Marsupialization Of Cyst Research Articles

A rare case of arachnoid cyst of the fourth ventricle resulting in an Isolated fourth ventricle: Case report and review of the literature

Introduction: Post-hemorrhagic or post-infectious isolated or trapped fourth ventricles are rare occurrences associated with cystic lesions of the V4. However, the even less frequent arachnoid cyst of the fourth ventricle poses a differential diagnosis challenge and may be easily overlooked during initial medical assessments of V4 cystic lesions. Case Report: An 11-year-old child, previously healthy, presented with symptoms indicative of intracranial hypertension syndrome, including headaches, vomiting, and bilateral Grade II papilledema. Neuroradiological examination revealed a significantly enlarged fourth ventricle (V4) alongside small lateral and third ventricles. Initially suspected as a V4 arachnoid cyst, the patient underwent surgical intervention with a sub-occipital approach for cyst marsupialization, showing positive progress in the first postoperative month. However, one month later, intracranial hypertension symptoms recurred, and imaging indicated cyst recurrence within V4. A second procedure involved a V4-peritoneal shunt, resulting in a favorable postoperative outcome for one month. One month later, headaches and vomiting without papilledema reappeared, and imaging revealed moderate ventricle dilation. The therapeutic approach included ventriculocisternostomy alongside the V4 peritoneal shunt, leading to a favorable outcome with no signs of intracranial hypertension during follow-up consultations and a normal clinical examination. Conclusion: Trapped fourth ventricle is a rare clinico-radiologic entity, with limited cases reported. Treatment options encompass direct microsurgical approaches, fourth ventricle outflow fenestration, and alternative treatments like fourth ventriculoperitoneal shunts. Additionally, the combination of ventriculoperitoneal shunt and endoscopic treatment (VCS) may be considered for comprehensive management.

Surgical alternatives to classical phonomicrosurgery for vocal fold cysts: our experience.

Treating options for vocal fold cysts became more diversified with office-based laryngological surgery advances, offering new soft interventions, promising a good vocal outcome within a shorter healing period. We proposed two types of in-office surgeries, performed in the outpatient setting: a cyst punction-aspiration emptying the cyst, relieving its tension and improving the mucosal wave, with 4 cases showing no refilling within one year of follow-up, and a cyst marsupialization with Blue Laser, with 3 reported cases showing good vocal fold healing within three months. Both techniques showed promising results in improving vocal function and minimizing recovery time.

Enucleation vs Marsupialization of dentigerous cysts in children

Dentigerous cysts are common developmental odontogenic cysts found in the oral cavity. They are often discovered incidentally on dental X-rays or noticed as asymptomatic swellings. These cysts forms from reduced enamel epithelium that remains attached at the cementoenamel junction around the crown of an unerupted or impacted tooth. Although most dentigerous cysts are developmental, in young patients, they may also arise due to inflammation, often arising from decay in the primary teeth. Treatment options for dentigerous cysts range from marsupialization to complete removal, depending on the effect of the cyst on surrounding structures. The loss of a permanent tooth during the treatment of a dentigerous cyst can significantly impact a child's oral development. This article discusses 2 cases of primary teeth associated with cysts and their different treatment options.

Case Report of a Congenital Subglottic Cyst.

This article presents the case of a full-term newborn who underwent tracheal intubation after birth due to rapid breathing and cyanosis of the lips. Ultrasonography, computer tomography (CT), and magnetic resonance imaging revealed the presence of a subglottic cyst. The patient underwent cyst marsupialization via endoscopy under general anesthesia, with successful extubation on the second postoperative day. In the later follow-up, it was shown that the cyst recurred quickly. However, the special feature of this case is that during the follow-up, the size of the cyst remained unchanged, but suddenly disappeared spontaneously in the third year. As for the reason for the disappearance of the cyst, we can only make theoretical speculations. Whether other recurrent cases will also resolve spontaneously, there are currently no relevant reports.

Marsupialization of a maxillary cyst – case report.

