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BACKGROUND Transvaginal mesh (TVM) has been used for treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Mesh-related complications are reported in 3% of women receiving mid-urethral sling surgery for SUI and in up to 20% of women who receive TVM for POP. The Australian Senate Enquiry report in March 2018 recommended that each Australian state establish specialist multidisciplinary units for management of TVM complications. AIMS The aims of this study are to report on the setting up of the Queensland Pelvic Mesh Service (QPMS) and summarise its first 24 months to provide a potential framework for the establishment of similar service models within Australia and internationally. MATERIALS AND METHODS The planning and implementation of QPMS was a complex two-stage co-design process involving clinicians and consumers representing women with TVM complications. Consumer input in planning was important for the optimal establishment of QPMS to meet women's holistic needs. RESULTS From April 2019 to April 2021, 484 women had been treated by the medical team; 257 women had undergone cystoscopy and examination under anaesthesia; 91 patients had undergone mesh revision surgery - 65 complete excision and 25 partial excision and one sling division; and 180 women had been discharged from QPMS. CONCLUSIONS Providing a comprehensive multidisciplinary service for managing TVM complications requires careful planning with consumer involvement before initiation. Addition of these patients to an existing service may not succeed. Emphasis on surgery may be misplaced for many. QPMS patients, as in sufferers with chronic pain conditions, benefit from psychological support and allied healthcare.

Osteomyelitis of the phalanx caused by Candida species are rare. A 49-year-old female patient was admitted to an external center with a splinter injury of the third phalanx of the middle finger of her left hand about 45 days ago. She was referred to our clinic with persistent pain and discharge, despite four-week antibiotherapy. Debridement and curettage were performed and partial excision of the distal phalanx at an appropriate level was done. Her complaints gradually resolved postoperatively with prescribed antibiotics for the pathogen identified as Candida lusitaniae based on the intraoperative cultures. At her three-month follow-up visit, treatment yielded near-excellent results. To the best of our knowledge, this is the first case of osteomyelitis of the distal phalanx caused by Candida lusitaniae in the literature, highlighting the importance of definitive diagnosis and pathogen-specific treatment, rather than empirical treatment, to achieve favorable results with cure.

Choristomas are congenital lesions presenting normal tissue in an abnormal location. A conjunctival dermolipoma is a congenital choristomas tumor usually localized in the temporal aspects of the bulbar conjunctiva, near the lateral canthus. It may be associated with developmental anomalies of the second branchial arch, such as Goldenhar syndrome. The association between dermolipoma and lateral canthal cleft without other congenital anomalies is uncommon. The purpose of this paper is to present a series of isolated choristomas in the lateral canthus associated with a lateral cleft. We present 3 cases of dermolipoma at the lateral canthus associated with isolated lateral cleft. The dermolipomas’ appearance ranges from a flat lesion to a large pedunculated tumor, obliterating the lateral conjunctival fornix. A partial removal of the dermolipoma was done with canthoplasty to close the lateral coloboma. Surgical management of dermolipoma with partial excision aimed at reducing visible tumor produced good cosmetic results, without complications. Microscopic examination of the tumor revealed a mass covered by stratified squamous keratinized epithelium. The mass comprised largely of mature adipose tissue interspersed with bundles of collagen. The presence of pilosebaceous units was also noted. Based on these features, a histopathological diagnosis of a dermolipoma was made. The association between dermolipoma and isolated lateral canthal cleft is much less common than the associations with other distinguishing abnormalities. In summary, these cases illustrate that dermolipomas are also a part of a wide spectrum that characterizes benign growths of the eyelids. Level of evidence: Level V, therapeutic study.

The management of prosthetic dialysis arteriovenous graft infection comprises antibiotic treatment and total or partial excision of infected grafts for infectious source control. Partial excision with graft bypass is an important graft preservation strategy for localized infection but carries a higher reinfection risk. Here, we report a case of prosthetic graft infection that was successfully treated with partial excision, a graft bypass procedure, and a portable negative pressure wound therapy system, PICO, applied to the open wound postoperatively. The combined approach may be a useful strategy that decreases reinfection risk, shortens the length of hospital stay, and preserves graft patency.

Background: In end-to-side vessel-anastomoses, a side fenestration should be made by a slit incision or partial excision of the vessel wall. However, a slit incision might restrict blood flow acros...

