Large colloid cyst in lateral ventricle simulating brain tumour

Summary This case report describes a patient presenting with symptoms of increased intracranial pressure, whose computerized tomographic (CT) scan was highly suggestive of a large low-grade glioma invading the basal ganglia. Magnetic resonance imaging (MRI) revealed a well-demarcated space-occupying mass of increased intensity in the left lateral ventricle and adjacent white matter. Following stereotactic biopsy, which yielded a homogeneous jelly-like material, the mass was removed microsurgically and was found to be most like a colloid cyst on histological examination. Discussion focusses on the clinical and differential diagnostic implications of this very unusual combination of findings.     

四叠体池蛛网膜囊肿

目的:探讨四叠体池蛛网膜囊肿的临床特征和治疗方法。方法:对11例四叠体池蛛网膜囊肿进行了回顾性总结分析。所采用的手术方法有:①脑室分流手术;②囊肿-腹腔分流术;③囊肿切除;④囊肿切除加囊肿-脑池分流术,或囊肿部分切除(即囊肿开窗术),或囊肿切除加脑室-脑池分流术。结果:其主要临床表现以颅内压增高症和中线综合征为主。上述方法中单纯囊肿壁切除只能使部分病人的病情缓解,脑室分流或囊肿切除加脑室分流手术的疗效较好。结论:四叠体区蛛网膜囊肿常合并梗阻性脑积水,单纯囊肿切除不能解除多数病人的梗阻性脑积水。作者根据囊肿是否与蛛网膜下腔相通提出:对交通性蛛网膜囊肿采用单纯性脑室分流术,对非交通性者采用囊肿切除加脑室分流手术的治疗方法。     

Symptomatic liver cyst: Special reference to surgical management

We conducted a retrospective study of 14 patients with symptomatic liver cysts to evaluate current therapeutic interventions for this condition. Abdominal pain (n = 7) or abdominal mass (n = 5) were the most frequent presentations. Three patients also had renal cyst. Percutaneous aspiration with ethanol sclerotheraphy was carried out in 4 patients and all cysts so treated diminished in size, with relief of the symptoms. One patient was treated by aspiration only and re-retension occurred. Cystectomy was performed in 2 patients, unroofing in 5, and fenestration in 2 patients. All patients gained relief of symptoms, with no recurrence of symptoms. Computed tomography revealed that the cysts were diminished or were no longer observable after all the treatments. Our experience indicates that unroofing, fenestration, and cystectomy are safe and suitable procedures for treatment of the condition. Ethanol sclerotherapy may be a feasible alternative to surgical intervention in selected patients. Received for publication on July 23, 1997; accepted on Dec. 25, 1997     

Imaging of thoracic and lumbar spinal extradural arachnoid cysts: report of two cases

Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal which may communicate with the subarachnoid space. Usually in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report cases of thoracic and lumbar arachnoid cysts studied by cystography, myelography, CT and MRI. These techniques showed extradural cystic lesions containing cerebrospinal fluid, with variable communication with the subarachnoid space, causing anterior displacement and flattening of the spinal cord. Received: 3 November 1995 Accepted: 16 April 1996     

Choroid plexus cysts-Association with trisomy: Prospective review of 16,059 patients

OBJECTIVE: The purpose of the study was to determine the incidence of isolated choroid plexus cysts in association with trisomy 18 and other abnormalities.STUDY DESIGN: All patients from June 1992 through December 1995 were followed up after a screening ultrasonography. Any patient with a choroid plexus cyst was offered genetic counseling and an amniocentesis. Screening ultrasonographic examinations were performed on 16,059 patients, and 301 patients had a fetus with a choroid plexus cyst. One hundred thirty patients elected to have an amniocentesis. Patients were followed up to delivery.RESULTS: Two hundred sixty-three patients had an isolated choroid plexus cyst. Thirty-eight patients had a choroid plexus cyst associated with additional risk factors. Risk factors included advanced maternal age, additional ultrasonographic abnormalities, past obstetric history, or family history. No abnormalities were noted in the group with an isolated choroid plexus cyst. Four patients had an abnormality when the choroid plexus cyst was associated with an additional risk factor, including two patients with trisomy 18 and one with trisomy 21.CONCLUSION: An isolated choroid plexus cyst was not associated with a trisomy or other abnormalities in this study. When a choroid plexus cyst was associated with an additional risk factor, 10.5% of the patients had an abnormality. Amniocentesis is recommended when a choroid plexus cyst is found in association with additional risk factors. (Am J Obstet Gynecol 1997;176:1381-3.)     

