Root Cyst Research Articles

A systematic comparative outcome analysis of surgical versus percutaneous techniques in the management of symptomatic sacral perineural (Tarlov) cysts: a meta-analysis.

Symptomatic perineural or Tarlov cysts (TCs) are a rare cause of chronic low-back pain. Given the rarity of the disease, there is no literature consensus regarding the optimal management of these cysts. The authors conducted a systematic comparative outcome analysis of symptomatic TCs treated with surgery (group A, 32 studies, n = 333) or percutaneous interventions (group B, 6 studies, n = 417) analyzing the demographic characteristics, baseline characteristics of the cysts, clinical presentations, types of interventions, complication rates, and the recurrence rate in both treatment groups. The literature search was performed using the PubMed, MEDLINE, Cochrane, and Ovid databases up to 2018. The MeSH search terms used were "Tarlov cyst," "sacral perineural cyst," "sacral nerve root cyst," "meningeal cyst of the sacral spine," "extra meningeal cyst with spinal nerve root fibers," "spinal extradural arachnoid pouch," and "cyst of the sacral nerve root sheath." The authors used statistical tests for two proportions using the "N-1" chi-square test with the free version of MedCalc for Windows for comparison among the groups. Overall symptomatic improvement was reported in 83.5% of patients in both groups; however, exacerbation of preprocedural symptoms was significantly higher in group B than group A (10.1% vs 3.3%, p = 0.0003). The overall complication rates in the surgical and nonsurgical groups were 21% and 12.47%, respectively. Transient sciatica was the most common complication in both groups (17% vs 8%, respectively; p = 0.017). The incidence of cyst recurrence was much lower in group A than group B (8% vs 20%, p = 0.0018). The mean follow-up duration for the surgical group was 38 ± 29 months (25 studies, n = 279), while that for the nonsurgical group was 15 ± 12 months (4 studies, n = 290) (p < 0.0001). The authors noted that although the surgical interventions were associated with higher postprocedural complication rates, long-term efficacy and success in terms of cyst resolution were superior following surgery compared to percutaneous procedures in the management of symptomatic TCs. There was no difference in symptom recurrence with either of the techniques.

Periodontite Apical Crônica: Aspectos clínicos e histológicos

INTRODUÇÃO: A periodontite apical crônica (PAC) é uma doença inflamatória crônica, de progressão lenta, frequentemente assintomática e que envolve o ápice dentário. OBJETIVO: Analisar os aspectos clínicos e histopatológicos mais relevantes dos casos de periodontite apical crônica diagnosticados no Centro de Referência de Lesões Bucais. MATERIAIS E MÉTODOS: Realizou-se um estudo descritivo retrospectivo, utilizando 82 laudos histopatológicos compatíveis com as PACs diagnosticados no período de 2006 a 2017. As variáveis avaliadas foram referentes aos aspectos clínicos e histológicos das PACs. A análise estatística foi realizada pelo programa Software Statistical Package for the Social Sciences (SPSS) versão 17. RESULTADOS: A análise clínica das lesões mostrou que estas acometeram preferencialmente a maxila (94,6%), com lesões medindo até 10 mm (75%). Nas radiografias, as mais comuns foram as de lesão radiolúcida com halo radiopaco (32,1%) e as de lesão radiolúcida sem halo radiopaco (32,1%). Histologicamente, houve a prevalência de cistos radiculares (63,4%), com presença de tecido conjuntivo (95%), deposição de colágeno (87,5%) e infiltrado inflamatório (100%), sendo frequente a presença da cápsula cística (63,4%). Os cistos radiculares representaram a maioria das suspeitas clínicas (81,4%), mas não houve diferença estatística entre a suspeita clínica e o diagnóstico histopatológico (p=0,09). CONSIDERAÇÕES FINAIS: Observou-se que, na população avaliada os cistos radiculares foram as PACs mais encontradas, sendo importante que novos estudos sejam realizados a fim de apurar a concordância do diagnóstico clínico e histológico.

Clinical research on surgical treatment of benign lesions in maxillary sinus by modified prelacrimal duct recess approach

Objective:To explore the clinical effects, surgical procedure and indications of surgical treatment for benign lesions in maxillary sinus through modified prelacrimal duct recess approach. Method:All 21 patients in this study who diagnosed with benign lesions in maxillary sinus, received routine preoperational exam and underwent endoscopic maxillary sinus surgery through modified prelacrimal duct recess approach. Postoperatively patients received routine medical treatment, and regular follow-up for average 11.3 months(from 3 months to 16 months). Result:Among 21 patients, there were 9 cases diagnosed with maxillary sinus cyst, 6 cases diagnosed with maxillary sinus choanal polyps, and 5 cases diagnosed with maxillary sinus hemorrhagic and necrotic polyps, 1 case of maxillary sinus root cyst. During the operation, the roots of maxillary sinus cyst or polyps were found in anterior or inferior wall of maxillary sinus. All patients recovered very well without recurrence. Conclusion:Modified prelacrimal duct recess approach appears to be a safe and effective method to resect benign lesions in the maxillary sinus, especially when lesions involved in anterior and inferior wall of the maxillary sinus.

