Alterations of lacrimal sac vasculature in lacrimal disorders: Chromo endoscopic assessment with changes in effective spectral response

PURPOSE

To study the structural and dynamic alterations in the lacrimal sac vasculature of patients with congenital, primary, and secondary acquired nasolacrimal duct obstructions (CNLDO, PANDO, SANDO) and patients with acute dacryocystitis (AD) and failed dacryocystorhinostomy (DCR).

METHODS

A prospective study was performed on 65 consecutive lacrimal sacs following their complete exposure during endoscopic dacryocystorhinostomy. High magnification chromo endoscopy and changes in effective spectral response was achieved using the Storz professional image enhancement system (SPIES®). Structural characteristics studied include vascular arrangement, superficial and deep vessels, vessel calibers on cut section, abnormal branching, localized and generalized dilatations and pathologies like varices. Flow characteristics in different caliber vessels and their alterations were assessed in Spectra A mode of SPIES®.

RESULTS

Distinct vascular alterations were noted in several lacrimal disorders. Vascular dilatations differed between the fundus and the body segments of the lacrimal sac, except in cases of traumatic SANDO and prior failed DCRs. 23% (7/30) of PANDO sacs showed peri sac varices and severe tortuosity. The flow in the dilated vessels was either very slow or showed intermittent backflow. Moderate dilatation of peri sac venous plexus with distinct surface linear vessels was noted in CNLDO. The cut surface of the sac wall and luminal surface differentially demonstrated several vascular patterns like speckled, scattered, branched loops, and skip areas in various diseased states.

CONCLUSION

The present study found distinct alterations of lacrimal sac vasculature in several lacrimal drainage disorders and provides impetus to the vascular theory for pathogenesis of PANDO.

[Acute respiratory distress due to tracheostomy tube migration]

Tracheostomy cannula care is of paramount importance in the daily management of tracheotomized patients. While some complications are commonplace, specific events can occur, often according to type of cannula. We herein report the case of a 71-year-old patient; following a lengthy stay in the intensive care unit, she had received a Safe T-Tube cannula designed to provide support in a stenotic trachea. At home, while suctioning her tracheal secretions, she suddenly experienced respiratory distress requiring a rapid intervention. On arrival, no seeable cannula was found, either in the tracheostomy or in the patient's immediate surroundings. Following her transfer to intensive care, a new cannula was inserted into the tracheostomy opening, enabling mechanical ventilation to begin and achieving rapid relief of dyspnea and improvement of the patient's overall condition. Bronchial fibroscopy was then performed, during which the Safe T-Tube cannula was found folded on itself in a supra-carinal intra-tracheal position. It was extracted and replaced by a cannula of the same model, which was sewn to the skin. Although rare and usually limited to flexible cannulas, this complication is potentially fatal. Generally speaking, when cannula obstruction is suspected, bronchial endoscopy in an intensive care setting is a vital necessity. It is not only the cornerstone of the diagnosis, but also of paramount importance in treatment taking into full account the mechanism of obstruction.

[The role of HFNC oxygen in pre-oxygenation prior to intubation and the practice of invasive procedures]

Over recent years, High Flow Nasal Cannula (HFNC) oxygen therapy has been more and more extensively applied in numerous medical settings, and it is now carried out in invasive procedures such as pre-oxygenation before orotracheal intubation, often leading to complications. More generally, pre-oxygenation is aimed at maintaining the highest possible oxygen saturation for extended periods of time. With this in mind, HFNC seems as effective as standard oxygen delivery with regard to hematosis in patients with mild or moderate hypoxemia, and it presents the advantage of reducing the adverse events associated with intubation. That said, during pre-oxygenation of patients with severe hypoxemia, non-invasive ventilation (NIV) is probably more effective than HFNC, especially in the prevention of respiratory events. However, in patients with little or no hypoxemia undergoing risky procedures such as bronchial endoscopy, HFNC allows better oxygen saturation than standard methods. To summarize, even though NIV remains useful in unstable patients, especially in decreasing desaturation episodes, HFNC could represent a reasonable alternative in case of poor tolerance, allowing continuous oxygenation of patients requiring digestive endoscopy or trans-esophageal ultrasound.

