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Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management.

Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management. [ABSTRACT FROM AUTHOR]

Aim: Surgery for pediatric choledochal cyst (CC), complete excision (CE), and Roux-en-Y hepaticojejunostomy anastomosis (HJA) can be performed using laparoscopy (Lap), robotic-assistance (Rob; da Vinci Xi/Si), or both (Lap/Rob). Methods: Lap was used exclusively between 2009 and 2021 (n = 31) and Rob was introduced in 2017 (n = 23). All subjects were matched for age, weight, BMI, and episodes of preoperative pancreatitis. For Rob, the first 15/23 were Lap-CE/Rob-HJA and the last 8/23 were Rob-CE/Rob-HJA. Results: Total anastomotic time (TAT), TAT per suture during HJA, and time taken for dissection during CE were significantly shorter with less variance for Rob, although overall operative times were similar. Serum amylase on postoperative days 3, 5, and 7 were significantly higher for Lap. Times taken to ambulate, for return of bowel sounds, and discharge home were all significantly shorter for Rob. All postoperative complications occurred after Lap; HJA leak (n = 1; 3.2%), HJA stricture (n = 1; 3.2%), both treated by open re-HJA; and pancreatic fistula (n = 6; 19%), all treated conservatively. Conclusion: Dissection and recovery were faster with Rob while overcoming Lap-associated shortcomings to prevent complications associated with suturing. Both CE and HJA were safer and more reliable with Rob, a reflection of Rob's superiority. [ABSTRACT FROM AUTHOR]

Retroperitoneal Cysts (RPC) are uncommon, with an estimated incidence of 1 in 5,750 to 1 in 250,000. A 26-year-old woman presented with dull aching, non-radiating pain in the upper abdomen for the past two months, with no aggravating or relieving factors. On clinical examination of the abdomen, a grossly visible mass measuring approximately 10x10 cm with a smooth surface, firm consistency, and well-defined borders was observed in the left lumbar and iliac region. Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed a well-circumscribed cystic lesion measuring 9.3x9.5x5.5 cm in the left lumbar region near the tail of the pancreas. The pancreas appeared normal with no surrounding fat stranding or inflammatory changes. Peripheral enhancement and peripheral wall calcification were observed. The patient underwent laparotomy and cyst excision. Intraoperatively, the cyst was found to arise from the retroperitoneum located in the lesser sac. It was dissected out from the tail of the pancreas, and no obvious communication with the pancreas was observed. The cyst was excised completely. Histopathological examination revealed a cyst with absent endothelium, suggestive of a pseudocyst. Previous literature reports indicate that RPCs are very rare and are often discovered incidentally. Patients may be asymptomatic or present with vague symptoms. Imaging can help diagnose these lesions, but surgery is crucial in confirming the diagnosis.

Gashaw Arega,1 Rahel Argaw Kebede,1 Hanna Getachew Woldeselassie,2 Temesgen Lingerh,1 Tadele Yayeh1 1Addis Ababa University, School of Medicine, Department of Pediatrics and Child Health, Addis Ababa, Ethiopia; 2Addis Ababa University, School of Medicine, Department of Pediatric Surgery, Addis Ababa, EthiopiaCorrespondence: Gashaw Arega, Addis Ababa University, School of Medicine, Department of Pediatrics and Child Health, P.O.Box: 9080, Addis Ababa, Ethiopia, Tel +251911417235, Email gashawarega@gmail.comAbstract: Hydatidosis is a parasitic disease caused by Echinococcus granulosus, which is endemic in many parts of the world. Hydatid cysts can occur in any organ of the human body and the lung is the most common site in children, primarily related to higher lung tissue elasticity. Bilateral pulmonary hydatid cyst is a rare clinical phenomenon in young children. Here, we report on a 3-year-old boy diagnosed with bilateral pulmonary hydatid cyst after he came with four months history of dry cough and progressive worsening of shortness of breath. Computed tomography of the chest revealed large bilateral thick-walled pulmonary cystic mass lesions, with bilateral perihilar extension and pressure effect on the diaphragm with surrounding atelectatic changes. The patient underwent left posterolateral thoracotomy and cyst excision was done for the left hydatid cyst. Two months after the first surgical cyst excision, right posterolateral thoracotomy and cystectomy was done for the right lung hydatid cyst. He recovered well post-operatively.Keywords: hydatidosis, Echinococcus granulosus, chest tomography, cyst excision

