Decrease In Cyst Volume Research Articles

Neuroendoscopic treatment of symptomatic cyst of the septum pellucidum in children: A case series

BackgroundSymptomatic cysts of the septum pellucidum (CSP) are extremely rare in children and surgical indications are not well defined. A very careful clinical and neuroradiologic evaluation is necessary to consider a patient for surgical indication. MethodsWe present a surgical series of 7 pediatric patients. Clinical and radiological features of the patients, including clinical presentation, previous treatment, pre, and post-operative MRI, immediate postoperative, neuropsychiatric assessment, and outcomes were reviewed. ResultsThere were 5 males and 2 females (mean age 8 yrs). Five patients presented a history of severe intermittent headaches, two of them were admitted with acute symptoms of raised intracranial pressure. One patient presented Epilepsy and ADHD and one patient had severe psychosis. Overall, psychiatric disorders were diagnosed in six patients, three patients had Intellectual Disability (ID). In all cases, the cyst presented a ballooning feature, with a mean volume of 18,36 cm3 (range 10,62–28,5) and significant lateral bulging of both layers. All were operated on endoscopically without complications. After surgery, a very significant decrease in cyst volume was observed (mean volume 5,68 cm3; range 3,18–10,1) with complete disappearance of the ballooning aspect. Headaches resolved in all patients. In two patients operated in emergency papilloedema and vision improved in the first week after surgery. No recurrence of the cysts was noted during follow-up in all patients. ConclusionsCSP may be associated with behavioral or psychiatric problems also in children. Neuroendoscopic surgery is a safe and effective therapeutic modality to treat CSP presenting with symptoms and signs of intracranial hypertension with good clinical results.

The Effect of Transplantation of Olfactory Ensheathing Cells on the Size of Posttraumatic Spinal Cord Cysts

We studied the effect of transplantation of ensheathing cells obtained from the olfactory mucosa of rats and humans on the size of posttraumatic spinal cord cysts. MRI examination showed that transplantation of these cells into experimental posttraumatic cysts of the spinal cord led to a significant decrease in cyst volume and even their complete disappearance in two animals receiving transplantation of rat or human cells. These findings attested to regenerative processes developing as a result of ensheathing cell transplantation. Further studies in this field will be aimed at elucidation of the mechanisms underlying spinal cord regeneration in the area of posttraumatic cysts after transplantation of ensheathing cells.

EVALUATION OF BONE REGENERATION OF MAXILLARY CYSTIC DEFECT GRAFTED WITH PUERARIN WITH CALCIUM SULPHATE GRANULES VERSUS CALCIUM SULPHATE GRANULES AS A SOLOGRAFT: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Aim: The aim of this study was to evaluate bone regeneration of maxillary cystic defect grafted with puerarin with calcium sulphate granules versus calcium sulphate granules as a solograft. Materials and Methods: This was a randomized controlled clinical trial conducted on 20 patients suffering from maxillary cystic lesions with size more than 3 cm2 indicated for enucleation without the need for resection or plate reconstruction. In the first group (A): Bony cavities were grafted by Puerarin mixed with hemihydrated calcium sulphate bone graft granules, while in the second group (B): The bony cavities were grafted by hemihydrated calcium sulphate bone graft granules only. All patients were followed up for 6 months recording the progress of the healing both clinically and radiographically via CBCT. Results: Surgeries went uneventful in patients of both groups. No notable complications occurred during the surgical procedures and the healing period of the two groups. Radiographic results after 6 months showed that there was a significant decrease in cyst volume in the purerein group compared to the other group. Conclusions: Puerarin is a promising graft material with probably an osteoinductive role, an issue that needs more researches to optimize its use and to understand its bone forming mechanism.

