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Şakir Ekşi M, Ece Özcan-Ekşi E, Orhun Ö, Akkaş A, Harun Yaşar A, Zarbizada M, Canbolat Ç, Güdük M, Bozkurt B, İmre Usseli M, Erşen-Danyeli A, Hamit Aytar M, Kalelioğlu M, Özgen S, Necmettin Pamir M, Benzel EC. Could gas-filled pseudocyst mimick extruded disc herniation? J Clin Neurosci 2021; 93:147-154. [PMID: 34656239 DOI: 10.1016/j.jocn.2021.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
There are case reports and small case series in the literature reporting gas-filled pseudocysts (GFP). However, a systematic review presenting overall view of the disease and its management is still lacking. In the present study, we aimed to make a systematic review of GFP cases, and present an exemplary case of ours. Our second aim was to discuss current theories for pathogenesis of GFP. A systematic review of GFP was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two large-scaled data search engines were used. A total of 53 articles were retrieved from the literature and presented with an exemplary case of ours. Mean age of the historical cohort was 59.47 years. There were 66 male (54.1%) and 56 female (45.9%) patients. The most prevalent clinical presentation was radicular sign/symptom in lower limbs with (29.1%) or without low back pain (LBP) (67%). Gas-filled pseudocyst has most commonly been diagnosed at the lower lumbar spine (L4-L5, 45.3%; L5-S1, 37.7%). Surgery was the treatment of choice in most of the patients (80%). In the whole cohort, 79.1% of the patients had complete recovery. Gas-filled pseudocysts are rarely observed in daily practice. They present mostly in men at the age of 60s. Precise differential diagnosis determination using appropriate imaging would help clinicians treat the patients properly. Gas-filled pseudocysts should be treated similarly to other spinal pathologies causing nerve root compression.
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Affiliation(s)
- Murat Şakir Ekşi
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
| | - Emel Ece Özcan-Ekşi
- Bahçeşehir University, School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Ömer Orhun
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey
| | - Alper Akkaş
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Ahmet Harun Yaşar
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Maftun Zarbizada
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Çağrı Canbolat
- Memorial Hizmet Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Mustafa Güdük
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Baran Bozkurt
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Murat İmre Usseli
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Ayça Erşen-Danyeli
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Pathology, Istanbul, Turkey
| | - Murat Hamit Aytar
- Acıbadem Healthcare Group, Acıbadem Kozyatağı Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Müfit Kalelioğlu
- Acıbadem Healthcare Group, Acıbadem Altunizade Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Serdar Özgen
- Acıbadem Healthcare Group, Acıbadem Maslak Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - M Necmettin Pamir
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Edward C Benzel
- Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, OH, USA
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Liu XX, Xin X, Yan YH, Ma XW. Imaging characteristics of a rare case of monostotic fibrous dysplasia of the sacrum: A case report. World J Clin Cases 2021; 9:1111-1118. [PMID: 33644174 PMCID: PMC7896654 DOI: 10.12998/wjcc.v9.i5.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/14/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fibrous dysplasia (FD) is a common benign intramedullary fibro-osseous lesion. Involvement of the spine is rare, with the literature including only case reports, and cases of monostotic FD (MFD) in the sacrum are extremely rare. A correct preoperative diagnosis of spinal MFD is important for clinicians to select proper treatment.
CASE SUMMARY We retrospectively assessed a case report of MFD in the sacrum. This patient was examined by computed tomography (CT) and magnetic resonance imaging (MRI), and the diagnosis was confirmed by pathology. A review of the literature was performed to analyze the imaging characteristics and differential diagnoses of spinal MFD. For our patient, the CT scan showed the lesion to be expansile, with ground glass opacity and a sclerotic rim. On MRI, the lesion showed iso-low signal intensity on T1WI and iso-high signal intensity on T2WI. A low signal rim was found on T1WI and T2WI. Our patient was treated by posterior focal excision, decompression, bone grafting, fusion and pedicle screw fixation. A satisfactory result was achieved, with pain disappearance. No complications had occurred at the 1-year follow up.
CONCLUSION MFD is an expansile osteolytic change. Ground glass opacity and a sclerotic margin are obvious characteristics. The lesion often involves the vertebral body and posterior element. Knowledge of these imaging characteristics of spinal FD could be helpful for diagnosis and prevent unnecessary procedures.
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Affiliation(s)
- Xin-Xin Liu
- MRI Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, China
| | - Xin Xin
- Department of Orthopaedics, Ankang Center Hospital, Ankang 725000, Shaanxi Province, China
| | - Yu-Hong Yan
- MRI Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, China
| | - Xiao-Wen Ma
- MRI Department, Honghui Hospital, Xi'an Jiaotong University, Xi'an 710054, Shaanxi Province, China
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