Groove pancreatitis associated with true pancreatic cyst

We report a case of groove pancreatitis (GP) associated with a true pancreatic cyst. An 81-year-old man who had suffered epigastric pain for 4 months was referred to Saisekai Kure Hospital. Computed tomography and endoscopic retrograde pancreatography showed a cystic lesion in the groove area of the pancreas. Serum amylase elevation and imaging findings suggested GP due to the cyst. Six weeks of medical treatment did not improve the clinical symptoms. Therefore, pancreatoduodenectomy was performed. Histologic examination revealed a true cyst with intraluminal necrosis, which produced a protein plug that obstructed the Santorini duct. The parenchyma surrounding the groove area showed marked fibrosis and inflammatory cell infiltration. GP due to true pancreatic cyst was diagnosed. Although GP is usually caused by overconsumption of alcohol, which leads to changes in the pancreatic juice and the ultimate blockage of pancreatic outflow, the histologic features in our patient suggest that true pancreatic cyst stands as a secondary cause of GP.     

经皮双针囊内注射类固醇治疗小儿孤立性骨囊肿

目的探讨经皮双针囊内注射类固醇治疗小儿孤立性骨囊肿的疗效. 方法 1996年1月～2004年1月,对28例小儿孤立性骨囊肿,在X线透视下,将2根细的骨穿针或腰穿针分别自囊腔顶部和底部刺入骨囊肿内,抽去囊液,冲洗囊腔后注入类固醇. 结果 27例随访10～62个月,平均28个月,无并发症发生.根据Chigira等X线骨囊肿愈合评价标准,Ⅳ级20例,Ⅲ级5例,Ⅱ例1例,Ⅰ级1例,治愈率92.6%(25/27).25例骨囊腔愈合时间3～10个月,平均4.5个月. 结论经皮双针囊腔内注射类固醇适合于小儿孤立性骨囊肿,简单,安全,治愈率高.     

腹腔镜下良性卵巢囊肿手术50例探讨

目的探讨腹腔镜下卵巢囊肿手术的适应证及手术技巧.方法腹腔镜下行卵巢囊肿剥除术、卵巢-卵巢囊肿切除术和输卵管-卵巢切除术50例.结果卵巢囊肿剥除术46例（92%）,卵巢囊肿切除术2例（4%）,输卵管一卵巢切除术3例（6%）.手术时间30～120min,平均58min.术中出血＜20ml,无中转开腹者,无气栓、出血、感染等严重并发症发生.术后病理诊断：卵巢巧克力囊肿23例（46%）、良性畸胎瘤10例（20%）、卵巢冠囊肿8例（16%）、黄素囊肿5例（10%）、浆液性囊肿3例（6%）、纤维瘤1例（2%）.结论腹腔镜手术治疗良性卵巢囊肿具有微创手术的优点.     

支撑喉镜下射频加囊肿揭盖术治疗会厌囊肿的临床研究

目的探讨囊肿揭盖术、囊肿揭盖术＋射频、射频＋囊肿揭盖术治疗会厌囊肿3种术式的疗效及其优劣。方法57例随机分为3组：单纯囊肿揭盖术组、囊肿揭盖术＋射频治疗组及射频＋囊肿揭盖术组。3组均采用表面麻醉＋强化麻醉经支撑喉镜下手术。随访6-12个月，比较3组总有效率、术中出血量及手术时间。结果3种术式总有效率均为100％，差异无显著性。囊肿揭盖术＋射频治疗组、射频＋囊肿揭盖术组与对照组比较，术中出血量、手术时间的差异均有显著性；囊肿揭盖术＋射频治疗组、射频＋囊肿揭盖术组术中出血量、手术时间相比较，差异均有显著性。结论3种术式均是治疗会厌囊肿的有效方法。射频＋囊肿揭盖术具有出血更少、手术时间更短、病人痛苦更小等优点，值得临床推广应用。