Radiofrequency ablation in management of simple non-parasitic liver cysts

Purpose. Comparison of the long-term outcomes of the treatment of simple liver cysts by traditional and modified RFA methods.Materials and methods. From 2015 to 2018, US-guided RF ablation was used to treat simple nonparasitic hepatic cysts in 14 patients. There were 15 operated cysts in total. 7 patients of group A underwent standard RFA session without temperature restrictions. 7 patients of group B with localization of cysts closely to large vessels and bile ducts or the area of portal fissure, underwent RFA at 60 °C with preinjection of 10% NaCl solution into the cyst cavity. During the intervention, the temperature of the surrounding electrode tissue and the exposure time were recorded.Results. All patients underwent interventions satisfactorily; no complications were observed. In group A, the mean cyst diameter was 50.3 ± 15.2 mm, and the mean initial cyst volume was 77.09 ± 23.2 cm3. In group B, the mean cyst diameter was 61.8 ± 14.9 mm, and the mean initial cyst volume was 137.8 ± 39.2 cm3. After 3 months, the overall decrease in the volume of operated cysts on CT was in group A – 27.1%, in group B – 50.6%; after 6 months – 49.8% and 60.4%, respectively. After 12 months, similar indicators in group A amounted to 64.2%, in group B – 79.2%. 1.5 years after surgery, the volume of operated cysts in group A decreased by 65.2%, in group B by 91.2%; and after 2 years – by 68.9% and 93.6%, respectively. The total decrease of cyst volume at the last control in group B was 24.7% more than in group A. The decrease in cyst volume by more than 50% was noted in group A in 37.5%, in group B – in 85.7%. Complete reduction of the cyst cavity was noted in group A in 25%, in group B in 28.5%. The difference in the decrease of the cyst volumes between the groups after 2 years is statistically significant (p = 0.03), thus it can be concluded that a significantly more pronounced decrease in cyst volumes was observed in group B than in group A.Conclusion. Preinjection into the cystic cavity of a 10% solution of NaCl allowed to achieve a more pronounced decrease of the cystic cavities with the lower RFA temperature regime. At a temperature of 60 °C, the thermal damage minimally spreads to adjacent healthy liver tissue andis sufficient for the radical treatment of the cystic cavity. This makes possible to use the modified RFA method for cysts, located close to the large vessels and bile ducts.

Microsurgical, endoscopic, and shunt management of pediatric temporosylvian arachnoid cysts: a comparative study.

Arachnoid cysts (ACs) are most frequently located in the middle cranial fossa. Some patients are asymptomatic whereas others exhibit signs of increased intracranial pressure, seizures, or cognitive and behavioral symptoms. When ACs do require treatment, the optimal surgical technique remains controversial. This study was conducted to assess the most effective surgical treatment for these cysts. The authors retrospectively reviewed 240 temporal intracranial ACs managed over a 25-year period in their pediatric neurosurgical unit. Pre- and posttreatment results were clinically and radiologically assessed. A majority of male patients (74.6%) with an overall median age of 6.9 years were included. The mean cyst size was 107 cm3; the Galassi classification showed 99 (41.3%) type I, 77 (32.1%) type II, and 64 (26.7%) type III cysts. Forty-four ACs (18.3%) were diagnosed after rupture. Surgical management was performed by microsurgery (28.3%), endoscopic cyst fenestration (14.6%), cystoperitoneal shunting (CPS; 16.2%), or subdural shunting (10%). Furthermore, 74 children (30.8%) did not undergo operations. After a mean follow-up of 4.1 years, the mean percentage decrease in cyst volume and the overall rate of clinical improvement did not significantly differ. The endoscopy group had earlier complications and a shorter event-free survival (EFS) time (EFS at 3 years = 67.7%, vs 71.5% and 90.5% for CPS and microsurgery, respectively; p < 0.007) and presented with more subdural hematomas compared to the microsurgery group (p < 0.005). The microsurgery group also showed a tendency for longer cystocisternostomy permeability than the endoscopy group. Concerning the management of unruptured symptomatic temporal ACs, microsurgery appears to be the most effective treatment, with longer EFS and fewer complications compared to shunting or endoscopy.

Supraorbital Keyhole Microsurgical Fenestration of Symptomatic Temporal Arachnoid Cysts in Children: Advantages and Limitations.

