Experience of endoscopy versus surgery as initial management of chronic pancreatitis.

INTRODUCTION AND AIM: Chronic pancreatitis is a pathologic fibroinflammatory syndrome of the pancreas. Treatment includes medical management and endoscopic and/or surgical interventions. Our aim was to describe progression in patients with chronic pancreatitis whose initial management was either endoscopic or surgical. MATERIAL AND METHODS: A retrospective, analytic, observational, and longitudinal study was conducted that included patients diagnosed with chronic pancreatitis treated at the Hospital de Especialidades of the Centro Médico Nacional Siglo XXI from 2015 to 2021. RESULTS: Twenty-two patients were included in the study; 12 underwent endoscopy and 10 underwent surgery. The mean number of interventions performed was 3 in the endoscopic management group and 1.1 in the surgical management group (p = 0.001). Regarding pain remission (partial or total), results were statistically significant in favor of surgical management (p = 0.035). Of the 12 patients that initially underwent endoscopy, 7 (58.3%) eventually required surgery during follow-up. There were no statistically significant differences with respect to opioid and pancreatin use, readmissions, weight loss, steatorrhea, newly diagnosed diabetes, or deaths during follow-up. CONCLUSION: Pain is the main indication for invasive treatment, whether endoscopic or surgical, in patients with chronic pancreatitis. Slightly more than half of the patients that were initially managed endoscopically required surgery during follow-up. Management decisions should be multidisciplinary and individualized for each patient.

Flexor Digitorum Profundus Avulsion With Distal Interphalangeal Joint Dorsal Dislocation: A Case Report.

An irreducible closed dorsal dislocation of the distal interphalangeal (DIP) joint of the finger is a rare injury, often caused by factors such as the interposition of the volar plate, entrapment of the flexor digitorum profundus (FDP) tendon behind the head of the middle phalanx, or the buttonholing of the middle phalanx head through the volar plate or flexor tendon. This case report presents a rare instance of FDP avulsion combined with dorsal dislocation of the DIP joint in a 42-year-old male who sustained trauma to his right middle finger during a workplace accident. Clinical examination and imaging confirmed FDP avulsion along with dorsal dislocation of the DIP joint. Urgent surgical intervention was performed, successfully reducing and repairing the FDP tendon and stabilizing the DIP joint. Subsequent follow-up showed satisfactory functional outcomes. This case highlights the importance of prompt diagnosis and appropriate surgical management in treating complex finger injuries.

Giant basal cell carcinoma in a non-sun exposed area with four years follow-up: a case report.

Basal cell carcinoma (BCC) is a low-grade malignant tumor that if properly managed has an excellent prognosis. Development of BCC outside the skin areas exposed to sun rays is infrequent. Giant BCC is a rare entity, especially in unexposed areas of the body. It carries a considerable implication on patients' quality of life because of the risk of being a source of infection that may progress to severe sepsis and/or metastasis. An old female presented with a long-standing solitary lesion measuring 7.5x6 cm overlaying the lumber 4-5 vertebral region about 2.5 cm from the line of the sacral promontory. No lymph nodes or distant metastases were detected. For many years, it was misdiagnosed by other physicians as eczema, psoriasis, and fungal infection and accordingly failed to respond to treatment. A histopathological examination of lesional punch biopsy assured the diagnosis of giant superficially spreading BCC. The lesion was excised with a circumferential safety margin of about 5 mm. During the follow-up period of 4 years, no recurrence was detected. Despite being a long-standing Giant basal cell carcinoma (GBCC) in a sun-hidden skin area, the growth behaved as a locally malignant lesion without metastasizing. A wide local surgical excision of the GBCC with 5 mm safety margins was feasible, safe, and with a good aesthetic outcome. Importantly, family practitioners should avoid such missed cases through accuracy in their diagnosis and early referral of any atypical cases to a dermatologist.

Surgical management and outcomes of renal tumors with inferior vena cava extension among children: a single center retrospective study from Pakistan.