The bHLH transcription factor ILR3 modulates multiple stress responses in Arabidopsis.

ILR3 and PYE function in a regulatory network that modulates GLS accumulation under iron deficiency. The molecular processes involved in the cross talk between iron (Fe) homeostasis and other metabolic processes in plants are poorly understood. In Arabidopsis thaliana the transcription factor IAA-LEUCINE RESISTANT3 (ILR3) regulates iron deficiency response, aliphatic glucosinolate (GLS) biosynthesis and pathogen response. ILR3 is also known to interact with its homolog, POPEYE (PYE), which also plays a role in Fe response. However, little is known about how ILR3 regulates such diverse processes, particularly, via its interaction with PYE. Since GLS are produced as part of a defense mechanism against wounding pathogens, we examined pILR3::β-GLUCURONIDASE expression and found that Fe deficiency enhances the wound-induced expression of ILR3 in roots and that ILR3 is induced in response to the wounding pathogen, sugarbeet root cyst nematode (Heterodera schachtii). We also examined the expression pattern of genes involved in Fe homeostasis and aliphatic GLS biosynthesis in pye-1, ilr3-2 and pye-1xilr3-2 (pxi) mutants and found that ILR3 and PYE differentially regulate the expression of genes involved these processes under Fe deficiency. We measured GLS levels and sugarbeet root cyst nematode infection rates under varying Fe conditions, and found that long-chain GLS levels are elevated in ilr3-2 and pxi mutants. This increase in long-chain GLS accumulation is correlated with elevated nematode resistance in ilr3-2 and pxi mutants in the absence of Fe. Our findings suggest that ILR3 and PYE function in a regulatory network that controls wounding pathogen response in plant roots by modulating GLS accumulation under iron deficiency.

Epidural Blood Patch Treatment for Headache Caused by a Ruptured Tarlov Cyst

(Can J Anaesth. 2017;64(9):983–984) There are limited data on the management of Tarlov cysts, which are cerebrospinal fluid–containing nerve root cysts located between the endoneurium and perineurium. Patients with Tarlov cysts may be asymptomatic.

Increasing the effectiveness of mandibular molars root resection surgery using retrograde endodontic revision

The purpose of the present study was to increase the effectiveness of mandibular molars apical root resection surgery. The study included 21 patients with diagnosis 'persistent apical periodontitis', 'root cyst', in 11 cases surgery was performed with less traumatic access with piezoelectric surgery system for separation of cortical bone block and subsequent reposition after resection and retrograde root filling. The planning and procedure was described by 2 clinical cases. Bone block reposition surgical procedure showed clinical effectiveness and was considered as a most acceptable technique of root resection.

Management of Palatally Positioned Impacted Mesiodens: 2 Case Reports

By definition the extra teeth present in the oral cavity are the supernumerary teeth which are found in any area of the oral cavity. Sometimes Supernumerary teeth are present even in the anterior region of the maxilla which is called as mesiodens. Mesiodens are the most common supernumerary teeth, occurring in 0.15–1.9% of the population. The exact etiology of mesiodens is not fully understood, but proliferation of the dental lamina and genetic factors can be the reason. Mesiodens can be either paired or single, unerupted or impacted which can be unaesthetic and most of the time associated with complications like midline diastema, rotation, displacement, and root resorption and cyst formation. It should be properly diagnosed for the appropriate management to reduce the complications to the developing dentition. In the present cases mesiodentes were found in the anterior maxilla, one erupted and another unerupted and inverted in one case and unerupted causing resorption of root of permanent central incisor in another case. In these cases mesiodentes are prophylactically extracted to prevent its adverse effects on developing dentition.

Tarlov cyst – an uncommon cause of back pain

Tarlov cysts, also known as perineural or sacral nerve root cysts, are cerebrospinal fluid-filled dilatations of the nerve root sheath most commonly found at the sacral spine, near the dorsal root ganglion. The cysts are relatively rare and usually asymptomatic, but some can exert pressure on the nerve root, causing perineal pain/discomfort or lower back pain or sphincter/sexual dysfunction. Tarlov (perineural) cysts of the nerve roots were first described in 1938.