Objective To describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations. Methods A total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing. Results Preoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p

Objective: To describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations. Methods: A total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing. Results: Preoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus. Conclusions: Arthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended. [ABSTRACT FROM AUTHOR]

• Most series of SEAC cases were reported. • Novel key findings of pathogenesis and Clinical features. • Novel key findings of classification. • Novel key findings of treatment strategies. • Novel key findings of microsurgery. We designed this study to share our management experiences on spinal extradural arachnoid cysts (SEACs) to add more to the body of evidence for their treatment. We retrospectively reviewed 41 patients who underwent microsurgery for thoracolumbar SEACs at our hospital from June 2009 to June 2019. All clinical data, including medical history, clinical features, imaging manifestation, operative findings, and prognosis, were extracted from medical records and databases. Perioperative differences of the Visual Analogue Scale (VAS), the Oswestry disability index (ODI) score, and postoperative Odom's criteria were used to assess the surgical outcome. The most common and very first clinical symptom in the 41 patients was pain (VAS = 2.82 ± 0.89), and the mean ODI value was 61.7 ± 8.9%. Imaging revealed that the cystic lesions in the thoracolumbar spine involved an average of 2.85 segments. Of the 41 patients, 39 underwent total cyst excisions, and 36 had their dural defect repaired by one of three methods. The mean postoperative follow-up time was 52.3 months. Postoperatively, one case developed kyphoscoliosis and two cases experienced a recurrence. The majority of patients showed excellent outcomes according to Odom's criteria, the postoperative VAS (0.80 ± 1.08), and the ODI (15.4 ± 9.3%). The most common clinical symptoms of thoracolumbar SEACs included progressive discomfort and pain around the involved spinal segments. Early surgical intervention relieved the patients from their symptoms. Microsurgery was recommended to resect the complete cyst and to repair the dural defect, but resection of the complete cyst is more necessary than just repairment of the dural defect for providing promising outcomes. [ABSTRACT FROM AUTHOR]

Introduction Choledochal cysts are infrequent congenital cystic dilation of the biliary tract. The aim of this study is to analyze the clinicopathological profile and short-term operative outcomes of patients with choledochal cysts. Methods This is a retrospective study of 32 consecutive patients of choledochal cyst who underwent multidisciplinary management in last two and half years at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 24.67±16.4 years (range from 2 to 56 years). The most common presenting symptoms were pain 31(96.88%), jaundice 10(31.25%) and mass 5(15.63%). Triad of pain, jaundice and mass was present in 4(12.5%). Transabdominal Ultrasonography (100%) was the initial diagnostic modality followed by Magnetic resonance cholangiopancreatography (MRCP) (68.75%), and contrast enhanced computed tomography (CECT) (31.25%). Endoscopic retrograde cholangiopancreatography (ERCP) was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy (HJ). The overall morbidity was seen in 6 patients (18.75%). There was no mortality. None of our patient had cholangiocarcinoma on pathological examination. Conclusion Choledochal cyst was common in young females. Type IC and IVA choledochal cyst were the most common types and majority of them were symptomatic. Cyst excision with Roux-en-Y hepaticojejunostomy was the commonest surgical treatment modality and had excellent perioperative outcome. [ABSTRACT FROM AUTHOR]

Retroperitoneal Cysts (RPC) are uncommon, with an estimated incidence of 1 in 5,750 to 1 in 250,000. A 26-year-old woman presented with dull aching, non-radiating pain in the upper abdomen for the past two months, with no aggravating or relieving factors. On clinical examination of the abdomen, a grossly visible mass measuring approximately 10x10 cm with a smooth surface, firm consistency, and well-defined borders was observed in the left lumbar and iliac region. Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed a well-circumscribed cystic lesion measuring 9.3x9.5x5.5 cm in the left lumbar region near the tail of the pancreas. The pancreas appeared normal with no surrounding fat stranding or inflammatory changes. Peripheral enhancement and peripheral wall calcification were observed. The patient underwent laparotomy and cyst excision. Intraoperatively, the cyst was found to arise from the retroperitoneum located in the lesser sac. It was dissected out from the tail of the pancreas, and no obvious communication with the pancreas was observed. The cyst was excised completely. Histopathological examination revealed a cyst with absent endothelium, suggestive of a pseudocyst. Previous literature reports indicate that RPCs are very rare and are often discovered incidentally. Patients may be asymptomatic or present with vague symptoms. Imaging can help diagnose these lesions, but surgery is crucial in confirming the diagnosis. [ABSTRACT FROM AUTHOR]