To investigate the impact of endoscope-assisted microsurgical fenestration on temporal arachnoid cysts, and to determine the advantages and limitations of the technique. Twenty-five children with symptomatic temporal arachnoid cysts were operated via eyebrow supraorbital keyhole microsurgical fenestration targeting the medial cyst wall. Preoperative magnetic resonance imaging (MRI) of the brain was done for all patients. Preoperative clinical presentation of the patients included headache (80%), nausea & vomiting (64%), drug resistant epilepsy (52%), macrocephaly (12%) papilledema (28%), motor weakness in the form of right-sided hemiparesis (12%) and cranial nerve palsy. Postoperative complete subsidence of headache was noted in 50%, while 20% remained unchanged. Drug resistant epilepsy improved in 69% of the patients. Postoperative MRI showed initial decrease in cyst volume as early as 3 months, only in a range of 5-12% volume reduction, and the late follow-up done at 6 and 18 months continued to show further reduction reported to be significant (p < 0.001). Transient subgaleal cerebrospinal fluid (CSF) collection was the most common complication (20%). Only 1 patient experienced CSF leak mandating cysto-peritoneal shunting. Conclusıon: Eyebrow supraorbital keyhole microsurgical fenestration for temporal arachnoid cysts can be performed with a fairly low risk of complications and yields a favorable improvement in clinical and neuroimaging outcomes.

An mTOR anti-sense oligonucleotide decreases polycystic kidney disease in mice with a targeted mutation in Pkd2.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common life-threatening hereditary disease in the USA. In human ADPKD studies, sirolimus, a mammalian target of rapamycin complex 1 (mTORC1) inhibitor, had little therapeutic effect. While sirolimus robustly inhibits mTORC1, it has a minimal effect on mTOR complex 2 (mTORC2). Polycystic kidneys of Pkd2WS25/- mice, an orthologous model of human ADPKD caused by a mutation in the Pkd2 gene, had an early increase in pS6 (marker of mTORC1) and pAktSer(473) (marker of mTORC2). To investigate the effect of combined mTORC1 and 2 inhibition, Pkd2WS25/- mice were treated with an mTOR anti-sense oligonucleotide (ASO) that blocks mTOR expression thus inhibiting both mTORC1 and 2. The mTOR ASO resulted in a significant decrease in mTOR protein, pS6 and pAktSer(473). Pkd2WS25/- mice treated with the ASO had a normalization of kidney weights and kidney function and a marked decrease in cyst volume. The mTOR ASO resulted in a significant decrease in proliferation and apoptosis of tubular epithelial cells. To demonstrate the role of mTORC2 on cyst growth, Rictor, the functional component of mTORC2, was silenced in Madin-Darby canine kidney cell cysts grown in 3D cultures. Silencing Rictor significantly decreased cyst volume and expression of pAktSer(473). The decreased cyst size in the Rictor silenced cells was reversed by introduction of a constitutively active Akt1. In vitro, combined mTORC1 and 2 inhibition reduced cyst growth more than inhibition of mTORC1 or 2 alone. In conclusion, combined mTORC1 and 2 inhibition has therapeutic potential in ADPKD.

Effects of lovastatin treatment on the metabolic distributions in the Han:SPRD rat model of polycystic kidney disease

BackgroundWe previously demonstrated that lovastatin decreases cyst volume and improves kidney function in the Han:SPRD (Cy/+) rat model of ADPKD. Since endothelial dysfunction and inflammatory activity are evident in patients with ADPKD, we investigated whether lovastatin reduces the inflammation and vascular dysfunction and improves kidney cell energy metabolism of Cy/+ rats.MethodsCy/+ and normal littermate control animals (+/+) were treated with either lovastatin (4 mg/kg/day) or vehicle (ethanol) from 3–8 weeks of age. 1H-NMR analysis was performed on water-soluble and lipid kidney fractions following perchloric acid extraction. Targeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to assess endothelial dysfunction, oxidative stress and inflammation markers in plasma and kidney tissue extracts.ResultsCy/+ rats showed perturbations in fatty acid metabolism and increased synthesis of pro-inflammatory lipoxygenases-produced bioactive lipids was observed. Lovastatin decreased inflammatory markers, specifically 13-HODE, 12-HETE and leukotriene B4. In Cy/+ rats, lovastatin reduced the elevated homocysteine and allantoin plasma levels and increased arginine, that is known to positively affect NO production.In terms of kidney cell metabolism, Cy/+ rats showed reduced Krebs cycle activity. Treatment with lovastatin increased the Krebs cycle activity as well as the glycolytical lactate production, thus improving the overall energy state of the cystic kidney.ConclusionAs previously described, lovastatin was able to decrease kidney weight and cyst volume density in Cy/+ rats. The decrease in cyst volume was accompanied by a reduction in arachidonic acid-mediated inflammation markers, the normalization of metabolism of NO precursors and the improvement of kidney energy cell metabolism.

