OBJECTIVE
The rarity of colloid cysts in children makes it difficult to characterize this entity and offer meaningful advice on treatment. Infrequent case reports exist, but to date there has been no age-specific assessment. The purpose of this study was to define any differences between children and adults who are evaluated and treated for colloid cysts of the third ventricle.
METHODS
Patients with colloid cysts were reviewed and stratified by age. Individuals ≤ 18 years of age were defined as pediatric patients and those > 18 years of age as adults. Clinical and radiographic data, treatment, and postoperative outcomes were compared between both groups. Bivariate analysis was conducted using the Fisher exact test for categorical variables and Mann-Whitney U-test for continuous variables.
RESULTS
Of 132 endoscopic resections (121 primary, 10 secondary, and 1 tertiary) of a colloid cyst, 9 (6.8%) were performed in pediatric patients (mean age 14.1 years, range 9–18 years) and 123 (93.2%) were performed in adult patients (mean age 43.8 years, range 19–73 years). Cases were found incidentally more commonly in pediatric than adult patients (66.7% vs 37.4%, p > 0.05), and pediatric patients had lower rates of hydrocephalus than adult patients (11.1% vs 63.4%, p < 0.05). Acute decompensation at presentation was found in 8 adults (6.5%) but no children. Complete cyst removal (88.9% vs 90.2%, p > 0.05) and length of stay (1.6 days vs 2.9 days, p > 0.05) were not significantly different between the groups. Postoperative complications (6.5% in adults, 0% in children) and recurrence (2.4% in adults, 0% in children) were rare in both groups, and there were no treatment-related deaths. The mean postoperative radiological follow-up was longer in pediatric patients (45 months, range 4–89 months) than adults (44.1 months, range 1–171 months).
CONCLUSIONS
While differences exist between children and adults regarding colloid cyst presentation, these are in keeping with the predicted evolution of a slow-growing lesion. Consistent with this observation, children had lower rates of hydrocephalus and a smaller mean maximal cyst diameter. Contrary to the published literature, however, sudden deterioration was not observed in pediatric patients but occurred in adult patients. In this limited pediatric sample size, the authors have not recorded any postoperative complications or recurrences to date. These encouraging results with endoscopic removal may positively impact future decisions related to children given their protracted life expectancy and projected rates of progression.
Introduction
Obesity is a known risk factor for many medical complications. Spinal surgery in overweight or obese patients poses specific challenges related to technical difficulties and risks of complications. Minimally invasive spinal (MIS) surgery has been developed with the purpose of decreasing post operative pain, operative blood loss and to promote early ambulation while offering the same outcomes of traditional open techniques. Nonetheless, there is a paucity of information as to whether these techniques are safe and their results reproducible in overweight or obese patients. We report perioperative outcomes in a retrospective cohort of overweight or obese patients after minimally invasive lumbar spine surgery.
Material and Methods
Retrospective chart analysis of patients treated with minimally invasive techniques for lumbar spinal pathology was performed, starting from January 2007 to December 2011. Fifty – seven patients with a body mass index (BMI) greater than or equal to 25 kg/m2 were included for analysis. 40 patients with a BMI lower than 25 kg/m2 were included for comparison. Multivariate logistic regression analysis was performed.
Results
Out of the 97 patients included in the study, 9 presented complications. These were distributed by BMI groups as follows: Two patients in the group below BMI 25 kg/m2; five patients in the group between 25 and 29.9 kg/m2, and two patients in the group above BMI 30. There were no reported mortality cases. After multivariate logistic regression analysis, none of the variables observed (BMI, age, gender, type of fusion) demonstrated a statistically significant increase in morbidity.
Conclusion
MIS surgery doesn't appear to have a higher risk of perioperative complications in overweight or obese patients with lumbar spine pathology.
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