Cysts of the upper and lower jaw are a usual radiographic finding, sometimes detected by chance, that affect the dentition and the adjacent anatomical structures. There have been described various approaches for their management, but two of them are nowadays applied, namely marsupialization and enucleation. The aim of this study is to assess marsupialization as a usual treatment for cystic lesions and highlight the usefulness of oral radiology in their diagnosis and treatment. A clinical case of maxillary cyst is presented. The patient visited the School of Dentistry and, after the clinical examination and radiographic images (OPG and CBCT), a wide cyst was diagnosed in the anterior left region of the upper jaw. The cyst had penetrated the buccal and palatal alveolar bone, as well as the osseous floor of the left nasal cavity. The surgeons suggested marsupialization as the best surgical choice. So, after patient's consent, teeth #23 and #24 were extracted and the cyst's epithelium was excised through their post-extraction alveoli. The formation of osseous bridge was monitored with regular CBCT imaging. This clinical case is being presented to highlight the value of marsupialization in managing large cysts.

Optimal time to definitive enucleation of large cysts following marsupialization: A single center, retrospective study

ObjectivesOptimal time to enucleation following marsupialization of large odontogenic mandibular cysts is undefined. We aim to assess volume reduction throughout follow-up, to indicate optimal time to enucleation. Secondary objectives include the identification of factors influencing cyst reduction. Study designWe retrospectively enrolled 15 patients with mandibular cysts of different histological types treated with marsupialization at our center between 2018 and 2022. Cyst volume was assessed with cone-beam computed tomography (CBCT) and a semi-automatic segmentation algorithm, at baseline and between 6 and 8 months post marsupialization. ResultsThe overall mean cyst volume reduction percent (VR%) was 57.7 % or 0.2 % per day. VR% at 8 months was significantly higher than those assessed at 6 and 7 months (67.1% vs 47.1 %, p = 0.003). Time to CBCT was the only independent variable influencing cyst VR%. ConclusionOur study proves that the optimal time to enucleation for mandibular cyst is 8 months, independent of histological cyst type, patient age, baseline cyst volume and the number of pre-operative residual bone walls.

Probing versus primary nasal endoscopy for the treatment of congenital dacryocystoceles

To compare outcomes and complications of three surgical techniques for the treatment of congenital dacryocystoceles: nasolacrimal probing and irrigation (P+I), P+I plus nasal endoscopy (NE) with intranasal cyst marsupialization, and primary NE with intranasal cyst marsupialization. The medical records of children ≤2 years of age at a single academic center with a diagnosis of dacryocystocele from 2012 to 2022 were retrospectively identified and reviewed. The primary outcome was resolution of the dacryocystocele (ie, elimination of the medial canthal mass and resolution of tearing or discharge) after a single procedure ("primary success"). Surgical techniques were compared using exact logistic regression. Of 54 patients, 21 (39%) underwent P+I, 23 (43%) underwent P+I plus nasal endoscopy, and 10 (18%) underwent primary NE. Primary success was 76% for P+I and 100% for the other two cohorts. Most patients (89%) who underwent P+I received general anesthesia compared with none who underwent primary nasal endoscopy. Most complications were related to the use of general anesthesia, with a complication rate of 10% for P+I, 48% for P+I plus NE, and 0% for primary NE. Most P+I procedures required hospital admission compared to half of primary NE procedures. In our study cohort, primary NE provided good outcomes and was associated with a lower complication rate than P+I with or without NE.

Endoscopic endonasal marsupialization of rathke cleft cysts: clinical outcomes and risk factors analysis of visual impairment, pituitary dysfunction, and CSF leak.

