著低于参照组[(14.05±7.27)个](P0.05),但3组间双原核(2PN)受精率、优质胚胎率、移植胚胎数比较均无显著性差异(P0.05)。穿刺组的临床妊娠率(39.13%)呈低于囊肿剔除组(53.85%)的趋势,但无显著性差异(P0.05)。结论卵巢子宫内膜异位囊肿术后的IVF-ET临床结局与本中心一般IVF妊娠结局相似。卵巢子宫内膜异位囊肿行剔除术和穿刺术各有优势,在临床工作中应根据患者实际情况选择合适的治疗方式。     

儿童肠系膜囊肿和大网膜囊肿临床诊疗分析

目的总结儿童肠系膜囊肿和大网膜囊肿的临床诊治经验。方法回顾性分析我院收治的大网膜囊肿和肠系膜囊肿共34例患者的临床资料。结果本组肠系膜囊肿25例,大网膜囊肿9例。所有患儿均行手术治疗,术后均恢复满意,术后10d内治愈出院。术后无出血、感染、梗阻、肠瘘等近期并发症。结论儿童肠系膜囊肿和大网膜囊肿足儿童少见疾病,尽管手术治疗效果佳,但是还需要进一步提高诊断准确率,避免误诊。