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Current Pain and Headache Reports May 2020Intracranial dermoid cysts are benign, rare mass-occupying lesions of the central nervous system arising from the neuroectodermal cell lines. While rupture of...
PURPOSE OF REVIEW
Intracranial dermoid cysts are benign, rare mass-occupying lesions of the central nervous system arising from the neuroectodermal cell lines. While rupture of intracranial dermoid cysts is rare, it can present with a variety of clinical manifestations. To explore the headache manifestations among patients with ruptured intracranial dermoid cysts. To our knowledge, limited studies focusing on headache due to the intracranial dermoid cysts rupture have been published to date. A literature review was done through PubMed/Medline. Articles within the past 10 years were reviewed. Articles in languages other than English were excluded.
RECENT FINDINGS
Rupture of intracranial dermoid cysts could have various manifestations including headache, seizure, and meningitis. Depending on the location of the cyst, headache secondary to the rupture of the intracranial dermoid cysts could present in different ways. A detailed systematic literature review of headache presentations due to intracranial dermoid cysts rupture is provided.
Topics: Brain Neoplasms; Central Nervous System Cysts; Dermoid Cyst; Headache; Humans; Magnetic Resonance Imaging; Meningitis, Aseptic; Migraine Disorders; Rupture, Spontaneous; Seizures; Tomography, X-Ray Computed
PubMed: 32472229
DOI: 10.1007/s11916-020-00863-x -
Frontiers in Endocrinology 2021In this article, we present a 31-year-old female who presented with intermittent headache and oligomenorrhea of over 10 years' duration. Imaging revealed a large...
In this article, we present a 31-year-old female who presented with intermittent headache and oligomenorrhea of over 10 years' duration. Imaging revealed a large suprasellar mass with sellar extension. The patient underwent an endoscopic endonasal trans-sphenoidal surgery to resection of the mass. Clinical, radiological, and operative findings from this patient were initially considered to be Rathke's cleft cyst (RCC). However, postoperative histological examinations revealed a mature cystic teratoma. No radiotherapy was performed after surgery. At the most recent follow-up, approximately 1 year later, the patient is doing well with no headache and no recurrence of the teratoma.
Topics: Adult; Female; Humans; Central Nervous System Cysts; Diagnosis, Differential; Endoscopy; Sella Turcica; Teratoma
PubMed: 34659119
DOI: 10.3389/fendo.2021.731088 -
Frontiers in Pediatrics 2021The use of robotics-assisted surgery in oncology has been proved effective and safe in adults. Despite these results, the use of robotics has been rarely reported for...
AIM
The use of robotics-assisted surgery in oncology has been proved effective and safe in adults. Despite these results, the use of robotics has been rarely reported for pediatric oncology. Our review aims to evaluate the safety and feasibility of robotics-assisted surgery in this field, analyzing our experience and performing a systematic review of the most recent studies.
METHODS
We reviewed all patients affected by an oncological disease who underwent a robotics-assisted procedure at our institute. We performed a systematic review of the literature from 2012 to 2021 on the subjects.
FINDINGS
A total of 14 patients underwent robotics-assisted tumor resection. Eleven procedures (median age 13.2-years old) were carried out in children with adnexal lesions (seven tumor excision and four ovariectomies). Histological diagnosis was mature teratoma (six), serous papillary cystadenofibromas of the fallopian tube (two), ovarian serous cystadenoma (one), ovarian mucinous cystadenoma (one), and ovarian seromucinous cystadenoma. The median length of stay was 2 days. No recurrences or complications at a median follow-up of 2.1-years were observed. A 5-year-old girl underwent a complete posterior resection of a type 3 sacrococcygeal tumor with a robotics-assisted approach for the dissection of a possible intraabdominal residual component of the lesion. No intra- and postoperative complications were recorded. Complete excision of a recurrent differentiating neuroblastoma of the left para-renal region was performed on a 9-year-old girl. An idiopathic anaphylactic shock occurred 1 day after the procedure. At 9 months' follow-up, no local recurrences of the lesion were observed. Overall, we reported no conversion to open surgery. Lastly, a robotic excision of a growing left superior mediastinal intermixed ganglioneuroblastoma was performed on an 8-year-old girl with no postoperative complications. Follow-up was uneventful (7 months). In the literature, the rate of complications ranges from 0 to 28%, mainly related to difficult dissection and impaired anatomy. Conversion is reported in 5% of all oncological procedures, due to more invading tumors and altered anatomical features. No robotics-related complications were reported.
CONCLUSION
Robotics-assisted surgery in pediatric oncology has proven to be feasible. Nevertheless, its use should be limited to selected cases and performed by highly trained oncological surgeons. Preparation and patient positioning, alongside a correct port placement, are crucial to carrying out these procedures. Further innovations in robotics may allow a wider application of this technology in pediatric oncology.
PubMed: 35118030
DOI: 10.3389/fped.2021.780830 -
Journal of Plastic, Reconstructive &... Jan 2024Nasal dermoid cysts are surgically treated using external incision, open rhinoplasty, transnasal endoscopy, or combined approaches. It is unclear how these approaches... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Nasal dermoid cysts are surgically treated using external incision, open rhinoplasty, transnasal endoscopy, or combined approaches. It is unclear how these approaches differ with regard to the incidence of adverse events.