OBJECTIVE: The aim of this study was to assess management and determine outcomes of renal tumors with inferior vena cava (IVC) and intracardiac (IC) extension in a tertiary care center in Pakistan. METHODS: A retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, Pakistan. All patients from 1 to 18 years of age with renal tumors with intravascular extensions, surgically managed from January 1988 till June 2016, were included. Data was extracted by reviewing medical records, and the tumor details, treatment and outcomes were analyzed. RESULTS: A total of 18 patients out of the total 61 patients with renal tumors, presented with IVC and/or IC extension, with the majority involving the right kidney. Mean age was 5.9 (SD:4.9) and a female preponderance (56%) was seen. Wilms tumor (77%) was the most common tumor type, with the level of tumor extension into IVC predominantly being below the diaphragm (55.5%). Fourteen patients received preoperative chemotherapy, with tumor regression, seen in 10. Most patients underwent thrombectomy through the renal vein (56%). Regarding outcomes, frequency of mortality and morbidity was 1 and 2, respectively, with 7 patients having no recurrent 5 years post-surgery. CONCLUSION: A greater incidence (29.5%) of IVC and or IC Tumor extension was found compared to existing literature, which could likely be due to a higher referral rate to the center. Moreover, this is a single-center study and so a multi-center study is crucial to form an assessment of surgical management in resource-limited settings. Our study is the first from Pakistan on this particular renal tumor presentation. Considering the varying case presentations and surgical techniques used, further studies are needed to standardize surgical management and optimize patient outcomes.

Bilateral Chylothorax Following Neck Dissection: A Systematic Review and Proposed Management Algorithm.

Aims: Bilateral chylothoraces are rare but potentially life-threatening complications of neck dissections (ND). The condition is generally treated with a combination of dietary, medical, procedural, and surgical approaches. The aim of this review is to highlight the management options currently utilized in clinical practice and propose a management algorithm for this condition. Methods: In accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; utilizing the Pubmed, EMBASE, and Web of Science databases, a systematic review of all available literature on bilateral chylothoraces was conducted. Primary outcomes measures included clinical presentations and type of neck dissection performed with interventions employed to manage the condition. Secondary outcome measures included the time to resolution alongside patient outcomes. Results: We identified 37 patients (female n = 27, male n = 10) who presented with bilateral chylothoraces within the years 1951-2018. The mean age was 51.4 ± 16.5 years within the age ranges of 17-78 years. Most common pathologies included papillary thyroid carcinoma (n = 16), squamous cell carcinoma (SCC) of the larynx (n = 3), supraglottic SCC (n = 3). Left sided ND was done in (n = 18); bilateral ND in (n = 17); central/left ND in (n = 2). Chylothorax was treated by surgery in n = 10, n = 5 of which performed lymph node embolization; and n = 5 used lymph node ligation. Resolution was found in all cases. Discharge times ranged from 2 to 40 days. Conclusions: This systematic review highlights the different management modalities in treating bilateral chylothoraces alongside providing a decision algorithm in treating the condition by suggesting diagnostic tools and management modalities to optimize patient care.

Layer upon layer: Imaging techniques of bladder matrix stone: A case report.

Matrix lithiasis within the bladder is an extremely rare and diagnostically challenging condition, characterized by its atypical presentation and complex imaging appearance. We report the case of a 69-year-old woman with nonspecific urinary symptoms, including hematuria and abdominal pain. Initial ultrasonography revealed an echogenic lesion on the bladder wall, leading to further investigations using computed tomography (CT) and magnetic resonance imaging (MRI). CT imaging initially delineated the lesion's structure, revealing a complex, multilayered cystic mass. Subsequent MRI provided detailed insights into the internal architecture of the mass, further elucidating its layered structure. Although a parasitic etiology was initially suspected, matrix lithiasis was later confirmed. This case highlights the critical role of a comprehensive imaging strategy in diagnosing rare urological conditions and emphasizes the importance of multimodal imaging in differentiating potential diagnoses.