A pediatric dermatology expert working group performed a narrative review to describe care related to congenital melanocytic nevi (CMN) in neonates and infants. There are no published guidelines for most aspects of care, including routine skin care and visit intervals. Few guidelines exist for surgical management; newer recommendations favor conservative practice. Emerging evidence contributes to recommendations for screening MRI to evaluate for neural melanosis and related central nervous system complications, however, more research is needed. Risk for melanoma is generally low, but those with large, giant, or multiple CMN have a higher risk. Multidisciplinary care, with a focus on family and patient preferences, is of paramount importance. Without standardized screening and management guidelines, questions abound regarding appropriate physical examination intervals, potential treatment including full or partial excision, timing and frequency of imaging, melanoma risk, and assessment for neural melanosis. This review highlights the current state of knowledge concerning care of patients with CMN, reveals gaps in the literature surrounding skin care, and provides management recommendations. We additionally discuss cutaneous complications of CMN, such as pruritus, hypertrichosis, and wound healing. Resources and references for families and providers can help patients navigate this sometimes challenging diagnosis. Finally, we contribute expert care recommendations to the current body of literature as a foundation for the development of future, more comprehensive care guidelines.

We describe the first case of proximal ulnar pseudoaneurysm due to extended-spectrum beta-lactamase-producing Escherichia coli. We performed an open ligation of the ulnar artery and partial excision of the aneurysmal sac. This article discusses the etiology and surgical management of ulnar-infected pseudoaneurysms according to the literature data.

A calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor characterized by a hypocellular fibroblastic proliferation with associated chronic inflammation and variably prominent calcification. Gastrointestinal (GI) tract is the most common predilection site of CFT. English-language literature reveals approximate 50 such reports of GI-CFTs. In addition, the most frequently identified sites of the GI tract are stomach, small bowel, and colon. However, CFT has not been reported in the pancreas. In addition, we present the first pancreatic-CFT in this case report.

Aim: The widely accepted method in treatment of osteoid osteoma is either the complete excision or destruction of the nidus. The aim of this study was to evaluate the efficacy of partial nidus excision using a bone marrow biopsy needle as a minimally invasive technique for management of atypical cancellous osteoid osteomas.Material and Method: Partial excision of the nidus was performed in four cases using an 11-G bone marrow biopsy needle under fluoroscopic guidance. The lesions were located in the capital femoral epiphysis, the posterosuperior side of the femoral neck, the distal tibial epiphysis and the olecranon process of the ulna.Results: The patient’s pain resolved the night following excision of the nidus. No recurrence was observed at the 72, 36, 32 and 24 month follow-ups.Conclusion: Partial excision of the nidus may be considered a remarkable technique especially in the treatment of atypical cancellous osteoid osteoma, where surgical intervention is challenging., Amaç: Osteoid osteoma tedavisinde yaygın olarak kabul edilen yöntem nidusun ya tam eksizyonu ya da tahrib edilmesidir. Bu çalımanın amacı, atipik kansellöz osteoid osteoma tedavisinde minimal invasiv teknik olarak kemik iliği biyopsi iğnesi ile kısmi nidus eksizyonu etkinliğini değerlendirmekti.Gereç ve Yöntem: Dört olguda 11-G kemik iliği biyopsi iğnesiyle floroskopi kılavuzluğunda nidusun kısmi eksizyonu uygulandı. Lezyonlar femur başı epifizi, femur boynu posterosüperior tarafı, tibia distal epifizi ve olekranon çıkıntıda yerleşmişlerdi.Bulgular: Hastaların ağrısı nidus eksizyonunu takip eden gece geçti. 72, 36, 32 ve 24. aylardaki takipte nüks görülmedi.Sonuç: Nidusun kısmi eksizyonu özellikle cerrahi girişimin zor olduğu atipik kansellöz osteoid osteoma tedavisinde dikkate değer bir teknik olarak düşünülebilir.