[Tracheal lipoma: An exceptional cause of tracheal tumors]

INTRODUCTION

Tracheal tumors are rare, they are most often malignant and can manifest themselves by a non-specific respiratory symptomatology with progressively increasing dyspnea orienting in the first place towards a COPD or even an asthma. Among them, tracheal lipoma is exceptional. Its management is based on removal by rigid bronchoscopy.

OBSERVATION

We report the case of a 73-year-old male patient who presented with non-specific dyspnea that progressively worsened over several months. The EFR showed a flattening of the flow-volume curves, the CT scan showed an anterolateral oval tracheal tumor with fatty density, the bronchial endoscopy showed a tumor lesion with stenosis of about 90% of the airway. Management consisted of a rigid bronchoscopy to delete obtruction with biopsies. Anatomopathology concluded to a tracheal lipoma.

CONCLUSION

Progressively worsening dyspnea, especially if there are signs of inspiratory dyspnea, required a systematic bronchial endoscopy to avoid the possibility of a tracheal tumor.

[Single-use versus reusable flexible ureteroscope: Technical and medico-economic aspects]

INTRODUCTION

Sate of the art on the indications, methods of implementation and medico-economic considerations of reusable flexible ureteroscopes (URSr) vs single use (URSuu)?

METHOD

Review of the literature (Pubmed) on reusable and single-use ureteroscopes, as well as on the expertise of our center. A PubMed search and narrative review of the data was performed in July 2021. Only articles in French or English were selected.

RESULTS

The URSr and URSuu have similar technical characteristics and are suitable for the exploration of the upper urinary excretory tract: treatment of stones of the kidney <2cm or of the ureter. The URSr is the most common type of ureteroscope. URSuu are newer and associated with many advantages: no sterilization procedure, immediate availability of equipment in the operating room, reduced waste production at the institutional level. A hybrid use of URSr and URSuu currently seems to be the best compromise from a medico-economic point of view for high volume centers. In the case of a smaller activity or a secondary site, URSuu are more advantageous and the reduction in purchasing costs should accentuate this benefit.

CONCLUSION

URSr and URSuu are technically similar and allow identical treatment of upper urinary tract pathologies. Their complementary use optimizes the care of urology patients. The barrier to the exclusive use of URSuu remains their cost.

[Relevance of oesophageal biopsies during graft-versus-host disease]

INTRODUCTION

Graft-versus-host disease (GVHD) is a complication of hematopoietic stem cell transplantation. It frequently affects the digestive tract. Oesophageal damage is not part of its typical clinical picture. The objective of this study was to determine whether oesophageal lesions could be found in this condition.

MATERIAL AND METHODS

Cases coded as GVH at the CHU of Amiens in anatomopathology were identified from 2004 to 2019. Each patient who had an oesophageal biopsy was included. The slides were re-read by 2 pathologists to assess the lesions.

RESULTS

A total of 24 patients were included. A total of 79.1 % of the biopsies showed inflammatory lesions: 25 % erosions, 37.5 % a cleavage between the lamina propria and squamous epithelium, 41.7 % a lichenoid inflammatory infiltrate, 54.1 % apoptotic cells and 54.1 % epithelial vacuolations. 25 % of the biopsies were classified as Lerner's grade 4 (used in dermatopathology to assess cutaneous GVH lesions), 12.5 % as grade 3, 25 % as grade 2, 16.7 % as grade 1, and 20.8 % of the biopsies did not show oesophageal GVH lesions. None of the histological lesions observed were correlated with the prognosis, however erosions and epithelial cleavage were more frequently associated with death.

CONCLUSION

Lesions evocative and probably specific for acute GVH can be found in the esophagus. They could help and be part of the diagnosis. A protocol for oesophageal biopsy sampling, and the exclusion of other causes of esophagitis, should be performed in the future during suspicion of acute GVH.

Endoscopic resection of forehead osteomas: Technical notes

INTRODUCTION

Forehead osteoma is an uncommon benign bone tumor that causes cosmetic disfigurement and occasional pain. Traditional excision directly over the lesion creates a visible scar on the forehead.