The paper considers the possibilities, prospects, and drawbacks of the mixed reality (MR) technology application using mixed reality smartglasses Microsoft HoloLens 2. The main challenge was to find and develop an approach that would allow surgeons to conduct operations using mixed reality on a large scale, reducing the preparation time required for the procedure and without having to create custom solutions for each patient. Research was conducted in three clinical cases: two median neck and one branchial cyst excisions. In each case, we applied a unique approach of hologram positioning in space based on mixed reality markers. As a result, we listed a series of positive and negative aspects related to MR surgery, along with proposed solutions for using MR in surgery on a daily basis.

Previous research has confirmed that patients with choledochal cyst have an elevated risk of cholangiocarcinoma and gallbladder carcinoma. Current data suggest a risk of malignancy of 6 to 30% in adults with choledochal cyst. Malignancy has also occasionally been identified in children and adolescents. Multiple factors, including the age of the patient, cyst type, histological findings, and localization, have an impact on the prognosis. Information on long-term outcomes after cyst excision is limited. However, recent data suggest a lifelong elevated risk of up to 4% of cancer development following operation. This paper presents a review of the literature on cancer in patients with choledochal cyst before and after excision. A postoperative follow-up concept that consists of annual controls of CA19-9 and abdominal ultrasound is introduced. [ABSTRACT FROM AUTHOR]

Background. Arachnoid cysts account for 1% of intracranial mass lesions. Quadrigeminal cistern arachnoid cysts are even rarer lesions. We report 18 cases of quadrigeminal cistern arachnoid cysts treated at our institute from 2002 to 2012. Methods. We retrospectively analysed 18 patients with quadrigeminal cistern arachnoid cyst for clinical presentation, demographic profile, management and outcome. The age of the patients ranged from 29 days to 50 years (mean 17 years). The cysts were classified into 3 subtypes based on MRI findings. Surgical intervention was carried out in all the patients. Results. Two patients had Type 1 cysts, 4 had Type 2 cysts and 12 had Type 3 cysts. Two patients (Type 1) underwent endoscopic third ventriculostomy (alone). Craniotomy and cyst wall excision along with ventriculocystostomy and cystocisternostomy were done in 4 patients with Type 2 cysts, and endoscopic fenestration of cysts to the sub-arachnoid space or the ventricles and endoscopic third ventriculostomy were done in 7 patients with Type 3 cysts. Two patients with Type 3 cysts underwent only endoscopic ventriculocystostomy and cystocisternostomy without endoscopic third ventriculostomy, while three patients underwent ventriculoperitoneal shunt. The follow-up period ranged from 6 months to 48 months (mean 23.7 ± 12.3 months). Conclusion. Quadrigeminal plate arachnoid cysts are generally symptomatic and require some form of surgical intervention. We believe that endoscopic fenestration of the cyst with cystocisternostomy or cystoventriculostomy, when combined with third ventriculostomy, is the procedure of choice for such patients. We do not recommend the placement of a ventriculoperitnoeal shunt alone. Operative re-exploration should be planned only after obtaining proper clinico-radiological correlation and not on the basis of imaging findings alone, as sometimes the cysts fail to regress but the symptoms improve. [ABSTRACT FROM AUTHOR]