Lymphangioma is a benign neoplasm caused by a congenital malformation of the lymphatic vessels.Purpose. To study the possibility of momentary radical removal of lymphangioma in children based on a prospective cohort study in parallel groups.Characteristics of children and research methods. The article presents the results of treatment of 152 patients with lymphangioma, reported from the Department of Vascular Surgery of the Children’s Republican Clinical Hospital of Tatarstan. All patients were divided into 3 groups according to the applied method of treatment. The patients in Group 1 (n=95) underwent radical removal of lymphangioma, patients in Group 2 and Group 3 underwent partial removal followed by sclerotherapy of the residual cavity of the lymphangioma.Results. The authors observed relapse in 17 (11.2%) cases, 11 of these cases were observed after previous operation of complete excision (Group 1). According to the study of the distribution of relapses, there was no difference between the groups.Conclusion. Momentary radical excision of lymphangioma is implementable in 63.3% of cases. If it is impossible to remove lymphangioma completely they use partial excision and sclerotherapy of the residual cavity. The probability of relapse does not increase in case of impossibility to remove lymphangioma completely. Minimal invasive procedure is a priority of modern surgery, as it reduces surgical trauma, facilitates postoperative period and improves cosmetic result.

We report the case of a 58-year-old man who had Rosai-Dorfman disease (RDD) with aortitis. He developed a mass in the chest wall, for which a partial excision via thoracoscopy was performed. In add...

The article reflects modern views on epidemiology, clinical manifestations, classification, principles of diagnostics and treatment of hemangiomas. The purpose of our study was the analysis of the results of different methods of treatment inof children with hemangioma over a ten-year period (from 2007 to 2017) at Irkutsk Regional Children Hospital. We have found a significant reduction in cases of invasive treatment in patients with this pathology. In 2017, inhemangioma was excised in 179 children, and in 2017, this method was used only in 28 patients. Since 2009 cryolysis of vascular neoplasms has not been performedcryolysis. Conservative treatment of hemangiomas include hormone therapy with prednisone as well as systemic and local treatment with beta-adrenergic blocking agents. At the same time, we showed that conservative treatment of hemangiomas is effective before surgery. That is confirmed by the clinical observation of the child with an extensive perineal hemangioma, who underwent the combined treatment using surgical cryodestruction and hormone therapy. This example shows that a good aesthetic result has been obtained only when using hormone therapy, while partial excision of hemangiomas resulted in a violation of the anatomy of the external genitalia, and cryodestruction resulted in an extensive hypertrophic scar on both buttocks. It is concluded that the reasons for the change in treatment tactics in children with hemangiomas are determined by the possibility of using non-invasive methods with obtaining the optimal result of treatment in both oncological and aesthetic terms.

Purpose The purpose of this study is to evaluate partial excision of the levator ani muscle (PELM) enables preservation of anal sphincter function although levator ani muscle (LAM) was invaded. Methods Functional outcomes and oncologic outcomes of 23 consecutive patients who underwent robotic PELM for low rectal cancer at the anorectal ring level invading or abutting the ipsilateral LAM are analyzed. Results Secured resection margins were achieved, especially for the circumferential resection margin. During a median follow-up of 44 months, the 3-year local recurrence rate was 14.4%. Among patients who underwent diverting ileostomy closure, mean Memorial Sloan Kettering Cancer Center Bowel Function Instrument and Wexner scores were 68.3±11.9 and 10.7±5.3, respectively, at 1 year after closure. Conclusion PELM is a sphincter-preserving alternative to APR or extralevator APR for low rectal cancer invading the ipsilateral LAM at the level of the anorectal ring. This article is protected by copyright. All rights reserved.

Human penile ossification is a rare urologic condition with approximately 40 cases reported in the literature so far. While bone is essential for penetrative intercourse in many non-human mammals, human penile ossification appears to be part of a metaplastic process occurring after injury or trauma. Conditions such as Peyronie's disease, diabetes mellitus, local trauma, and end-stage renal disease have been associated with this entity. We report the case of a 65-year-old male with penile curvature and a history of painful intercourse who underwent partial excision and grafting with bovine pericardial graft and was found on pathologic examination to have penile ossification.

We report simplified surgical management of giant congenital forehead nevus that customarily requires the use of tissue expander for complete excision. Commencing treatment at the age of 3 months, the TopClosure tension relief system (TRS) was applied as an external tissue expander allowing preoperative skin stretching by mechanical creep. This was followed by partial excision of the nevus. Intraoperative stress-relaxation allowed further expansion of the skin. Postoperative wound closure was secured with the aid of the TRS. Repeated, six simple staged excisions of the forehead lesion and a minor skin graft to the eyelid part, allowed for delayed primary closure of the entire lesion by the age of 2. This simple alternative approach, which allows the early start and early conclusion of the reconstructive process, should be considered as the primary option in the treatment of these patients.