PROCEDURE

We describe a method of endoscopic resection of the forehead osteoma, via incisions within the hairline. The access incision was hidden behind the frontal hairline and the dissection plane went in the subperiosteal layer. The injury of the nerve branch and vessel can be easily avoided and endorsed by manipulating the endoscope.

CONCLUSION

Aesthetic considerations are important features in the craniomaxillofacial region. Especially for patients who are not willing to accept the risk of a prominent forehead scar. Endoscopic resection of forehead osteomas might be a useful tool in forehead osteoma resections. It might be an alternative tool in an Oral and Maxillofacial Surgeon's and in a Plastic Surgeon's repertoire.

[Does diagnostic ureterorenoscopy increase the risk of bladder recurrence after total nephroureterectomy? A review of the literature]

OBJECTIVE

The objective of our study was to evaluate, in a review of the literature, the impact of diagnostic ureteroscopy before total nephroureterectomy (NUT) on the risk of bladder recurrence.

METHODS

We conducted a literature review in the Pubmed database in March 2018. Initial research identified 45 publications. Following full text screening, 9 studies were finally included, with a total of 1041 NUT with URS prior versus 2909 NUT alone. The primary endpoint was bladder recurrence. Secondary objectives were specific survival and overall survival.

RESULTS

Bladder recurrence was reported in the 9 studies included. Diagnostic ureteroscopy was significantly associated with an increased risk of post-NUT bladder recurrence (HZ 1.42 [1.29-1.56], P<0.01). The specific survival and overall survival at 5 years, were reported in respectively 4 and 2 studies. There was no impact of the pre-NUT diagnostic URS on the specific survival (HZ 0.75 [0.54-1.03], P=0.08) or post-NUT overall survival (HZ 1.15 [0.68-1.96], P=0.59).

CONCLUSION

The URS diagnostic before NUT for TVEUS is associated with a significant increase in the risk of postoperative bladder recurrence.

[Bronchoscopic treatment of bronchopleural fistula]

Bronchopleural fistula is an uncommon complication occurring especially following lung resection (pneumonectomy) and associated with high morbidity and mortality rates. The treatment is surgical but some studies reported bronchoscopic treatment. Localization and size of the fistula may indicate different endoscopic procedures. This overview described the different endoscopic procedures and their benefits.

[Tuberculous pseudotumour, a challenging diagnosis]

INTRODUCTION

The pseudotumorous form of tuberculosis is a rare entity. Whatever its location, it can simulate neoplasia by its radiological and/or endoscopic appearances. We highlight the diagnostic difficulties associated with this type of presentation.

METHODS

We performed a retrospective study of inpatient records from 2003 to 2016 in the pneumology department of La Rabta Hospital to identify cases of thoracic tuberculous pseudo-tumor.

RESULTS

Seventeen patients were identified. The median age was 41 years and their symptomatology was dominated by cough and general debility. All had abnormal radiology with 10 cases of suspect lesions. Fibre-optic bronchoscopy revealed endobronchial abnormalities in 11 cases. The median overall diagnostic delay was 97 days. The diagnosis was confirmed bacteriologically in five cases, histologically in 14 cases and based on clinical presumption in one case. The progression was favourable: 13 patients have been declared cured and four patients are still undergoing treatment.

CONCLUSION

Making a positive diagnosis of thoracic tuberculous pseudotumour can be difficult, as bacteriological samples are often negative. This can lead to a significant delay in diagnosis and treatment.

[Endoscopy and face-lift]

For many years, the face-lift has not been the only intervention for facial rejuvenation. It is necessary today to specify the type of face-lift, cervico-facial lifting, frontal lifting or facelift. We will consider in this article the frontal lift and centro-facial lift and its possible execution assisted by endoscopy with therefore minimal scars, hidden in the scalp. We will consider successively its technique, its indications and its results highlighting a very long hold over time.