This paper assesses the clinical and imaging characteristics, histopathological findings, and treatment outcomes of patients with Rathke's cleft cyst (RCC), as well as identifies potential risk factors for preoperative visual and pituitary dysfunction, intraoperative cerebrospinal fluid (CSF) leak, and recurrence. Through analyzing these factors, the study aims to contribute to the current understanding of the management of RCCs and identify opportunities for improving patient outcomes. We performed a retrospective analysis of 45 RCC patients between ages 18-80 treated by Endoscopic Endonasal Approach (EEA) and cyst marsupialization between 2010 and 2022 at a single institution. The median patient age was 34, and 73% were female. The mean follow-up was 70 ± 43 months. Preoperative visual impairment correlated with cyst diameter (OR = 1.41, 95% CI = 1.07 to 1.85, p-value = 0.01) and older age (OR = 1.06, 95% CI = 1.01 to 1.11, p-value = 0.02). Intraoperative CSF leaks were 11 times more likely for cysts ≥ 2cm (OR = 11.3, 95% CI = 1.25 to 97.37, p-value = 0.03), with the odds of leakage doubling for every 0.1cm increase in cyst size (OR = 1.41, 95% CI = 1.08 to 1.84, p-value = 0.01). Preoperative RCC appearing hypointense on T1 images demonstrated significantly higher CSF leak rates than hyperintense lesions (OR = 122.88, 95% CI = 1.5 to 10077.54, p-value = 0.03). Preoperative pituitary hypofunction was significantly more likely in patients with the presence of inflammation on histopathology (OR = 20.53, 95% CI = 2.20 to 191.45, p-value = 0.008 ) and T2 hyperintensity on magnetic resonance imaging (MRI) sequences (OR = 23.2, 95% CI = 2.56 to 211.02, p-value = 0.005). Notably, except for the hyperprolactinemia, no postoperative improvement was observed in pituitary function. Carefully considering risk factors, surgeons can appropriately counsel patients and deliver expectations for complications and long-term results. In contrast to preoperative visual impairment, preoperative pituitary dysfunction was found to have the least improvement post-surgery. It was the most significant permanent complication, with our data indicating the link to the cyst signal intensity on T2 MR and inflammation on histopathology. Earlier surgical intervention might improve the preservation of pituitary function.

Management of Nasoalveolar Cyst by Transnasal Endoscopic Marsupialization

Introduction: A nasoalveolar cyst is a benign nonodontogenic mass situated in the anterior region of the maxilla. They are often located submucosally in the anterior nasal floor giving rise to swelling in the nasolabial area at the base of nasal alae. Traditionally, the approach of choice was intraoral sublabial marsupialization, however the trend is shifting to lesser invasive and scarless transnasal endoscopic marsupialization.
 Materials and Methods: This is a retrospective observational study comprising of 16 patients who underwent microdebrider assisted endoscopic transnasal marsupialization of nasoalveolar cyst.
 Results: 16 patients underwent endoscopic transnasal marsupialization under general anaesthesia. They were followed up for 6-16 months (mean 9.43) and none of them had any recurrence.
 Conclusion: The traditional treatment for the same has been by external approach. However, a scar in this area of face is not acceptable for many. Also, it is not easy to excise the whole cyst in toto. In our experience, microdebrider assisted endoscopic transnasal marsupialisation is an easier, faster, safer, and equally efficacious technique to treat nasolabial cyst without any recurrence. 
 Key words: nasoalveolar cyst; nasolabial cyst; endoscopic marsupialization

Endoscopic marsupialization of nasolabial cysts with added mucosal flap spacer prevents recurrence

Endoscopic marsupialization of nasolabial cysts with added mucosal flap spacer prevents recurrence

A Clinical Observation Study for Transnasal Endoscopic Marsupialization in the Treatment of Maxillary Cyst.

The aim of this study was to investigate the feasibility and evaluate the clinical effects of transnasal marsupialization of maxillary cyst under nasal endoscope. Twenty patients with maxillary bone cysts were treated with endoscopic marsupialization. According to the location of the maxillary bone cyst, the opening window was selected in the nasal base or the inferior or middle nasal meatus. The cyst wall of the window was removed, and the fluid was drained out. The diameter of the opening window was more than 1cm, so that the cyst and the maxillary sinus can be fused into a cavity. This ensured nasal drainage through the cyst cavity and nasal cavity or maxillary sinus. The patients were followed up for 6 to 18 months. No serious complications occurred. The cyst wall epithelialized 2 or 3 months after the operation, and the cyst cavity drained well with no recurrence. Intranasal marsupialization under a nasal endoscope is a feasible alternative for the treatment of maxillary cysts. It makes the procedure simple, safe, less traumatic, has definite clinical effects, and low recurrence rate. Especially suitable for maxillary cysts protruding into the nasal floor or maxillary sinus.