This case report focuses on the risk factors, diagnosis, and management of vascular graft infections. A complex and intriguing case is presented and the latest evidence on aetiology and management of this challenging condition are summarised. The contention regarding the diagnostic criteria for graft infection is addressed, and how different imaging modalities and genetic or systemic biomarkers could aid this diagnostic process. Key management challenges are also discussed. Firstly, the difficulties of penetration and efficacy of antimicrobials and the issues surrounding biofilm formation. Secondly, the different surgical options such as graft preservation with partial excision or muscle flap coverage, or excision and revascularisation. Further, the type of explant and the latest innovations in the field of biological grafts are considered. Overall, this case report brings to the fore the lack of structured guidelines and level 1 evidence for the diagnosis and management of vascular graft infection, and calls for a more structured, unified, multi-disciplinary approach.

The aim of this study is to investigate the clinical presentation and outcomes associated with endoscopic endonasal resection of Rathke cleft cysts (RCCs). The authors retrospectively studied a series of 13 patients who were diagnosed with RCCs after endoscopic endonasal resection at the Second Xiangya Hospital between June 2016 and December 2017. All 13 patients (8 women) underwent a purely endoscopic endonasal approach (EEA) for fenestration and aspiration of RCCs with excision of the cystic wall. The patient ages varied from 25 to 67 years (mean, 45.1 years), and the follow-up period ranged from 8 to 25 months (mean, 16.6 months). Headache was a presenting symptom in all 13 patients, with 11 (80%) out of the 13 having experienced postoperative improvement of their headaches. Six (46%) of the 13 patients were admitted with pituitary dysfunction, all of them had postoperative improvement. Four (31%) of the 13 patients had temporary postoperative pituitary dysfunction, although there was not any permanent pituitary dysfunction. Six patients had intraoperative complications with CSF leaks, and after the operation, three of them developed temporary diabetes insipidly, one of them had a postoperative infection, and another one had postoperative cerebrospinal fluid leaks, who was treated with absolute bed rest for 7 days. No patient experienced recurrent cysts. EEA is a safe and effective approach for the treatment of symptomatic RCCs. Notably, it is appreciated for protecting and restoring pituitary function; however, the postoperative recurrence rate still lacks a large sample related to the long time follow-up study. Complete aspiration of the cysts' contents with partial excision of the cyst wall is usually sufficient for treatment.

Introduction: Removal of intracranial supra-sellar masses continues to be a surgical challenge. Various approaches have been used by different authors with varying results. Anterior basal interhemispheric approach is most suitable with better results than other approaches for craniopharyngiomas Materials and methods: Fifteen patients with large craniopharyngiomas having third ventricular and or retro or supra-sellar extensions or reaching the interpeduncular cisterns were operated by this approach, over a period of seven years since the first use of this approach at our institute. The data of patients opearated by this approach were then retrospectively analysed. There were eleven males and four females with five patients in the pediatric age group. Follow up range was from 2 to 83 months with a mean of 21.6 months. Results: Total excision was achieved in seven (46.6%) and near total excision in another seven (46.6%), partial excision was done in only one (6.66%). Seven patients with total excision were disease free at mean follow up of 6.8 months. There was asymptomatic recurrence in two (13.33%) patient with near total excision at 11 and 63 months respectively and were given radiotherapy post-operatively. All patients were symptom free except one with diabetes insipidus (DI) and one mortality, and one with post operative visual deterioration. Conclusion: Anterior basal interhemispheric approach is a useful alternative to other transcranial approaches in the management of the craniopharyngiomas. It has the advantage of being a midline approach and displays the tumour brain interface better. Keywords: Intracranial, transcranial, craniopharyngiomas

Because of the known tendency for early redislocation following open reduction, we developed surgical methods for shortening the ligamentum teres to improve immediate postoperative stability when performing medial approach open reduction (MAOR) for the management of developmental dysplasia of the hip. Between 2004 and 2014, 32 patients with dysplasia of the hip were managed by MAOR with partial excision and plication of ligamentum teres. The patients were followed up for an average of 6.9 years. At the final follow-up, clinical outcomes achieved were categorized as excellent and good in 39 (39/40; 97.5%) hips. At the latest follow-up, 97.5% (39 hips) were classified as good or excellent on the basis of the Severin classification (Severin grade 1 or 2). In conclusion, this series of MAOR, in which ligamentum teres partial excision and plication was utilized, we found stable reduction in all hips. On the basis of these positive results, we recommend this method for children treated with MAOR. LEVEL OF EVIDENCE Level IV: case series.