METHODS
We conducted a systematic review of studies on the surgical management of midline nasal dermoids. Following data abstraction, we carried out a series of single-arm meta-analyses to estimate summary risks of recurrence and combined adverse events (recurrence, revision, infection, or readmission) according to the surgical approach.
RESULTS
Forty-three eligible studies published between 1958 and 2020 reported on 439 cases of nasal dermoid cysts. Treatment approaches included external incision (25 studies), rhinoplasty (15 studies), and transnasal endoscopy (5 studies). To our knowledge, no study has compared outcome incidence between the surgical approaches. External incision had the lowest summary incidence of both recurrence (1.78% [95% CI: 0.57%, 3.65%]) and combined adverse events (4.94% [95% CI: 2.72%, 7.77%]). Rhinoplasty had a higher incidence of recurrence (4.81% [95% CI: 0.91%, 11.6%]) and combined adverse events (8.32% [95% CI: 2.77%, 16.5%]), and transnasal endoscopy had the highest incidence of recurrence (the only reported adverse event; 7.89% [95% CI: 0%, 28.9%]).
CONCLUSION
Our results suggest that the incidence of adverse events was lowest among patients who were subjected to external incision for nasal dermoid removal. Incidence was higher for patients who underwent rhinoplasty and the highest for patients who underwent transnasal endoscopy. Future work on this topic should include well-designed prospective studies that compare rates of adverse events and cosmetic outcomes between surgical approaches.
Topics: Humans; Dermoid Cyst; Prospective Studies; Nose Neoplasms; Rhinoplasty; Endoscopy
PubMed: 37983980
DOI: 10.1016/j.bjps.2023.10.114 -
World Neurosurgery Feb 2024Intracranial dermoid cyst (DC) is a rare benign, slow-growing lesion, most commonly arising along the midline. They can occur in the supratentorial compartment, very... (Review)
Review
OBJECTIVE
Intracranial dermoid cyst (DC) is a rare benign, slow-growing lesion, most commonly arising along the midline. They can occur in the supratentorial compartment, very rarely involve the sellar region and only exceptionally are intrasellar. The aim of our study is to address the challenges in the diagnosis and management of sellar DCs.
METHODS
We performed a systematic review of sellar DCs, in keeping with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and described an intrasellar DC in a 32-year-old female who presented with bilateral blurring vision.
RESULTS
The review identified 4 intrasellar, 29 suprasellar, and 28 parasellar cases. Intrasellar DCs more likely present with progressive visual impairment and pituitary hormone dysfunctions during the fifth decade of life. Suprasellar and parasellar DCs are typically diagnosed during the third decade of life because of diplopia, ptosis, trigeminal hypoaesthesia/para-esthesia or cyst's rupture. Sellar DCs are typically hypodense on computed tomography scans and contain calcifications. Magnetic resonance imaging features include T1 hyperintensity, T2 heterogeneous intensity, no restriction on diffusion-weighted images, and no contrast enhancement. Surgery is the treatment of choice. Gross total resection is achieved in 60% of intrasellar and 61.9% of suprasellar and parasellar DCs. Early postoperative complications are reported in 40.0%, 16.7%, and 23.8% of intrasellar, suprasellar, and parasellar DCs, respectively.
CONCLUSIONS
Intrasellar DCs are rare lesions typically diagnosed later than suprasellar and parasellar DCs due to their different clinical presentations. However, they should be considered in the differential diagnosis of cystic lesions of the sella, including epidermoid cysts, craniopharyngiomas, Rathke's cleft cysts, and teratomas.
Topics: Female; Humans; Adult; Dermoid Cyst; Pituitary Neoplasms; Central Nervous System Cysts; Epidermal Cyst; Magnetic Resonance Imaging; Sella Turcica
PubMed: 37995988
DOI: 10.1016/j.wneu.2023.11.057 -
Archives of Gynecology and Obstetrics Apr 2022Prostatic tissue in an ovarian teratoma is an unusual finding, whose initiation in a 46, XX karyotype tissue is yet to be clarified. We present a case from our files and...
PURPOSE
Prostatic tissue in an ovarian teratoma is an unusual finding, whose initiation in a 46, XX karyotype tissue is yet to be clarified. We present a case from our files and review the literature for this intriguing finding.
METHODS
Unstained histology sections of the ovarian teratoma containing prostatic tissue were evaluated using immunohistochemistry for PSA and androgen receptor.
RESULTS
Both PSA and androgen receptor immunostainings were positive in the prostatic tissue. From the literature review, it appears that most of the patients (74%) with similar findings were either pregnant or experiencing a miscarriage, menopausal or infertile at presentation, showing that an imbalanced hormone status is frequently associated with the presence of male structures in ovarian teratomas.