[Diagnosis, evolution and prognosis of prenatally diagnosed suprasellar cysts]

Suprasellar arachnoid cysts (SAC) in children are considered rare, but the incidence is increasing due to the improvement of prenatal diagnosis. We present 15 cases of SAC diagnosed during the antenatal period between 2005 and 2015. The records were reviewed retrospectively by specifying the radiological characteristics, treatment modalities, outcomes, and long-term monitoring. Mean follow-up was 71 months. The forms (SAC-1) accounted for 2 cases (13%) with hydrocephalus. We observed 8 (53%) lower forms (SAC-2) with interpeduncular cistern expansion without hydrocephalus. The 5 (33.5%) remaining patients showed asymmetrical forms (SAC-3). Six patients (40%) were treated by ventriculo-cysto-cisternostomy, 1 by fetoscopy, 1 (6.5%) by ventriculo-peritoneal shunt, 2 (13.5%) by pterional craniotomy, and 6 (40%) were simply followed. The surgical outcomes were initially favorable in 9 cases (100%), 1 patient (13%) had to be re-treated later. Non-operated patients were all type 2 and showed no radiological changes. In the long-term, 1 patient (6.5%) had endocrine disruption, 1 had delayed development, 2 (13.5%) had minor neuropsychological impairments, and 1 had epilepsy. Combined monitoring with prenatal MRI and ultrasound can be used to distinguish three subtypes of SAC. SAC-1 and SAC-3 have an excellent prognosis after treatment in the perinatal period. SAC-2 can benefit from simple monitoring and remain asymptomatic in their majority. This classification allows a better prognosis estimation and better treatment decision.

[Endoscopic management of postoperative ureteral wound. Retrospective unicentric study from October 2003 to June 2014]

BACKGROUND

Ureteral wounds are rare with an incidence of 0.5 to 1% of pelvic surgeries. Their supports and their prognosis remain dependant of the period of support and the level of ureteral lesion. The importance of early treatment reduces morbidity and improves patient prognosis.

METHODS

A retrospective study from October 2003 to June 2014 was performed in a university hospital using a systematic chart review of patients' urology, digestive surgery, vascular surgery and gynecology.

RESULTS

Forty-six wounds were found in 43 patients. The majority of the ureteral wound was found at the pelvic ureter, i.e. 69.6% of the study population (n=32). The main cause was gynecological surgery (n=25). In the simple wound group, endoscopic treatment was effective in nearly 90% of cases (n=6). In the other two groups, the efficacy was only 30% and imposed a surgical treatment as second-line.

CONCLUSION

The management is based primarily on early detection or intraoperative, and on a correct initial knowledge of the location and size of the lesion. Endoscopic treatment can in most cases treated with a simple and minimally invasive operation an ureteral wound with nearly 90% success rate. In more complex wounds, endoscopy remains a step in the management with about 30% success rate in our study.

LEVEL OF EVIDENCE

5.

Extended endoscopic endonasal approach to clival and paraclival tumors: Indications and limits

OBJECTIVE

To report our experience with the Extended endoscopic endonasal approach (EEEA) for clival and paraclival tumors.

DESIGN

Retrospective analysis of a consecutive series of patients.

RESULTS

Eleven patients were considered: 3 chordomas, 3 meningiomas, 3 metastatic lesions, one chondroma and one chondrosarcoma. Gross total resection (GTR) was achieved in all chordomas and in chondromas with patients free of disease at the last follow-up. The chondrosarcoma was first operated on using a transfacial approach and endoscopy was performed for local progression with subtotal resection. The meningiomas were treated by a combination of transcranial and endoscopic approach due to their extension. The resection was subtotal and the residue treated by radiosurgery. Two patients with rhinopharyngeal carcinoma underwent palliative debulking. One metastatic melanoma that underwent GTR experienced remission. Two patients had postoperative cranial nerve palsy. No other complications were observed.

CONCLUSIONS

EEEA allows a direct access to the skull base. Through a minimal access, it limits the incidence of neurological morbidities. For midline epidural clival tumors, EEEA allows a total excision. It also offers an excellent access to the clival component of intradural lesions. A combined approach permits good tumor control with minimal complications.

[Paranasal sinus mucoceles: About 32 cases]

INTRODUCTION

Mucocele is a pseudo-cystic tumor of the paranasal sinuses. Despite its benign histological nature, it is aggressive towards neighboring structures (orbit and brain). Our aim was to study the epidemiological, clinical, therapeutic, and evolution aspects of this pathology.