Background Scapulectomy is an inevitable treatment for sarcomas of the scapula. This procedure is unavoidable because it reduces the local recurrence rate but can impair shoulder movements and affect the activities of daily living. This study investigated the factors influencing functional outcomes after scapulectomy. Materials and methods The clinical results of 8 patients (5 males, 3 females) who were diagnosed with primary or metastatic sarcomas of the scapula were retrospectively reviewed. The mean age was 49 years (range, 11-86 years). We examined the correlation between the type of excision of the scapula (total, subtotal, or partial) and postoperative functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. In partial excision, the glenohumeral joint was preserved; in subtotal excision, the glenoid was completely resected and some bony components were preserved; and in total excision, the entire bony component of the scapula was resected. The average follow-up period was 55 months (range, 9-142 months). Results The partial, subtotal, and total excision groups had mean functional scores of 96.7%, 76.7%, and 62.2%, respectively. Although the mean functional scores were lower in patients who underwent total and subtotal excisions, 3 patients in whom the latissimus dorsi muscle was preserved had better function (mean MSTS score, 76.7%) than the 2 patients in whom it was not preserved (mean MSTS score, 55.0%). Conclusion These results suggest that the latissimus dorsi muscle, along with the deltoid and pectoralis major muscles, is one of the stabilizers of the proximal humerus after scapulectomy.

To determine if the consistency of pituitary adenomas can be predicted based on a preoperative MRI study and to assess the surgical outcome of firm pituitary adenomas.One hundred consecutive patients with pituitary adenomas and suprasellar extension were operated by a transsphenoidal approach from July 2003 to December 2006. In addition to the neurological examination, the patients were evaluated by ophthalmological, endocrinological and radiological workups. The signal intensity of the lesion on T2WI and other dimensions of the tumors were included in the MRI study.There were 52 male and 48 female patients with a mean age of 42.47 years. The mean diameter of the tumor was 32.97mm and the mean SSE was 14.95mm. Six out of 100 patients had firm adenomas peroperatively. Only one of the six patients had isointense SI on T2 WI. Of these 6 patients, total excision was performed in 1 patient, subtotal in 3 patients and partial excision in 2 patients. Among the six patients with firm adenomas, 4 had preoperative hypopituitarism (P0.001). There was a statistically significant correlation between consistency and the postoperative permanent hypopituitarism (P0.001). The average follow up was 43.5 months. The literature is reviewed and various aspects of pituitary adenoma consistency are discussed.With the present study, the consistency of pituitary adenomas cannot be reliably predicted based on a preoperative MRI study. Patients with firm adenomas likely to have more incidence of preoperative hypopituitarism and postoperative permanent hypopituitarism.

Posterior glottic stenosis (PGS) is a rare but life-threatening condition mostly caused by damage to the interarytenoid mucosa by an endotracheal tube. In surgical treatment of PGS, airway patency is prioritized, and the laryngeal functions involved in swallowing and phonation are considerably sacrificed. In the majority of cases, lateralization of a vocal fold or partial excision of a vocal fold and arytenoid cartilage results in glottal closure insufficiency and deterioration of phonatory function. We present the first report of transcricothyroid endoscopic subglottic surgery to treat a 46-year-old man with PGS who was intubated for 10 days. Postoperative hypofunction was not observed in the aerodynamic examination and acoustic analysis, and phonatory function has been maintained within normal limits.

Tunical plaque incisions are common techniques utilized during grafting procedures for Peyronie’s disease. The aim of this review was to examine the different tunical incisional and excisional techniques, as well as outcomes and complications of recent graft procedures utilizing these strategies. Studies on tunical incision, partial excision, and grafting techniques vary with regards to their surgical outcomes, post-operative erectile dysfunction rates, and other complications. Overall, significant penile straightening has been reported in recent studies of incision and grafting for Peyronie’s disease. Prospective trials comparing the different tunical incisional techniques are needed to better plan surgical interventions for Peyronie’s disease.