Topics: Humans; Immunohistochemistry; Karyotyping; Male; Ovarian Neoplasms; Prostate; Teratoma
PubMed: 34618214
DOI: 10.1007/s00404-021-06245-x -
Pediatric Surgery International May 2021Although surgical therapy for testicular tumors (TT) is often radical orchidectomy, tumor resection with preservation of healthy testicular parenchyma has been proposed....
PURPOSE
Although surgical therapy for testicular tumors (TT) is often radical orchidectomy, tumor resection with preservation of healthy testicular parenchyma has been proposed. This study herein reports a 20 year single center experience applying testicular sparing surgery (TSS) as a primary operative strategy in pediatric patients. A systematic literature review summarizes the utility and outcomes of TSS in appropriately selected patients.
METHODS
Pediatric patients with TT who underwent TSS between 1997 and 2018 were studied. TSS was indicated if patients presented evidence of adequately spared healthy testicular parenchyma on preoperative ultrasound and negative serum tumor markers. A systematic review of the literature was also performed.
RESULTS
12 cases met full inclusion criteria with 10 of 12 subjects in the prepubertal age group. Follow-up was 73 months (range 18-278 months). Only a single male patient (GSCCT) presented with early recurrence and orchidectomy was then performed. No cases of postoperative testicular atrophy were identified. Sexual maturation (Tanner stage) expected for age in each patient was documented. Review of the literature identified 34 published studies including 269 patients (94% prepubertal). Pathologic lesions here were mainly mature teratoma(s)-(62%) with a follow-up period of 4 years. Recurrent tumors were observed in only three patients (1.1%) notably two Leydig Cell Tumors and one Teratoma. Testicular atrophy reportedly occurred in only one single case (0.37%).
DISCUSSION
TSS is a feasible alternative to radical orchidectomy in pediatric male patients with localized TT and negative tumor markers. Long term follow-up is essential to monitor testicular growth, puberty with sexual development and psychological male health.
Topics: Adolescent; Biomarkers, Tumor; Child; Child, Preschool; Humans; Infant; Leydig Cell Tumor; Male; Neoplasm Recurrence, Local; Orchiectomy; Teratoma; Testicular Neoplasms; Ultrasonography
PubMed: 33454815
DOI: 10.1007/s00383-020-04850-6 -
Neurosurgery Sep 2019Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure.
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Myelomeningocele: Whether Prenatal or Postnatal Closure Affects Future Ambulatory Status.
BACKGROUND
Myelomeningocele (MM) is an open neural tube defect treated by pediatric neurosurgeons with prenatal or postnatal closure.
OBJECTIVE
The objective of this systematic review was to answer the question: What is the evidence for the effectiveness of prenatal vs postnatal closure of MM regarding short and long-term ambulatory status? Treatment recommendations were provided based on the available evidence.
METHODS
The National Library of Medicine PubMed database and Embase were queried using MeSH headings and keywords relevant to ambulatory status after prenatal or postnatal closure of MM. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidence table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III).
RESULTS
One randomized controlled trial (Class II) and 3 retrospective cohort studies (Class III) were included as evidence. Initial ambulatory status depended on anatomic level of the neural tube defect. In the short term, prenatal closure may improve ambulatory status compared to postnatal closure. Spinal cord tethering or dermoid inclusion cyst has been associated with neurologic deterioration in infants closed in utero and after birth. Ambulation may cease in both groups over time. No long-term studies evaluated whether there is a difference in the ability to ambulate upon reaching adulthood.
CONCLUSION
Prenatal closure of MM may improve ambulatory status in the short term (Level II). Spinal cord tethering in both groups caused deterioration in the ability to walk. Evaluation and treatment of spinal cord tethering may help maintain ambulatory status (Level III). No studies evaluate whether prenatal or postnatal repair provides improved ability to ambulate upon reaching adulthood.The full guideline can be found at https://www.cns.org/guidelines/guidelines-spina-bifida-chapter-3.
Topics: Adult; Evidence-Based Medicine; Female; Fetal Therapies; Humans; Infant; Meningomyelocele; Mobility Limitation; Neurosurgical Procedures; Pregnancy
PubMed: 31418040
DOI: 10.1093/neuros/nyz263 -
Revista Espanola de Patologia :... Sep 2022Germ cell tumors are the most frequent neoplasia in young males. The aims of this study is to describe a case in which a postpuberal teratoma suffers a transformation to...
Germ cell tumors are the most frequent neoplasia in young males. The aims of this study is to describe a case in which a postpuberal teratoma suffers a transformation to choriocarcinoma and metastasize to stomach. We have made a systematic review in PubMed and consensus documents to study this mismatch between the tumour, metastasis and the exception of gastric metastatic affectation. We describe three options to explain this discordance: a mixed germ cells tumour, a burned out tumour or a germ cells tumour derived from a malignant germ cell tumour precursor or different clonal strains. After made a thorough investigation we conclude that the most truly option is the last one as we extensive explain below. Once the gastric metastatic lesions are extremely rare and reach to <5%, but there are not conclusive assessments.
Topics: Choriocarcinoma; Female; Humans; Male; Neoplasms, Germ Cell and Embryonal; Pregnancy; Stomach; Teratoma
PubMed: 36075663
DOI: 10.1016/j.patol.2020.04.006