PATIENT AND METHODS

We conducted a retrospective study over a period of 9 years on 32 patients operated on and followed for mucocele in our department.

RESULTS

Mean age was 43.28 years with a sex ratio to 1. Mucoceles were located in the fronto-ethmoid sinus (27 cases), the maxillary sinus (3 cases) and the sphenoid sinus (2 cases). The most common symptoms were periorbital swelling and exophthalmia. CT scan confirmed the diagnosis in the majority of cases. MRI was performed in 3 patients. Surgery consisted in a large marsupialization by endonasal approach in 30 cases, and by a combined approach in two cases. A recurrence was observed in two patients after a mean period of 18 months.

DISCUSSION

Mucocele is a benign and expansive pseudo-cystic tumor, affecting mostly adults and developing in the paranasal sinuses. Clinical symptoms are not specific. It may reveal itself by ophthalmic or intracranial complications. Diagnosis is based on imaging (CT and MRI). Endonasal surgery has become the gold standard for the treatment of mucoceles and is endowed with low morbidity.

[Trapped temporal horn, an unusual form of obstructive hydrocephalus: 5 case-reports]

OBJECTIVE

"Entrapped temporal horn" is an unusual form of obstructive hydrocephalus which is due to an obstacle at the trigone of the lateral ventricle that seals off the temporal horn that may act as a space occupying process. In this study, our aim was to assess the clinical presentation, imaging, pathophysiology and the management of this entity.

METHODS

The medical records of patients with entrapped temporal horn diagnosed between January 2003 and December 2012 were reviewed retrospectively.

RESULTS

Five patients were identified. In four cases, the condition developed after cranial surgery; an infant having two revisions of a ventriculoperitoneal shunt; an adult operated for a glioblastoma, an infant operated on for cerebral hydatidosis and an infant operated for an occipital encephalocele. In the last patient, the entrapped temporal horn revealed sarcoidosis.

CONCLUSIONS

Trapped temporal horn syndrome can act as a space occupying process and requires surgical management. Internal shunting provides good results. However, the long term outcome depends on the etiology.

Interest and limits of endoscopic approaches for pineal region tumours

Endoscopy of pineal region tumours has been developed since the year 2000 either via a transventricular or extracerebral approach. The initial purpose of applying neuroendoscopy in the management of pineal region tumours was to resolve the obstructive hydrocephalus, and identify the pathological characteristics of the tumour. Based on this approach, a piecemeal resection of the tumour can be performed. The approaches, derived from the microsurgical pathway using an endoscope to expose the operative field, have been proposed either via an infratentorial supracerebellar approach or posterior transtentorial interhemispheric approach. Neuroendoscopic procedures can be considered as a therapeutic alternative to the microsurgical approach when CSF markers are negative. This procedure is considered mini-invasive for the approach along the surgical corridor access but extensive and in depth at the interface between the tumour and the surrounding neurological parenchyma. The limitations and complications are related to the type of procedure (mono- or bimanual) as well as the tumoral characteristics. Different approaches are presented in detail in order to avoid the occurrence of any surgical complications.

[Combined approach of parotid lithiasis. A technical note]

INTRODUCTION

Sialendoscopy, extracorporeal lithotripsy and transoral removal are the usual treatments for parotid lithiasis. These techniques cannot treat all the patients. In fact, removal of lithiasis bigger than the ductal diameter and situated in the middle or posterior third of the duct may fail with such techniques. For this reason the combined approach has been developed. Our technical note describes this procedure.

TECHNICAL NOTE

Preoperative check-up needs an ultrasound or a CT scan of the parotid region. The procedure is conducted under general anesthesia. It begins with the localization of the lithiasis with help of the sialendoscope light visible through the skin. A face lift approach is performed giving access to the SMAS that is opened over the lithiasis and the transilluminated area. A window is opened on the duct and the lithiasis is removed. Proximal duct permeability is assessed with the sialendoscope. The different layers are sutured and a suction drainage is left in place.

DISCUSSION

Combined approach is indicated in case of failure of conservative techniques. It provides good results in removal of lithiasis located in the posterior or middle thirds of the duct. Its morbidity is low. It can avoid performing a parotidectomy and lowers the risk of facial palsy. In case of failure, botulinum toxin injection may be indicated.