Background Many difficulties exist in establishing a treatment plan for slow-flow vascular malformation (SFVM). In particular, little research has been conducted on the surgical treatment of SFVMs. Thus, we investigated what proportion of SFVM patients were candidates for surgical treatment in clinical practice and how useful surgical treatment was in those patients. Methods This study included 109 SFVM patients who received care at the authors’ clinic from 2007 to 2015. We classified the patients as operable or non-operable, and analyzed whether the operability and the extent of the excision varied according to the subtype and location of the SFVM. Additionally, we investigated complications and self-assessed satisfaction scores. Results Of the 109 SFVM patients, 59 (54%) were operable, while 50 (46%) were nonoperable. Total excision could be performed in 44% of the operable SFVM patients. Lymphatic malformations were frequently non-operable, while capillary malformations were relatively operable (P=0.042). Total excision of venous malformations could generally be performed, while lymphatic malformations and combined vascular malformations generally could only undergo partial excision (P=0.048). Complications occurred in 11% of the SFVM patients who underwent surgery; these were minor complications, except for 1 case. The average overall satisfaction score was 4.19 out of 5. Conclusions Based on many years of experience, we found that approximately half (54%) of SFVM patients were able to undergo surgery, and around half (44%) of those patients were able to fully recover after a total excision.Among the patients who underwent surgical treatment, high satisfaction was found overall and relatively few complications were reported.

Hydroponics provides a stable root environment that can be easily controlled. In this paper, we investigated the effect of partial excision of early taproots of hydroponic carrots on their growth and components. Carrot taproots were excised after 30 days from sowing at 5 cm, 10 cm, and 15 cm from the stem base (C5, C10, and C15) and compared with nonexcised control plants. Time-course measurements revealed the taproot lengths of C10 and C15 plants gradually decreased. After 28 days of treatment, C5 taproot tips showed the most rounded shape among root-excised plants. Control plants possessed long taproots that were not enlarged at the site more than 15 cm from the stem base. Taproot fresh weight was lower in C5 plants and higher in C15 plants compared with controls. Although taproot sugar concentrations did not differ between treatments, total phenol concentration was higher in C5 taproots. These data suggest that partial removal of early taproots can regulate the shape and ingredients of hydroponic carrots.

A newborn boy presented with a progressively infiltrating and painful congenital ulcerated plaque on the back of his left foot. A partial excision was performed and histopathologic examination confirmed a diagnosis of a plexiform fibrohistiocytic tumor. This rare tumor usually appears in children and adolescents, with congenital presentations even more uncommon. This case details the exceptional presentation of a congenital ulcerated plexiform fibrohistiocytic tumor with a review of the current literature.

Endoscopic submucosal dissection is an effective procedure for treating non-invasive colorectal tumors. However, in cases of severe fibrosis, endoscopic submucosal dissection may be technically difficult, leading to incomplete resection. Here, we describe the case of a 74-year-old man who had early rectal cancer along with severe submucosal fibrosis caused by prior local excision. Combination treatment with endoscopic submucosal dissection and transanal minimally invasive surgery successfully enabled complete resection.

Take Home Message When choosing a management strategy for a patient with Peyronie’s disease (PD), it is critical to consider the phase of the disease, penile plaque characteristics, degree of curvature, associated deformities, stretched penile length, and baseline erectile function. Equally important is an understanding of the patient’s goals and expectations. Treatment cost and duration may also be vital considerations for the patient. In this case, the degree of curvature and large calcified plaque make treatment with intralesional injection of collagenase Clostridium histolyticum unlikely to result in a functionally straight erection despite 6–7 mo of therapy. Conversely, surgery with either penile plication or plaque incision/partial excision and grafting can provide reliable straightening with 0–1 d of hospitalization and approximately 6 wk of recovery. With careful preoperative counseling and joint decision-making, surgical treatment of PD deformity can provide more complete correction in less time and at lower overall costs.