In house customized 3D printed and designed device for marsupialization of a mandibular odontogenic cyst. Technical note

In house customized 3D printed and designed device for marsupialization of a mandibular odontogenic cyst. Technical note

Lateral sinus floor elevation with simultaneous mucosal cysts management

Introduction. Specialists in the field often face uncertainty in deciding whether to perform sinus lifting surgery in the presence of a mucosal cyst during the pre-implantation preparation of patients with maxillary sinus pathology. While some specialists believe that the sinus lifting operation cannot be performed in the presence of sinus pathology and should be resorted to after a long period of healing, others believe that it can be performed in the presence of sinus pathology or simultaneously with sinus sanitation. As a result, there are more controversies about the treatment tactics, stages, and timing required to achieve the rehabilitation of these patients, demonstrating the significance of the problem at hand. Materials and methods. The study included twenty patients who were referred to the Department of OMF Surgery and Oral Implantology “Arsenie Guţan” and the dental clinic “OmniDent” between 20.06.2016 and 01.01.2019 for implant-prosthetic rehabilitation due to partial edentulism in the upper jaw in the lateral area and the presence of a mucosal cyst in the maxillary sinus. The first group comprised of seven patients in whom the mucosal cyst was completely removed while simultaneously undergoing lateral sinus lifting. The second group consisted of five patients, aged between 18 and 67 years (average 45 years), who underwent marsupialization of the mucosal cyst. The third group comprised of six patients in whom the cyst content was only aspirated, without removal or marsupialization of the cyst. Results. All three methods were found to be effective, although total perforations of the sinus mucosa were recorded in the first two groups, preventing the performance of sinus lifting at that stage. The method of aspirating the cystic content, however, is a simple and low-risk procedure that does not carry the risk of perforating the sinus membrane and provides predictable results. Conclusions. The mucosal cyst does not present a contraindication to sinus lifting but requires additional surgical procedures.

(130) Marsupialization of the Bartholin Duct Cyst and Recanalization for Symptomatic Recurrent Bartholin Cysts

Abstract Introduction Bartholin glands (BGs) are located posteriorly on each side of the vaginal introitus. During sexual arousal, BGs release mucinous secretions into the vestibule at the 5:00 and 7:00 positions via a 2.5 cm Bartholin duct (BD). The BD may become obstructed from trauma, inflammation, infection, vestibular or vulvar surgery, or idiopathic factors. Despite BD obstruction, the glands may continue to produce mucinous secretion causing cystic dilation of the duct. Thus, a Bartholin duct cyst (BC) is formed and can result in pain during sexual arousal. Treatment strategies include sitz baths, hot compresses, aspiration, Word catheter placement, or BC marsupialization. Objective This chart review was performed to assess the safety and efficacy of a new technique for BD marsupialization in patients with symptomatic BC. Methods This is a chart review of patients with symptomatic BC who underwent BD marsupialization using a new technique. This new strategy involves marsupialization of the anterior wall of the BC, identification of the BD lumen on the posterior wall of the BC under surgical Loupes magnification and advancement of the BD lumen directly to the surface of the introitus at 5:00 and/or 7:00 locations. The BD neo-ostium was secured with interrupted 4.0 chromic sutures. Results 14 patients (mean age 28 ± 9 years) between 2015 - 2022 diagnosed with recurrent BC-induced pain during sexual arousal were treated by marsupialization of the BC and advancement of the BD directly to the mucosal surface of the introitus. Each patient averaged 3 prior BC treatments (range 0- 6). Symptoms included pain with sexual arousal or walking/sitting (100%) and an introitus mass interfering with penetration (50%). The mean BC size on ultrasound was 2.7 ± 1.6 cm x 2.4 ± 1.7 cm. All BD marsupialization surgeries were performed as outpatient procedures. Sexual arousal was encouraged early post-operatively and mucinous secretion documented by vestibular photography post-arousal. With an average follow-up of 14 months, 11/14 (79%) symptomatic BCs have resolved. Conclusions A new surgical strategy is described for patients with symptomatic BCs involving BD anastomosis directly to the introital mucosa at the 5:00 or 7:00 locations, resolution of BD obstruction, and excellent restoration of BG lubrication. Disclosure No