Background and Aim The aim of this study was to elucidate the risk of subsequent biliary malignancy in patients undergoing cyst excision for congenital choledochal cysts. Methods A retrospective analysis of 94 patients who had undergone cyst excision for congenital choledochal cysts was conducted. The median age at the time of cyst excision and median follow-up time after cyst excision were 7 years and 181 months, respectively. Results Biliary tract cancer developed in four patients at 13, 15, 23, and 32 years after cyst excision. The cumulative incidences of biliary tract cancer at 15, 20, and 25 years after cyst excision were 1.6%, 3.9%, and 11.3%, respectively. The sites of biliary tract cancer were the intrahepatic ( n = 2), hilar ( n = 1), and intrapancreatic ( n = 1) bile ducts. Of the four patients with biliary tract cancer after cyst excision, three patients underwent surgical resection and one patient received chemo-radiotherapy. The overall cumulative survival rates after treatment in the four patients with biliary tract cancer were 50% at 2 years and 25% at 3 years, with a median survival time of 15 months. Conclusions The risk of subsequent biliary malignancy in patients undergoing cyst excision for congenital choledochal cysts seems to be relatively high in the long-term. The risk of biliary malignancy in the remnant bile duct increases more than 15 years after cyst excision. Despite an aggressive treatment approach for this condition, subsequent biliary malignancy following cyst excision for congenital choledochal cysts shows an unfavorable outcome. [ABSTRACT FROM AUTHOR]

Background: Proximal tibiofibular joint (PTFJ) ganglion cysts are rare; however, their optimal management remains unclear. This study aimed to systematically review the surgical treatment options with a focus on recurrence rates and complications., Methods: A systematic review of the literature was performed, searching three electronic databases, according to the PRISMA guidelines. The presentation, treatment, and outcomes of PTFJ ganglion cysts of minimum 1-year follow-up was collected. Study quality was assessed using the Modified Downs and Blacks checklist. Surgical interventions were considered ordinally from simple to more extensive as follows; cyst aspiration, cyst excision, cyst excision with an intervention to the PTFJ, either a hemi-resection or arthrodesis., Results: Twenty-two studies comprising 100 patients (101 knees) met inclusion criteria. Among all patients, pain was present in 59.7%, a lateral fullness in 71.6% and symptoms of the common peroneal nerve in 57.4%. The overall rate of recurrence after primary treatment was 28.9%. Recurrence rates for aspiration, cyst excision, PTFJ hemi-resection and PTFJ arthrodesis were 81.8%, 27.4%, 8.3% and 0%, respectively. Revision excision for recurrence failed in all cases. Outcomes beyond recurrence were poorly reported., Conclusion: Addressing the PTFJ at the time of cyst excision reduces recurrence rates, however, the morbidity from PTFJ hemi-resection and arthrodesis are poorly reported. Whilst primary excision offers resolution in most cases (73%), revision cyst excision in isolation for the treatment of recurrent cysts is an inadequate treatment option. Cyst aspiration is ineffective. Data pertaining to patient reported outcomes for all treatment types are lacking., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Hydatid cyst is a parasitic infestation caused by the larval stage of Echinococcus spp. and a health problem in many parts of the world. Hydatic cyst is generally formed in the liver and lungs, while renal involvement is rare, comprising only 2% to 4% of cases. The aim of this study was to assess the efficacy of open cyst excision and omentoplasty surgery in the treatment of isolated renal hydatid csyt. Materials and methods: Seven patients with isolated renal hydatid cyst treated in our clinic with open cyst excision and omentoplasty surgery between April 1999 and June 2009 were reviewed, retrospectively. The patients were evaluated for demographics, symptoms, clinical, laboratory and radiological findings. Results: Of 7 patients, 5 (%71.4) were women and 2 (%28.6) were men. The mean age of the patients was 42.71±16.60 (range 17-65) years and follow-up period was 54.14±40.66 (range 6-126) months. The main clinical symptom was lumbar pain in 3 patients (42.9%), while 4 patients (57.1%) were asymptomatic. The only physical examination finding is abdominal mass in 1 patient. Eosinophilia was detected in 3 (42.9%) patients. A positive indirect hemagglutination test for Echinococcus granulosus was seen in 5 (%71.4) patients. The mean operation time was 109.29±39.63 (range 70-180) min and hospitalization time was 3.14±1.07 (range 2-5) days. There was no postoperative complication and recurrence was seen in follow-up period and all of the patients were alive. Conclusion: Cyst excision and omentoplasty is an effective surgical technique for the treatment of isolated renal hydatid disease. [ABSTRACT FROM AUTHOR]

