Possible Approaches to Endoscopic Treatment of Popliteal Cysts: From the Basics to Troublesome Cases.
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ABSTRACT:
SUBMITTER: Malinowski K
PROVIDER: S-EPMC6506792 | biostudies-literature | 2019 Apr
REPOSITORIES: biostudies-literature
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Possible Approaches to Endoscopic Treatment of Popliteal Cysts: From the Basics to Troublesome Cases.
Malinowski Konrad K Hermanowicz Krzysztof K Góralczyk Adrian A Guszczyn Tomasz T Sadlik Bogusław B Synder Marek M LaPrade Robert F RF
Arthroscopy techniques 20190311 4
Popliteal cysts can be an oppressive symptom in patients with concomitant intra-articular knee pathologies. Because isolated treatment of intra-articular lesions is usually not sufficient to resolve the problems associated with a large symptomatic popliteal cyst, a popliteal cyst should be concurrently addressed with other knee pathologies to maximize patient outcomes. Conservative treatment and open surgical excision are associated with high rates of recurrence, so arthroscopic techniques are t ...[more]
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Project description:Popliteal cysts, often referred to as Baker's cysts, are a common occurrence in the adult knee. Although controversy exists as to the exact indications for treatment, these structures can cause extreme discomfort and morbidity, including pain from rupture and symptoms from neurovascular compromise. Prior to the development of the arthroscope, open treatment of popliteal cysts was not uncommon. Complications such as poor wound healing, cyst recurrence, and knee flexion contractures were reported after such treatment. Owing to the presence of a valve-type structure, also called the posterior transverse synovial infold, there is 1-way flow of synovial fluid into the cyst. Although seldom described, there is a reproducible and relatively straightforward arthroscopic treatment for this pathology. This technical report will describe the arthroscopic treatment of popliteal cysts and clarify the posterior knee anatomy that gives the surgeon the landmarks to perform safe and effective arthroscopic treatment of popliteal cysts.
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Project description:When treating a popliteal cyst in the knee joint, it is often necessary to simultaneously treat the intra-articular lesions so as to reduce the recurrence of the cyst after the operation. Herein, we propose an arthroscopic resection technique for popliteal cyst, in which the position of the popliteal cyst is indirectly located by finding out the location of the semimembranosus tendon during the operation, thereby completing the arthroscopic resection of the popliteal cyst. This method does not involve the posteromedial compartment of the knee joint. Arthroscopic treatment can be performed on the combined intra-articular lesions through anteromedial and anterolateral approaches before or after popliteal cyst resection.
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Project description:BackgroundAlthough aneurysmal bone cysts (ABCs) are benign tumours, they have the potential to be locally aggressive. Various treatment approaches, such as en bloc resection, open curettage, radiotherapy, sclerotherapy, and embolization have been proposed, but the most appropriate treatment should be selected after considering the risk of tumour recurrence and treatment complications. Endoscopic curettage (ESC) may be a less invasive alternative to open curettage for ABC treatment. We aimed to describe the use of ESC for the treatment of ABCs and to report our clinical outcomes, including the incidence rate of recurrence, radiological appearance at final follow-up, time to solid union, complications, and postoperative function.MethodsBetween 1998 and 2015, 30 patients (18 men and 12 women; mean age, 17.4 years) underwent ESC for the treatment of primary ABCs at our hospital (mean postoperative follow-up, 55 months). ESC was performed under arthroscopic guidance for direct visualization, and curettage extended until normal bone was observed in the medullary cavity. To investigate bone healing after ESC, we evaluated the consolidation of cysts at the final evaluation (based on the modified Neer classification) and time to solid union after surgery, which was defined as sufficient cortical bone thickness to prevent fracture and allow physical activities.ResultsRecurrence was identified in 3 cases (10%). Curative outcomes were obtained after repeated ESC or open curettage. A log-rank analysis indicated that age < 10 years (p = 0.004) and contact of the tumour with the physis (p = 0.01) increased the risk of tumour recurrence. Residual tumours were identified in 9 cases (30%); these lesions remained inactive over the extended follow-up period. The average time to solid union after endoscopic curettage was 3.2 months. Transient radial nerve palsy was identified in 1 case. Good postoperative functional recovery occurred in all cases.ConclusionsESC is a minimally invasive technique for the treatment of ABCs, and the tumour recurrence rate is comparable to that of other standard procedures. However, the application of this method should be carefully considered, especially for patients < 10 years and when the tumour comes in contact with the physis.