Endoscopic Aspiration and Marsupialization for Colloid CYST

Background: Colloid cyst is a benign intracranial tumor found in the anterior third ventricle. Due to location of this tumor, it has propensity to cause obstruction to CSF flow causing hydrocephalus. Treatment options include excision or aspiration of cyst through open or endoscopic procedures or CSF diversion procedures. Recent years have seen a shift towards endoscopic approach to treatment of colloid cyst due to its relative simplicity among endoscopic procedures and other favorable patient related factors. We share our experience with endoscopic aspiration and marsupialization of colloid cyst. Methods: This descriptive retrospective study was done at Neuro surgery department of Neurosurgery, SMBB Institute of Trauma, Dow University of Health Sciences, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Data of patients who had endoscopic aspiration and marsupialization of colloid cyst between February 2017 and October 2020. Patient demographics, clinical presentation, radiological features, operative course and post-operative course was recorded. Clinical or radiologic recurrence was noted on follow-up. Results: Ten patients were operated during the study period. Headache was most common presenting symptom. Mean size of cyst was 21mm. There was incomplete aspiration in 3 patients as observed per-operatively and by residual cyst content on immediate post-operative CT scan which disappeared completely on subsequent scans. CSF leak was observed in 3 patients and 2 developed meningitis. No symptomatic recurrence occurred. Conclusion: Endoscopic aspiration with marsupialization of cyst wall is a safe and effective technique for treatment of colloid cyst. Incomplete aspiration of cyst contents may not require further intervention as the radiological resolution of cyst is observed over time. Further follow-up and larger sample size is needed to further establish the safety and efficacy of this procedure. Keywords: colloid cyst, endoscopic, follow-up studies

Squamous Cell Carcinoma Arising From Odontogenic Cyst Epithelium or Oral Mucosa Epithelium After Marsupialization of Odontogenic Radicular Cyst in Posterior Mandible?

Squamous cell carcinomas (SCCs) are common malignant tumors in the oral and maxillofacial region. However, SCCs secondary to marsupialization of odontogenic radicular cysts are extremely rare. The authors report an unusual case of a 43-year-old male presented with dull pain in the right molar region of the mandible without numbness of lower lips, who had a long history of smoking, alcohol consumption, and betel nut chewing. Computerized tomography revealed a round well-defined unilocular radiolucent at the apex of lower right premolars, 2 nonvital teeth. The clinical diagnosis was the radicular cyst of the right mandible. The patient was initially treated with root canal therapy of the teeth followed by marsupialization with a mandibular vestibular groove incision. While the patient did not follow the instruction of irrigation of the cyst and had no regular follow-up. The reexamination of computerized tomography indicated a round well-defined unilocular radiolucent at the apex of lower right premolars and filled with a soft tissue without clear boundary with buccal muscles at 31 months follow-up. There were no masses or ulcer around the mandibular vestibular groove incision and the patient had no sign of numbness of lower lips. The clinical diagnosis was the radicular cyst of right mandible with infection. A curettage was performed. However, the pathologic diagnosis was well-differentiated SCC. An extended radical surgical resection including segmental resection of the right mandible was performed. The histopathology was well-differentiated SCC without the cyst epithelium and invasion of bone, which can be distinguished from primary intraosseous SCC. The case indicates that marsupialization performed in patients with a history of smoking, alcohol consumption, and betel nut chewing, has a risk of suffering from oral SCC.