The clinical classification and treatment of middle cranial fossa arachnoid cysts in children

ObjectiveThe optimal management for middle fossa arachnoid cysts (MFAC) remains controversial, but cystocistern fenestration is effective. MFACs are divided into non-communicating arachnoid cysts (NCIAC) and communicating arachnoid cysts (CIAC). This retrospective observational study evaluated the role of phase-contrast cine magnetic resonance imaging (PC-MRI) in the diagnosis and postoperative evaluation of MFACs and assessed surgical outcomes. MethodsTwenty-eight children with MFAC that were diagnosed by conventional neuroradiology were enrolled. PC-MRI was performed preoperatively. The clinical manifestations, cyst volumes and PC-MRI data were analyzed, and the flow of cerebrospinal fluid (CSF) at the fistula was qualitatively evaluated. ResultsNo communication with the adjacent subarachnoid space was found on preoperative PC-MRI in 20 patients, and they were diagnosed with NCIAC. A statistically significant decrease in cyst volume was observed in all 20 patients postoperatively. Symptoms resolved or improved in the 14 patients who were symptomatic preoperatively, and a positive CSF flow was found in all 20 patients postoperatively. PC-MRI diagnosed eight patients with CIAC, and the cyst sizes did not increase during follow-up. ConclusionsCystocistern fenestration is an effective treatment for children with lateral fissure IAC. PC-MRI can be used to determine the IAC type and to evaluate the effectiveness of cystocistern fenestration.

Changes in Bone Density and Cyst Volume After Marsupialization of Mandibular Odontogenic Keratocysts (Keratocystic Odontogenic Tumors)

To evaluate bone formation after marsupialization of odontogenic keratocysts (keratocystic odontogenic tumors) of the mandible. A total of 53 patients with mandibular odontogenic keratocysts underwent marsupialization. Clinical and radiographic examinations were done at 1, 3, and 6 months postoperatively. The bone density of the cyst site was measured on the panoramic radiographs using the Digora. The volume of the cyst was measured by injection of saline solution into the cyst cavity. Student t test and Spearman's rank correlation were used for statistical analysis. Healing was uneventful in all patients. The diameter of the cysts was 4.1 to 11.0 cm (average 5.4). The panoramic radiographs showed a continuous increase in bone density of the cystic area, with a 22.42% increase at 1 month, 46.07% at 3 months, and 64.69% at 6 months postoperatively compared with the preoperative values. The decrease in cyst volume was 19.05% at 1 month, 55.62% at 3 months, and 79.67% at 6 months postoperatively. The increase in bone density and decrease in cyst volume were more significant in the first 3 months than in second 3 months (P < .01). The increase in bone density correlated inversely with the decrease in the cyst volume (P < .01). Bone regeneration can occur more rapidly in large mandibular odontogenic keratocysts after marsupialization with drainage by a cyst plug. After 3 months, secondary enucleation of the cyst can be performed.

Percutaneous Management of Renal Cysts: Results of a Four-Year Study

A standardized technique for percutaneous therapeutic management of renal cysts is described. After partial aspiration of the cyst fluid, the fluid is replaced with Pantopaque, Renografin 60 and air. Fifty-six renal cysts so treated were followed at intervals of up to four years and 68% showed a 50% or more decrease in cyst volume. Only 13% of a control group of 15 renal cysts which were percutaneously punctured but did not have Pantopaque instilled showed a 50% or more decrease in cyst volume. The results suggest that instillation of Pantopaque into a renal cyst can alter the natural history of the cyst by causing it to decrease in size.