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Project description:GoalsTo examine the utility of integrated molecular pathology (IMP) in managing surveillance of pancreatic cysts based on outcomes and analysis of false negatives (FNs) from a previously published cohort (n=492).BackgroundIn endoscopic ultrasound with fine-needle aspiration (EUS-FNA) of cyst fluid lacking malignant cytology, IMP demonstrated better risk stratification for malignancy at approximately 3 years' follow-up than International Consensus Guideline (Fukuoka) 2012 management recommendations in such cases.StudyPatient outcomes and clinical features of Fukuoka and IMP FN cases were reviewed. Practical guidance for appropriate surveillance intervals and surgery decisions using IMP were derived from follow-up data, considering EUS-FNA sampling limitations and high-risk clinical circumstances observed. Surveillance intervals for patients based on IMP predictive value were compared with those of Fukuoka.ResultsOutcomes at follow-up for IMP low-risk diagnoses supported surveillance every 2 to 3 years, independent of cyst size, when EUS-FNA sampling limitations or high-risk clinical circumstances were absent. In 10 of 11 patients with FN IMP diagnoses (2% of cohort), EUS-FNA sampling limitations existed; Fukuoka identified high risk in 9 of 11 cases. In 4 of 6 FN cases by Fukuoka (1% of cohort), IMP identified high risk. Overall, 55% of cases had possible sampling limitations and 37% had high-risk clinical circumstances. Outcomes support more cautious management in such cases when using IMP.ConclusionsAdjunct use of IMP can provide evidence for relaxed surveillance of patients with benign cysts that meet Fukuoka criteria for closer observation or surgery. Although infrequent, FN results with IMP can be associated with EUS-FNA sampling limitations or high-risk clinical circumstances.
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Project description:Thyroglossal duct cyst is the most common congenital neck mass in children and young adults. The authors present two cases affecting two patients aged 7 and 9 years, respectively, who had a palpable painless swelling in the submental region. In both patients ultrasound (US) examination showed an anechoic or hypoechoic rounded mass with well-defined margins thus confirming clinical suspicion of thyroglossal duct cyst. One patient also had a second, deep-lying, nonpalpaple cyst which communicated with the superficial cyst. These cases are typical and confirm that US is essential in suspected thyroglossal duct cyst to confirm clinical diagnosis, detect lesions which are not clinically appreciable due to their small size or deep location, to assess communication between the lesions and to detect possible complications.Thyroglossal duct cyst is the most common congenital neck mass in children and young adults. The authors present two cases affecting two patients aged 7 and 9 years, respectively, who had a palpable painless swelling in the submental region. In both patients ultrasound (US) examination showed an anechoic or hypoechoic rounded mass with well-defined margins thus confirming clinical suspicion of thyroglossal duct cyst. One patient also had a second, deep-lying, nonpalpaple cyst which communicated with the superficial cyst. These cases are typical and confirm that US is essential in suspected thyroglossal duct cyst to confirm clinical diagnosis, detect lesions which are not clinically appreciable due to their small size or deep location, to assess communication between the lesions and to detect possible complications.
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Project description:BackgroundThe management of complicated symptomatic pineal cysts in the pediatric population is challenging and variable. Surgical management may include treatment of hydrocephalus alone, or direct treatment of the cyst with or without direct hydrocephalus management. This is typically done through craniotomy-based microsurgical approaches to the pineal region or an endoscopic transventricular approach.MethodsWe present a stepwise minimally invasive technique to treat complicated pineal cysts in young children associated with an obstructive hydrocephalus in a single procedure through third ventriculostomy combined with an intraventricular marsupialization of the pineal cyst through a single burr-hole using stereotactic navigation.ResultsTwo young patients with over 2 years of follow-up have done well without complication using this technique. Other literature reports for complex pineal cysts in pediatric patients are reviewed and this technique is not previously described for this population.ConclusionEndoscopic third ventriculostomy and cyst marsupialization using a single burr-hole and stereotactic navigation for symptomatic or enlarging pineal cysts in children allow for minimally invasive management, a rapid recovery, short hospital stay, and durable outcome owed to redundant CSF flow pathways.
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