Patient with right frontal low-grade oligoastrocytoma treated with partial excision surgery and subsequent combined radiation therapy–chemotherapy following anaplastic transformation. Morphofunctional MR follow-up performed with morphologic study, perfusion, and spectroscopy at 24 months after surgery and combined chemotherapy.

46-year-old patient with left frontal-opercular anaplastic astrocytoma and subsequent anaplastic transformation treated with surgery and partial excision and combined radiation therapy–chemotherapy and subsequent adjuvant second-level chemotherapy. 3T multimodal MR follow-up performed with morphologic sequences, diffusion, and perfusion imaging and spectroscopy preoperatively and at 6 and 12 months after surgery and combined radiation therapy–chemotherapy.

Sylvian fissure arachnoid cysts are known intracranial lesion in pediatric population. We describe a case of symptomatic cyst of Sylvian fissure that was managed with a standard endoscopic cystocisternostomy and re-endoscopy.We also describe the techniques of fenestration of medial wall cyst and partial removal of arachnoid membrane over third cranial nerve in anterior part (region near Dolenc medial triangle) and posterior part (region near Fukushima superior (paramedial) triangle) prevent closure of fenestration and recurrence of hypertension.A 6 years old girl presented with progressively increasing headache, left side hemiparesis, drag resistant of symptomatic epilepsy. MRI and CT scan showed right Sylvian fissure arachnoid cyst.The first endoscopic fenestration of cyst was done on standard basis. After operation patient improve clinically and radiologically. Two years later the patient came back with recurrent symptoms. The operation was performed by prof. Sufianov A. Endoscopic reoperation showed closure of fenestration in arachnoid membrane. Endoscopic re-fenestration with partial excision of arachnoid on over third cranial nerve in anterior and posterior part was excised. The patient again recovered radiologically and clinically till last follow up.In Sylvian fissure arachnoid cysts, endoscopic treatment with wide fenestration of medial wall of cyst preferably with partial removal of arachnoid may be very useful and preventing recurrent symptoms. Keywords: Endoscopic fenestration of cyst, Endoscopic cystocisternostomy, Sylvian fissure arachnoid cyst, Redo surgery, Endoscopic technique

Advanced multiple organ parasitic invasion is reported in the article. A thorough assessment of pathological process, surgical anatomy and preoperative examination resulted radical surgery despite multiple organ disease. Surgical procedure included extended left-sided hemihepatectomy, atypical resection of SОписана запущенная мультиорганная паразитарная инвазия. Несмотря на поражение нескольких органов, тщательная оценка характера патологического процесса, хирургической анатомии, предоперационное планирование позволили выполнить радикальную операцию, включающую расширенную левостороннюю гемигепатэктомию, атипичную резекцию S

Melanoacanthoma is a benign epithelial tumor composed of melanocytes and keratinocytes that can morphologically mimic malignant neoplasms. Two patients with melanoacanthoma that clinically masqueraded as melanoma are described: a 65-year-old African-American woman with a pigmented nodule on the right preauricular area and an 85-year-old Haitian-Creole man with a large exophytic nodule on his left lower abdomen. Melanoma was clinically suspected in both patients. Biopsies were performed, which established the diagnosis of melanoacanthoma. Complete removal of a melanoacanthoma should be considered since partial excision may result in recurrence.

Introduction and Study Design: Spinal arachnoid cyst is an uncommon entity, presenting with radiculopathy or paraparesis. These cysts are usually found in intradural extramedullary region; and the extradural region is a rare location. The exact pathogenesis in the existence of these cysts in the extradural region is still debated. In this article, we have retrospectively analyzed the clinical profile of the rare extradural arachnoid cyst (EDAC). Methodology: In this study, 19 patients of EDAC operated at our institute between January 2006 to June 2016 are analyzed. All patients with the Oswestry disability index score of >20 were managed surgically (open laminectomy and cyst excision). The clinical outcome was assessed at using 5-point satisfaction scale and McCormick grading. Results: All 13 operated patients had EDACs with communication with the intradural compartment. In 11 (84.6%) patients, cyst wall was excised completely, in 2 (15.3%) patients underwent partial excision of cyst wall; dural communication was closed in all patients (n = 13). None of the patients had clinical deterioration or radiological recurrence till the last follow-up. Mean follow-up was 52.2 months (range 1–160); all patients were satisfied after surgery (median score was 3). Discussion: Symptomatic EDACs account