Management strategies for neglected simultaneous bilateral femoral neck fractures: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Simultaneous bilateral femoral neck fractures are rare and challenging, often occurring due to high-energy trauma in younger adults or low-energy trauma compounded by metabolic issues in elderly populations. Neglected cases, particularly in the context of narcotic addiction and limited access to healthcare, present unique management dilemmas. This study aims to contribute insights into the clinical presentation, management strategies, and outcomes of two neglected simultaneous bilateral femoral neck fractures. CASE PRESENTATION: We present two cases: a 65-year-old woman and a 45-year-old man, both with a history of narcotic addiction, who presented with neglected simultaneous bilateral femoral neck fractures. Both cases demonstrated significant pain and functional impairment necessitating surgical intervention. CLINICAL DISCUSSION: Treatment involved one-stage bilateral hip hemiarthroplasty, which successfully restored function without postoperative complications during follow-up periods of 14 and 16 months. Discussion includes the challenges of diagnosing and managing neglected fractures in vulnerable populations, emphasizing the importance of early recognition and tailored surgical approaches. CONCLUSION: Our study suggests the efficacy of one-stage bilateral hip hemiarthroplasty in managing neglected simultaneous bilateral femoral neck fractures due to narcotic addiction. However, variability in outcomes across different surgical techniques highlights the need for individualized treatment plans based on patient-specific factors.

Long-Term Outcomes of Conservative versus Surgical Management of Dental Caries.

Introduction: The management of dental caries presents challenges for oral health professionals, with options including conservative and surgical interventions. However, debate persists regarding the long-term efficacy of these strategies. Methods: This retrospective cohort research involved 500 subjects diagnosed with dental caries at the University Dental Clinic between January 1, 2018, and December 31, 2020. Data on demographics, dental history, treatments, and follow-up were collected from patient records. Subjects were categorized into conservative and surgical groups based on treatment received. Outcome measures included tooth survival, caries recurrence, and patient satisfaction. Results: The research included 300 subjects, with 60% under conservative management and 40% under surgical management. Demographics were comparable between groups, and both groups showed similar outcomes in tooth survival, caries recurrence, and patient satisfaction. Statistical analysis revealed no significant differences in these outcomes between groups. Conclusion: Conservative and surgical management approaches demonstrate comparable long-term outcomes in treating dental caries, emphasizing the importance of personalized treatment decisions. Further research with larger samples and prospective designs is needed to validate these findings and guide evidence-based practice in dental caries management.

Postoperative Outcomes Following Surgical Management of Secondary Peritonitis in a Referral Hospital in Eastern Venezuela.

Background Secondary peritonitis (SP) arises from direct contamination of the peritoneum by spillage from the gastrointestinal or urogenital tracts. Objective This research aimed to evaluate the clinical and epidemiological characteristics of patients with SP undergoing surgical management and to study potential factors associated with morbidity and mortality in a reference hospital in Eastern Venezuela. Methodology A retrospective cross-sectional study was conducted on patients aged 18 to 80 undergoing surgical treatment for SP at "Dr. Luis Razetti" University Hospital in Barcelona, Anzoátegui state, Venezuela, between January and December 2022. We calculated odds ratios to assess mortality risks based on the presence of postoperative complications. Results Analysis of 168 adult patients revealed a predominantly male population (n=110, 65.5%) with a mean age of 35.63 years (SD=14.34). Generalized peritonitis was observed in 126 cases (75%), primarily originating from the appendix (n=117, 69.6%). Postoperative complications occurred in 18 patients (10.7%); sepsis represented the most common associated complication (n=10, 43.5%). Patients with secondary peritonitis associated with acute appendicitis had a lower mortality rate (p=0.042). Additionally, laparotomy was associated with higher frequencies of complications (p=0.001) and mortality (p=0.025), while open appendectomy showed lower frequencies of complications (p=0.002) and mortality (p=0.035). Notably, patients experiencing postoperative complications had a significantly elevated risk of mortality (OR=98, 95% confidence interval = 21.74 - 441.69). Conclusion The most common source of SP was appendicular. Patients undergoing exploratory laparotomy for the management of SP had a higher frequency of complications and mortality, whereas those undergoing open appendectomy had lower rates of complications and mortality.