A Brief Look IntoPratylenchusGenus Root Lesion Nematodes and Their Screening Procedures

Plant parasitic nematodes (PPNs) are responsible for severe yield losses and crop damagesworldwide. Plant parasitic nematodes like root lesion nematodes (RLNs) of Pratylenchus genus are of great economic importance as they infest large number of crop plants including cereals, vegetables, bioenergy and other food crops. Presence of Pratylenchus genus RLNs is recorded in most part of globe including Antarctica. However, in comparison to other PPNs like root knot and cyst nematodes less attention has been paid to these RLNs. Even sometime their absence in field is neglected. It is essential to understand the basic biology of these RLNs for proper differentiation and development of effective controlling measures. In the present review some basics of these RLNs like host range; life cycle and reproduction are being summarized. An optimized and tested screening method for these Pratylenchus genus RLNs is also discussed.

Inadvertent Application of a Drug Mixture into the Subarachnoid Space When Performing an Outward-Going Lumbar Intervertebral Foramina Injection

An outward-going intervertebral foramina puncture along the side of lumbar vertebra spinous process was used to avoid infusing drugs into the subarachnoid space. However, we still had an inadvertent malpractice. The patient was diagnosed with lumbar discogenic lower back pain and was administrated an outward-going intervertebral foramina puncture through the side of lumbar vertebra spinous process (L5-S1). The drug mixture, containing triamcinolone acetonide suspension, cyanocobalamin and bupivacaine HCl, was injected. The patient had palpitations, chest tightness, dyspnea, bradycardia, and hypotension 3 min right after the injection. The vital signs gradually stabilized after treatment with atropine sulfate; however, he had complete sensorimotor loss below the level of distribution of the T2 spinal nerve. The cerebrospinal fluid pressure was lower in the subarachnoid space and the cerebrospinal fluid was slightly turbid and light pink in color. Six hours later, the sensory, motor, defecation, and urination functions returned to normal level. The patient had follow-up evaluations at 1, 3, and 6 months. The lumbar and hip pain was mild-to-severe at times as usual, but there were no other neurologic sequelae. Conclusions: This case showed that there is a risk that drugs may stray into the subarachnoid space during an outward-going intervertebral foramina puncture through the side of lumbar vertebral spinous process. The complication may occur due to a distal nerve root cyst. The result of triamcinolone acetonide suspension and cyanocobalamin injection into the cerebrospinal fluid was not as serious as we imagined.

EXPRESSION OF P53 IN CULTURE OF ISOLATED STEM CELLS FROM INFLAMMATORY RADICULAR CYST

The inflammatory root cyst is defined as one of the most frequent inflammatory lesions in the oral cavity where it normally involves the apex of the dental roots, giving frequent pathognomonic clinical and radiological characteristics. The objective of this investigation was to determine the expression of p53 in the culture of isolated stem cells from the inflammatory root cyst. In its methodology, the report of a case of a 69-year-old patient was presented, who underwent surgical intervention to extract pieces 11 and 12, from which the sample was obtained for the isolation and culture of the cyst stem cells. periapical inflammatory, obtaining elongated, flat cells with fibroblastic appearance from day 4 and staining with markers for p53 giving a positive response in the evidence of the p53 gene both in the cytoplasm and in the nucleus of these stem cells. Finally, cells can be obtained from the inflammatory root cyst from 4 to 25 days with the use of a modified protocol, in the end, as a contribution to this article, the evidence of the p53 gene is provided both in the nucleus and in the cell cytoplasm. Keywords: Root cyst, p53 gene, stem cells, isolation and culture

The importance of standardizing acquisition settings and interpretation criteria of radionuclide cisternography.