Endoscopically assisted proximal radial nerve decompression: surgical technique

STATE OF THE ART

The proximal radial nerve compression syndrome includes supinator syndrome and proximal radial nerve constrictions. This article presents a new endoscopic assisted radial nerve decompression surgical technique described for the first time by Leclère et al. in 2013.

SURGICAL TECHNIQUE

Endoscopic scissor decompression of the proximal radial nerve is always performed under plexus anaesthesia. It includes 8 key steps documented in this article. We review the indications and limitations of the surgical technique.

CONCLUSION

Early clinical results after endoscopic assisted decompression of the radial nerve appear excellent. However, they still need to be compared with conventional techniques. Clinical studies are likely to widely develop because of the mini-invasive nature of this new surgical technique.

[Outcome of endoscopically assisted surgical treatment of mandibular condyle fractures: a retrospective study of 22 patients]

INTRODUCTION

The condylar region is a frequent localization of mandibular fractures; there are various types of management. Mini-invasive endoscopic surgery is an alternative to open reduction. We had as goal to evaluate the outcome of this technique.

MATERIAL AND METHODS

We performed a monocentric retrospective study of patients consecutively operated for a condylar fracture (type II to V in the Spiessl and Schroll classification) with intraoral route and endoscopic assistance, during 30 months. We assessed the functional and radiological outcomes, and the complications.

RESULTS

Twenty-two patients (25 fractures) were included. Seventeen patients (19 fractures) could be followed (mean follow-up: 16.7 months). The mean values were: interincisal opening, 45mm (±8.4); protrusion, 8.3mm (±1.9); ipsilateral excursion of the jaw: 8.6mm (±2); contralateral excursion: 8.7mm (±4). Three routes were used combined with a preauricular approach. The fracture reduction was good for 10 of the 19 fractures and poor for 3. The complications were: 3 cases of infection, 1 case of fixation failure with good consolidation; for combined approaches: 2 cases of temporary facial palsy and 2 cases of Frey syndrome.

DISCUSSION

Endoscopic assistance for the surgical management of the fracture of mandibular condyle is a reliable technique, with a good functional outcome, and a low rate of specific complications, especially for facial nerve lesion or esthetic outcome.

[Management of ocular and orbital complications in acute sinusitis]

PURPOSE

Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches.

METHODS

Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012).

RESULTS

There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications.

DISCUSSION

Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment.

Update on the management of pineal cysts: Case series and a review of the literature. Neurochirurgie. 2015;61:201-207. [PMID: 24907165 DOI: 10.1016/j.neuchi.2013.08.010]

OBJECTIVE

The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic pineal cysts may require a surgical solution but therapeutic indications have not yet been clearly established.

METHOD

From 1986 to 2012, 26 patients with pineal cysts were identified. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. A systematic review of the literature is also presented.

RESULTS

Twenty-six patients with pineal cysts were identified. The mean age was 23.5 years ranging from 7 to 49 years. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. Two adult cases presented with non-specific headaches and did not require surgery. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Overall, peri-operative mortality was nil. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months.

CONCLUSION

In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported.

Adult symptomatic and growing arachnoid cyst successfully treated by ventriculocystostomy: a new insight on adult arachnoid cyst history

BACKGROUND

Adult arachnoid cysts are known to be stable and asymptomatic but their history remains undefined.

CASE DESCRIPTION

The authors report the case of an 81-year-old woman with progressive hemiplegia and aphasia. CT scan revealed a voluminous left frontotemporal arachnoid cyst with a major mass effect on the midline and contralateral blocked hydrocephalus. Endoscopic ventriculocystostomy was performed with a spectacular neurological improvement.

DISCUSSION AND CONCLUSIONS

Symptomatic adult arachnoid cysts are extremely rare. To our knowledge, no similar clinical case of a growing arachnoid cyst in elderly patients has yet been reported in the literature. The mechanisms of cyst enlargement and decompensation still remain undefined and debated. The possibility of adult arachnoid cyst growth has to be considered in clinical practice. Endoscopic ventriculocystostomy is as effective as in paediatric cases.