Surgical treatment of sacral perineural cyst--case report

A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. His pain resolved without recurrence of the cyst or complications. Symptomatic perineural cysts are quite rare. Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.     

Laparoscopic excision of a gastric duplication cyst detected on antenatal ultrasound scan

The authors report a gastric duplication cyst detected antenatally and its subsequent laparoscopic removal at 2 months of age. Before birth, a cystic mass was detected behind the stomach on fetal ultrasound scan (US). After birth, an US, barium meal, nuclide scan, and cervical and thoracic vertebral x-rays suggested that the most probably diagnosis was a gastric duplication cyst. At 2 months of age, laparoscopic removal of the cyst was performed with closure of the muscle defect in the stomach wall. The patient was discharged 4 days later, feeding normally. Histology findings confirmed the diagnosis of a gastric duplication cyst. After the antenatal detection of a cyst behind the stomach, the laparoscopic removal of this gastric duplication in a 2 month old was accomplished without complications. This appears to be the first reported case using this type of procedure in an infant.     

Laparoscopic port-in-cyst technique for retrieval of hepatic hydatid and review of other techniques used in literature

AimTo describe a technique used for removal of hepatic hydatid cyst laparoscopically.Patients and MethodsThe removal of hydatid membranes was achieved by inserting a 10-mm port right above the cyst. The port is made to enter the cyst, and the membranes are removed without any contact to outer surface, thus avoiding peritoneal spillage.ResultsThe technique was used in 6 patients. Mean age was 3.5 years, range being. 2.5 to 6 years. Three patients had solitary cyst in the right lobe, and 2, in left lobe. One had multiple cyst involving both right and left lobes. Follow-up is of mean 6 months. There is no recurrence or evidence of new cyst owing to peritoneal seeding.ConclusionsSafe extraction of hydatid membranes during laparoscopy can be done by directly placing the port within the decompressed cyst and removing the membranes with minimal use of suction. The port-in-cyst technique excludes any possibility of peritoneal seeding, during hydatid removal which may lead to metachronous recurrence in the peritoneum.     

Choroidal epithelial cyst in the cerebellopontine angle associated with trigeminal neuralgia--case report

The authors describe the case of a 37-year-old female with a symptomatic epithelial cyst in the cerebellopontine angle, which is extremely rare. The cyst caused trigeminal neuralgia, which completely disappeared following its removal. The histological diagnosis was choroidal epithelial fluid-filled cyst. The wall of the cyst consisted of a single layer of epithelial cells with microvilli and a basement membrane.     

Nasal dermoïd cyst with intracranial extension: which approach?

Dermoïd cyst is the most common midline congenital nasal tumor. Intracranial extension is rare but possible, must be suspected and confirmed by a cerebral magnetic resonance imagining (MRI). Only total surgical removal via a combined intracranial/extracranial approach appears to provide a complete resolution and effective protection against late recurrence. We report a case of a 2 years old patient who was operated for a nasal congenital cyst extending to the nasal septum. Anatomopathology showed a dermoïd cyst. Five years later, he presented local recurrence of the dermoïd cyst with intracranial extension through a bifid crista galli. We conclude that to avoid recurrence, the removal of the nasal cyst and sinus tract must be followed to its dural attachment. A transfacial approach can be associated with frontal craniotomy, which can provide adequate exposure for complete removal of the intracranial component of the cyst and sinus tract. A literature review was performed.     

Total splenectomy for a recurrent giant splenic cyst

Primary splenic cysts are a rare finding. Some are large and require surgical removal. The Authors report a case of a recurrent huge splenic cyst in a 41-year-old female patient. A marsupialization was performed at another hospital 6 years before. Ultrasonography and computed tomography imaging revealed a cystic lesion in the spleen measuring approximately 20 cm in diameter. A total open splenectomy was performed. Postoperative course was uneventful. The histologic diagnosis was an epithelial cyst of the spleen with no atypical cells in the cyst wall, as previously found at the first operation. The epidermoid cysts have an epidermal lining, and prevention of recurrence is dependent on complete resection of the cyst wall preserving, whenever possible, the splenic tissue. Recurrence can be avoided with partial splenectomy in polar localization of the cyst, or complete removal of the cyst by "peeling" it off the splenic parenchyma. Marsupialization of the cyst, either via a laparoscopic or an open approach, is often ineffective.     