Dear Editor We read with interest the paper by Lu and colleagues on radionuclide cisternography (RNC) entitled “The Value of Changing Position in the Detection of CSF Leakage in Spontaneous Intracranial Hypotension Using Tc-99m DTPA Scintigraphy: Two Case Reports”, claiming an additive value of scanning the patients in the upright position for the detection of cerebrospinal fluid (CSF) leakage (1). In two cases of spontaneous intracranial hypotension (SIH), the authors observed the appearance of multiple images of increased radioactivity on both sides of the spinal canal after changing the patient position, which were interpreted as direct signs of CSF leaks. We fully agree with Lu and colleagues that direct signs of leakage should be always looked for in RNC, as early appearance of bladder radioactivity is an unreliable indirect sign, probably due to traumatism after lumbar puncture. This was elegantly shown by Takahashi et al. (2) and subsequently confirmed by others. However, in our opinion, the images of increased radioactivity showed by Lu et al. symmetrically distributed on both sides of the spinal canal, should not be regarded as direct signs of leakage. Rather, these images might correspond to prominent structural abnormalities such as meningeal diverticula or nerve root cysts. These anatomical variants together with any other structural meningeal weaknesses, are known to confer an increased risk of CSF leaks, potentially requiring corrective surgery (3). When the patient stands up, CSF is likely to spread to the loci of least resistance, not seen in the supine position. Correlative radiological imaging would be needed to show underlying anatomical abnormalities. In Figures 1 and ​and22 we give an example of that. Figure 1. Anterior projection of a radionuclide cisternography showing multiple small images of increased radioactivity on both sides of the spinal canal (left). On the right, there is the corresponding volumetric magnetic resonance reconstruction showing multiple ... Figure 2. The spine at the cervico-thoracic level in the same patient. Nerve root cysts (arrows) are seen on both radionuclide cisternography (left) and magnetic resonance imaging (right). SIH is being more frequently recognized as an important cause of persistent headache with rather typical clinical presentation (3). Symptom relief after epidural blood patching often provides a “ex-juvantibus” diagnosis. Although MRI and CT-myelography have nowadays the greatest impact on the diagnostic workout, being able to accurately define the extent and location of CSF leaks. However, RNC may still play a role in selected, uncertain cases. Unfortunately, a limitation of RNC is represented by the lack of a standardized acquisition protocol. Some authors suggested to acquire multiple early images in the lateral position after intrathecal injection (2), while our group and others have favored a change of posture for detecting CSF leaks with increased sensitivity (4, 5). Image quality and the choice of radionuclide represent additional issues, as signs of extradural activity accumulation are often subtle and difficult to detect. In conclusion, we think that the paper by Lu et al. provides a valuable suggestion for improving the RNC acquisition technique. However, larger case series are needed to prove whether changing the patient’s position does really offer a diagnostic advantage in terms of direct leakage detection. Moreover, comparative imaging would also be warranted in order to standardize the interpretation criteria of RNC, providing a compelling definition of its current role in the diagnosis of CSF leakage.

Tips and traps in neurological imaging: Imaging the perimedullary spaces

The spinal canal is frequently a source of difficulties, traps and diagnostic errors. Pitfalls related to artifacts are resolved by using appropriate sequences. Good knowledge of the appearance of certain particular anatomical structures (the cauda equina roots, the radicular veins of the lumbar spine and conus medullaris, the dorsal root ganglion) and of frequent variants (fibrolipoma of the filum terminale, common root sheaths, root cysts) will avoid a good many errors. Dilatation of epidural veins in intracranial hypotension can simulate the contrast enhancement of a tumour. An increase in epidural fat can induce pathogenic stenosis of the dural sheath.

Multiple Giant Tarlov Cysts Presenting as Polyradiculopathy: A Rare Manifestation

We describe a case of multiple giant Tarlov cysts presenting with complaints of low back pain with neurological claudication. Tarlov cysts are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. Most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints. NJR I VOL 2 I ISSUE 1 57-60 Jan-June, 2012 DOI: http://dx.doi.org/10.3126/njr.v2i1.6984

Clinical Experience of Symptomatic Sacral Perineural Cyst

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.

Molecular Diagnostics for Complex Pest and Disease Resistance and Tuber Quality Traits: Concept, Achievements and Perspectives

We summarize the concept of molecular diagnostic of complex traits related to pest and disease resistance and to tuber quality of potato, and describe recent achievements and perspectives. Many potato characteristics are controlled by multiple genetic and environmental factors. Knowing the genes and their allelic variants that underlay these characteristics allows developing molecular diagnostic tools to select for improved potato cultivars. Diagnostic DNA-based markers can be used to identify superior genotypes (precision breeding). Diagnostic markers can be identified by combining quantitative trait locus mapping, candidate gene mapping and association mapping using functional and positional candidate genes as markers. This approach was successfully used to identify loci, which contribute to the natural variation of important agronomic traits, including resistance against root cyst nematodes, late blight and wart disease and tuber quality (resistance to bruising and chip colour). In the future, whole genome association mapping based on single-nucleotide polymorphism genotyping methods in combination with the annotated potato genome sequence will allow identifying additional genes and gene variants controlling agronomic performance in potato. Prerequisites are accurate phenotyping under field conditions of advanced breeding materials, cost-effective and reliable genome-wide genotyping methods, and user-friendly software tools allowing to extract knowledge from massive quantities of data. This will further facilitate molecular diagnosis, selection and combination of superior alleles in potato-breeding programmes.