Proximal tibiofibular ganglion is a rare disorder. It may settle down in the subcutaneous tissue or may develop along the peroneal muscles and nerve. Common clinical findings are various sizes of mass, pain and hypoesthesis due to compression neuropathy. We report three cases of proximal tibiofibular ganglion and review the literature about the diagnostic tools, recurrence rates and treatment modalities. [ABSTRACT FROM AUTHOR]

The paper considers the possibilities, prospects, and drawbacks of the mixed reality (MR) technology application using mixed reality smartglasses Microsoft HoloLens 2. The main challenge was to find and develop an approach that would allow surgeons to conduct operations using mixed reality on a large scale, reducing the preparation time required for the procedure and without having to create custom solutions for each patient. Research was conducted in three clinical cases: two median neck and one branchial cyst excisions. In each case, we applied a unique approach of hologram positioning in space based on mixed reality markers. As a result, we listed a series of positive and negative aspects related to MR surgery, along with proposed solutions for using MR in surgery on a daily basis. [ABSTRACT FROM AUTHOR]

Choledochal cyst is often associated with pancreatobiliary malunion, and pancreatic juice usually refluxes into the bile duct via the malunion. Various pathological conditions develop in the biliary tract, pancreas, and liver: cholangitis, biliary dilatation, biliary perforation, biliary cancer, acute pancreatitis, and/or biliary cirrhosis. The performance of cystenterostomy has recently been abandoned because of high morbidity after surgery. Accurate delineation of the biliary tree and the pancreatobiliary junction obtained by endoscopic retrograde cholangiopancreatography or operative cholangiography is necessary. Cyst excision should be performed to prevent ascending cholangitis and biliary cancer. Many types of procedures are employed in biliary reconstruction, but free drainage of bile is imperative for preventing cholangitis and stone formation. This can be achieved only by a wide anastomosis performed at the hilum after ductoplasty. [ABSTRACT FROM AUTHOR]

Hydatid disease is endemic in parts of India, yet genitourinary involvement is rare. Laparoscopic management of such cases is uncommonly reported. We present a case of an adrenal hydatid and its management by laparoscopic aspiration, instillation of scolicidal solution, and partial excision of the cyst. [ABSTRACT FROM AUTHOR]

Reports of different synchronous tumors involving both ovaries are rare, and most fall in the malignant category. This is the case of a 15-year-old female with an unremarkable past medical history who presented with acute onset lower abdominal pain. Imaging studies demonstrated a large complex cystic and solid mass in the midline pelvis. During robotic pelvic mass excision, she was found to have two separate masses, one involving each ovary. The patient underwent successful bilateral ovarian-sparing mass excision. Pathology examination of the specimens revealed mature cystic teratoma of the right ovary and left ovarian serous cystadenoma. We present this case for the uniqueness of the bilateral ovarian pathology as well as to show that robotic-assisted resection of ovarian tumors in certain children is safe and feasible. [ABSTRACT FROM AUTHOR]

Two patients who suffered recurrent hydrocephalus after cysticercal removal by means of endoscopic transventricular (ETV) approach are presented. Severe inflammatory lesions within the ventricular system and basal cisterns, with a patent third-ventriculostomy were demonstrated during a second endoscopic observation. Mandatory shunting with prolonged steroid therapy may be indicated after intraoperative cysticercal rupture after ETV removal, as showed by sequential endoscopic observations. [ABSTRACT FROM AUTHOR]

Neurenteric cysts are congenital lesions of the spine usually diagnosed in children. There are few reports of diagnosis in adults. The abnormality is thought to arise during embryonic life and can be associated with other congenital deformities. We describe a case where the diagnosis occurred in a 54-year-old woman, whose symptoms improved following surgical excision of the cyst. We postulate that the cyst contributed to symptoms of cord tethering rather than cord compression and that the lateness of presentation was due to age-related spinal degeneration. [ABSTRACT FROM AUTHOR]

A rare case of unilateral benign essential tremor is presented that responded to surgical excision of a posterior fossa arachnoid cyst [ABSTRACT FROM AUTHOR]