A recurrent intradural cervical neurenteric cyst operated on using an anterior approach: a case report

The neurenteric cyst is an uncommon congenital lesion. In most reported cases, it has been operated on via a posterior approach using a laminectomy, despite the fact that the cyst is usually located ventral to the spinal cord. Reports have shown that early postoperative results have been good with the posterior approach, but very few studies of the long-term postoperative recurrence of neurenteric cysts have been conducted. Here, we report on a case of recurrent neurenteric cyst that was operated on using an anterior approach.A 42-year-old woman presented with a cervical neurenteric cyst that had recurred eight years after its partial removal via a posterior approach. The patient complained of pain on the lateral side of her upper arms, and an magnetic resonance imaging showed that the recurrent cyst was located ventral to the spinal cord and compressed the cord dorsally at the C4-6 level.The patient was operated on via an anterior approach using a vertebrotomy at the lower half of C5 and the upper half of C6. The cyst was attached to the spinal cord firmly and was subtotally removed, with the thickest portion adhering to the cord not being removed. The caudal end of the cyst was observed with the assistance of a rigid endoscope.A neurenteric cyst may recur after partial removal, and the patient's condition may deteriorate during postoperative follow-up. The anterior surgical approach provides good visualization and facilitates safe removal of the lesion.     

Frameless neuronavigation-guided endoscopic total en-bloc removal of a third ventricular colloid cyst: a case report on surgical technique.

A 26-year-old man was referred to our department with recurrent episodes of loss of consciousness. The radiological evaluation of the patient's cranium showed a third ventricular colloid cyst with only a slight degree of obstructive hydrocephalus. The complete, en-bloc removal of the cyst was achieved by a frameless neuronavigation-guided endoscopic resection technique. The patient had an uneventful post-operative period and was discharged home on the fourth post-operative day without any neurological or psychological deficit. The surgical technique and pertinent literature are discussed with emphasis on factors that contribute to our successful total en-bloc removal of the third ventricular colloid cyst.     

Surgical management of symptomatic pineal cysts.

The authors present a series of six patients with large symptomatic benign pineal cysts and review the 27 patients previously reported in the literature. Patients with symptomatic pineal cysts most often present with one of three syndromes: 1) paroxysmal headache with gaze paresis; 2) chronic headache, gaze paresis, papilledema, and hydrocephalus; or 3) pineal apoplexy with acute hydrocephalus. Surgical intervention with radical cyst removal is the treatment of choice for all symptomatic pineal cysts. Complete cyst removal is desirable; however, radical subtotal resection is appropriate if the cyst cannot be easily separated from the quadrigeminal plate. Ventricular shunting should be reserved for patients with persistent hydrocephalus after cyst resection.     

Ventral intradural endodermal cyst in the cervical spine treated with anterior corpectomy--case report

A 14-year-old girl who presented with an endodermal cyst manifesting as severe neck and shoulder pain along with vesicorectal disturbances. Cervical magnetic resonance imaging showed a slightly enhanced intradural cyst at the C6-7 level in the ventral side of the spinal canal, with significant dorsal shortening and thinning of the spinal cord. Anterior corpectomy was chosen because of the dorsal effacement of the spinal cord. The cyst wall was subtotally removed to avoid damage to the normal spinal cord. After cyst removal, the iliac bone and an anterior cervical plate were used for anterior fusion. Postoperatively, her pain subsided without neurological deficits. The histological diagnosis was endodermal cyst. The cyst did not recur during a follow-up period of 18 months. Endodermal cysts are rare congenital lesions of the spine lined by endodermal epithelium. The natural history of this lesion is unclear, and the surgical strategy for the approach route and the extent of removal of the cyst wall remain controversial. We suggest that the anterior approach may allow a safer and more effective surgical route for the treatment of ventrally located endodermal cyst compared to the posterior approach.     

颅内蛛网膜囊肿显微手术治疗

目的：回顾性分析开颅显微手术治疗颅内蛛网膜囊肿的疗效。方法：应用显微外科手术治疗上述病例２８例，男１９例，女９例，平均年龄２３岁。结果：囊肿全切除１５例，次全切除６例，部分切除加脑池（或蛛网膜下腔）交通术７例。术后平均随访３年，患者症状与体征均有改善。ＣＴ随访２１例，１８例囊腔消失或明显缩小，２例稍有缩小，１例较术前无变化。结论：精细操作，防止囊肿破裂并尽量完整切除或大部分切除囊肿，充分建立囊腔与周围脑池之间交通是手术成功的关键。     

Symptomatic choroidal epithelial cyst in the fourth ventricle

A case of choroidal epithelial cyst in the fourth ventricle is described. The cyst occupied the fourth ventricle almost completely, and produced an intermittent hemiparesis and hemisensory disturbance. After removal of the cyst wall, the patient recovered completely. On light microscopy, a single epithelial layer with a basement membrane lining the cyst wall was observed. An electron microscopic study was also made.     

Laparoscopic management of chemical peritonitis caused by dermoid cyst spillage

Background:

Dermoid cyst is the most frequent benign ovarian tumor. Spillage of cyst contents during surgery is common and can rarely lead to chemical peritonitis.