Suitability of Molecular Markers for Selection of Potatoes Resistant to Globodera spp

Globodera rostochiensis and Globodera pallida are parasitic root cyst nematodes of potato (PCN), which significantly reduce yield and quality. The genetics and available molecular markers should make resistance to nematodes an excellent candidate for marker assisted selection. The study presents results of testing the suitability of known molecular markers for detection of resistance in a set of cultivars. We revealed some inconsistencies in genealogical data of the cultivars and showed inconsistent usefulness in detecting resistant cultivars. The marker TG689 was identified in almost all cultivars resistant to G. rostochiensis and together with other markers was used for verifying the resistance in a group of breeding lines. The marker TG689 was the most effective. However, the efficiency of tested markers in selecting resistant individuals might be inadequate. In the case of quantitative resistance to G. pallida, marker SPUD1636 was found in resistant cultivars, and not in susceptible cultivars, but turned out to be inefficient in selecting resistant breeding lines.

Prevalence of biopsied oral lesions in a Department of Oral Surgery (2007 - 2009)

Objectives: To determine the prevalence of the hard and soft tissue lesions biopsied in the Department of Oral Surgery of the Barcelona University Dental Clinic (Barcelona, Spain). Study design: A retrospective descriptive study was made of the biopsies performed between January 2007 and April 2009 in our Department of Oral Surgery. The following variables were recorded: age, the sex, location of the lesion, the biopsy technique, the reason for consultation, and the histological result obtained. Results: A total of 460 lesions amenable to histological analysis and corresponding to 450 patients were analyzed. The most frequently biopsied lesions were maxillary cysts, including particularly root cysts (20%). Other very common disorders in our series were epithelial hyperplasias (10.6%) and fibromas (10%). There was a broad range of histopathological results, with un total of 36 different diagnoses. Three of the 460 biopsies yielded two squamous cell carcinomas and one ameloblastoma. Conclusions: The most prevalent hard tissue lesions were chronic maxillary periapical lesions, while epithelial hyperplasias and fibromas were the most frequent soft tissue lesions. Emphasis is placed on the need for biopsy particularly for studying premalignant and malignant lesions, in view of the importance of securing an early diagnosis.

Experience in diagnosis and treatment of neonate with congenital glossal root cyst

先天性舌根囊肿是甲状舌管发育异常（囊肿样变）所致.查阅国内外文献,关于该病诊断、治疗的追踪研究较少见[1-4],临床表现与先天性喉软骨软化、先天性喉蹼、先天性喉囊肿等症状类似,容易误诊.为提高对该病的认识及诊断和治疗水平,现将我院收治的8例新生儿先天性舌根囊肿处理经验总结并报告如下

Hiding in Plain Sight: A Case of Tarlov Perineural Cysts

A 52-year-old woman sought help for intractable lumbosacral pain, which began after she lifted a heavy object and fell onto her back more than 2 decades ago. Additional symptoms included burning, numbness, tingling, and pain in her right hip, posterior thigh, leg, and toes, and diminished sensation and sensitivity throughout her right leg and foot. Muscle spasms/ cramps, which often interrupted sleep, were intermittently present in her right buttock and right lower extremity. Right-foot drop impaired her ability to walk, and she used a wheeled walker with a seat because she could not walk more than a few steps without sitting. Other problems included: Severe pressure-type headaches, chronic abdominal and pelvic pain, cervical and thoracic back pain, frequent urinary tract infections, and urinary incontinence. Her pain increased with sitting, standing, and walking, and had been refractory to ibuprofen 800 mg tid, gabapentin 300 mg tid, oxycodone/acetaminophen 5/325 mg q4h PRN, and cyclobenzaprine 10 mg tid. Her medical history was unremarkable and her family history was notable for above-average height; most women in her paternal family are 5’10’’ to 6’ tall, and most men are 6’4’’ and taller. Many died in their 40s, and her brother and sister had been diagnosed with possible multiple sclerosis. Magnetic resonance imaging (MRI) of her pelvis revealed sacral nerve root cysts that were more completely imaged by sacral MRI (Fig 2). An MRI of the cervical spine from 2007 showed only mild C4-5 disc protrusion, but a repeat MRI in 2009 noted multilevel mild degenerative changes and small (#.6 cm) perineurial cysts at C4-5, C5-6, C6-7, C7-T1. In 2007, an MRI of the thoracic spine was interpreted as normal. The patient stated, ‘‘Everything in my life has been destroyed by these symptoms. It took over 2 decades