Teeth preservation in dentigerous cysts: conservative approaches in pediatric patients

OBJECTIVES: Dentigerous cysts are the most common developmental odontogenic cysts. They are usually asymptomatic and related to the crown of an unerupted tooth. The standard treatment was cyst enucleation, but in the last years most of the authors opted to a more conservative approach: cyst marsupialization. The key point in the treatment of a dentigerous … Continued

Laparoscopic Marsupialization of Liver Cyst with Staplers

Laparoscopic Marsupialization of Liver Cyst with Staplers

Ретророградная интраренальная хирургия заболеваний почек

Retrograde intrarenal surgery (RIRS) is being actively implemented in the treatment of renal stones and other diseases. If necessary, RIRS can be combined with percutaneous procedures.To study the results of RIRS in patients with nephrolithiasis and various renal disorders.A total of 106 patients who undergone RIRS were included in the study. There were 66 men (63.4%) and 40 women (36.6%). Mean age was 46.8+/-15.6 years. The indication for RIRS in 84 (79.2%) patients was renal stones. Calculus in calyceal diverticulum were diagnosed in 6 (5.7%), encrusted stents in 8 (7.7%), urinary fistulas after partial nephrectomy in 5 (4.7%), pelvis tumors in 2 (1.9%), pelvis perforation after marsupialization of parapelvic cyst in 1 (0.9%) patient, respectively. Simultaneous retro- and antegrade procedures were performed in 27 (25.5%) cases. In those with nephrolithiasis and encrusted stents, lithotripsy was done with the removal of stone fragments. Two patients underwent endoscopic resection of the pelvis tumor. In six patients, the neck of the diverticulum was incised after lithotripsy, while in five cases retrograde endoscopically controlled percutaneous treatment urinary fistulae was performed. In one case, laser fulguration of the pelvis defect with stenting was done.RIRS was effective in 72 (85.7%) of 84 patients with renal stones. The operation time was 70.8+/-10.2 minutes. In 12 (14.3%) cases with residual fragments, extracorporeal shock-wave lithotripsy (n=7) and repeated RIRS (n=5) were performed. The efficiency of RIRS after two sessions was 91.7%. Complications were observed in 11 (10.4%) patients. With encrusted stents, the operation time was 95.0+/-16.5 min. After laser fragmentation of encrustations in the lower part of the stent, percutaneous lithotripsy was performed with antegrade removal of its upper half. The time for RIRS in those with diverticula was 60.0+/-8.5 min, the average stone size was 8 mm (from 6 to 10 mm). In all cases lithotripsy with mucosal fulguration was successfully done. The procedures for urinary fistulae were also effective (operation time was 45.0 +/- 20.5 minutes) and there were no complications.RIRS is a safe and effective treatment for patients with nephrolithiasis and other kidney disorders. Modern flexible ureteroscopes allows to examine the collecting system and to perform lithotripsy and removal of stone fragments.

Current practices in temporal arachnoid cysts: a survey among Brazilian neurosurgeons

Introduction: There has been no consensus for the best treatment strategy for TACs. The aim of this survey was to aggroup the different practices between Brazilian pediatric neurosurgeons in the management of a children with TAC Galassi Type II and III. Methods: contributors answered a case questionnaire about TACs and select the answer that better reflect their conduct in asymptomatic or symptomatic patients (chronic headache, epilepsy and psychomotor retardation). Results: all respondents confessed that had doubts about TACs and 59-75% was not satisfied only with brain MRI. Fundoscopy was the most required exam (28-35%), followed by EEG/VideoEEG (19-20%), ICP-NI (16%) and MRI CSF flowmetry (12-13%). For asymptomatic, 61-85% suggested follow-up with clinical, radiologic and fundoscopic control. Still, surgery was the choice for 61-70% in symptomatic patients. The preferred technique for TAC type II was endoscopic cysto-cisternostomy (32%) and for type III craniotomy and arachnoid cyst marsupialization (25%). Discussion: Since the past 14 years, more information has become available about the natural history of TACs and innovative technologies arises for its management helps. Treatment is still debated, but endoscopy is increasingly common and proved to be safe and effective. Conclusion: modern technologies allow more security and subsidies to treatment chosen and even though for TAC Galassi type III open craniotomy still is preferred than endoscopic surgery, nowadays the least invasive treatment have been the choice for TAC Galassi Type II. The years of experience in endoscopy and the more availability of the tool into hospitals maybe contributed to this pattern change.