Case Report:

A patient presented 3 days after attempted laparoscopic removal of bilateral dermoid cysts. On examination, she had a low-grade fever, rebound tenderness with guarding, and a markedly elevated white blood cell count. A decision was made to proceed with laparoscopy with the presumptive diagnosis of chemical peritonitis. Laparoscopic findings included residual dermoid cyst contents and extensive filmy adhesions of the bowel and omentum to the peritoneal surface. The chemical peritonitis resolved after laparoscopic removal of residual dermoid cyst content including bilateral salpingo-oophorectomy and copious irrigation.

Conclusion:

Early recognition and prompt treatment by repeat laparoscopic surgery with removal of the remaining cyst contents and peritoneal lavage can be a successful method for treating chemical peritonitis.     

A rare case of choledochocele associated with calculosis of the gallbladder

The authors report their experience of a case of choledochocele (choledochal cyst) with stones, associated with a gallstone. The exceptional observation diagnosed before the operation node it possible to program total removal of the cyst.     

Thoracoscopic removal of oesophageal duplication cyst

A 4-year-old boy presented with vomiting and recurrent cough. He was investigated and found to have thoracic oesophageal duplication cyst. He was taken up for thoracoscopic removal of the cyst. The cyst was attached to the oesophagus and shared a common wall. The boy tolerated the procedure well and follow-up showed no recurrence of the cyst with total resolution of the symptoms. We share our experience with the management of this boy.     

Neuroenteric cyst of the anterior cranial fossa: case report and review of the literature

A case of intradural neuroenteric cyst located in the anterior cranial fossa is presented. The cyst caused anosmia and progressive personality changes in an elderly woman. The patient underwent bifrontal craniotomy with evacuation of cyst contents and removal of the cyst wall. Incidence, classification, histopathology, and histogenesis of neuroenteric cysts are discussed with review of the literature.     

Recurrent cystic meningioma

The authors report a case of recurrent meningothelial meningioma with a large cyst. At the first operation, the mural nodule was totally resected and the cyst wall was removed as much as possible. This cystic tumor recurred six years later at the site where the first operation was performed. Histologically, the cyst wall contained islands of the same neoplastic cells as were previously found in the mural nodule. The authors discuss the preoperative diagnosis and mechanism of cyst formation, and emphasize the importance of complete removal of the cyst wall for permanent cure.     

Cyst of the choroid plexus of the left lateral ventricle.

A cyst of the choroid plexus of the left ventricle is described. The cyst was lined by a choroidal epithelium and filled with cerebrospinal fluid. It produced an intermittent obstructive syndrome. The cyst was almost completely invaginated into the third ventricle, simulating an expanding process in the third ventricle. After microsurgical removal, the recovery of the patient was complete. Electronmicroscopy of the cyst wall is reported. Histological and neuroradiological features are discussed.     

An unusual pleural cyst in a child presenting as a pseudo-pneumothorax. Case report

This case highlights an unusual pleural cyst in a 3-year-old child that simulated a pneumothorax on chest radiograph. The child presented with mild respiratory distress and the 'pneumothorax' failed to respond to pleural intubation. At thoracotomy, a 10 cm air-filled cyst was found attached to the visceral pleura by a narrow pedicle. This was transfixed and divided, with removal of the cyst. Postoperatively, the lung expanded and the child recovered without any sequelae. Histological examination of the cyst showed it to be lined with mesothelial cells. It is suggested that this cyst arose from a mesothelial inclusion cyst or sub-mesothelial pleural tissue, which communicated with the peripheral lung tissue.     

Resolution of a fourth ventricle epithelial cyst after ventriculoperitoneal shunting: case report

BACKGROUND: Symptomatic cysts of epithelial origin occurring in the fourth ventricle are very rare. When such a cyst is encountered, the treatment strategy includes surgical removal or fenestration of the cyst into subarachnoid space. CASE 1: A 23-year-old male was diagnosed as having a cyst located in the fourth ventricle causing hydrocephalus; the patient underwent cyst removal via craniotomy. The histopathologic diagnosis was neuroepithelial cyst. Because clinical and neuroradiological findings persisted, he underwent VP shunting. The cyst disappeared and did not recur. CASE 2: A 54-year-old woman was diagnosed as having a cystic mass in the fourth ventricle and dilatation of the ventricles. Magnetic resonance imaging showed the same findings as those of the first case. The patient refused craniotomy for total mass excision. Therefore, a VP shunt was applied. Postoperatively, the clinical findings and hydrocephalus improved, and complete disappearance of the cystic mass was observed unexpectedly. Both cases had 2 years of follow-up. CONCLUSION: There is no proven mechanism to explain resolution of fourth ventricle cysts after a supratentorial VP shunting. We hypothesize that disappearance of the cyst could result from rupture of its wall because of pressure gradient, which might be facilitated by a VP shunt. The current report should not be taken as an argument against cyst removal, which is the established way of treatment. However, considering that the pathogenesis and pathophysiology of these cysts are unclear, VP shunting should be considered especially for recurrent cases accompanied by hydrocephalus.