Traumatic Floating Clavicle: A Case Report and Updated Literature Review.

Traumatic floating clavicle or bipolar dislocation is a rare injury. Herein, we present a case of ipsilateral sternoclavicular and acromioclavicular joint dislocation after a motorcycle accident. The patient was a 43-year-old man who presented with right shoulder pain and limited range of motion. The radiograph revealed superior displacement of the acromioclavicular joint dislocation and suspected ipsilateral sternoclavicular joint dislocation and a CT scan confirmed injuries to both the medial and lateral ends of the clavicle. Due to the patient being active and young, we considered operative treatment. The sternoclavicular joint was stabilized with FiberTape® suture (Arthrex, Naples, FL), and the acromioclavicular joint with Dog Bone™ Button (Arthrex) and suture cerclage. At the one-year follow-up, the patient reported excellent outcomes without complications. We also summarize the literature on this particular injury, including its characteristics, surgical options, and treatment outcomes.

Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 3 Palatal Surgery, Outcomes and Follow-Up, Complications, and Post-Operative Management.

Background/Objectives: Exploring and establishing a consensus on palatal surgery, the outcomes and follow-up after the palatal surgery, the complications of palatal surgery, and the post-operative management after palatal surgery for snoring and obstructive sleep apnea (OSA) among sleep surgeons is critical in the surgical management of patients with such conditions. Methods: Using the Delphi method, a set of statements was developed based on the literature and circulated among a panel of eight European experts. Responses included agreeing and disagreeing with each statement, and the comments were used to assess the level of consensus and to develop a revised version. The new version with the level of consensus and anonymized comments was sent to each panel member as the second round. This was repeated over a total of five rounds. Results: The final set included a total of 111 statements, 27 of which were stand-alone questions and 21 of which contained 84 sub-statements. Of the 34 statements regarding palatal surgery, consensus was achieved among all eight, seven, and six panelists for 50%, 35.3%, and 5.9% of the questions, respectively. Of the 43 statements regarding the outcomes and follow-up after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 53.5%, 23.3%, and 4.7% of the questions, respectively. Of the 24 statements regarding complications after the palatal surgery, consensus was achieved among all eight, seven, and six panelists for 91.7%, 0%, and 4.2% of the questions, respectively. Of the 10 statements regarding post-operative management after palatal surgery, consensus was achieved among all eight, seven, and six panelists for 10%, 30%, and 30% of the papers, respectively. Conclusions: This consensus provides an overview of the work of European sleep surgeons to develop a set of statements on palatal surgery for the treatment of snoring and OSA, the outcomes and follow-up, the complications, and the post-operative management of palatal surgery. We believe that this will be helpful in everyday practice. It also indicates key areas for further studies in sleep surgery.

Left Para-Duodenal Hernia Presenting With Recurrent Abdominal Pain: A Diagnostic Challenge.

Paraduodenal hernias (PDH) are a type of internal hernia that results from errors in midgut rotation and failure of mesenteric fusion. Internal hernias themselves are a rare presentation that accounts for less than 1% of total hernias, and paraduodenal hernias contribute more than half of internal hernias. Left paraduodenal hernias (LPDH) occur more frequently as compared to right paraduodenal hernias. Left paraduodenal hernias happen when the small intestine bulges out in the left paraduodenal space, which is also called the space of Landzert. This can cause vague abdominal pain and signs of intestinal blockage, which makes diagnosis difficult. We present a case of a 28-year-old male with recurrent abdominal pain for 7 years, diagnosed with LPDH via laparotomy after inconclusive imaging studies, such as the whirlpool sign on USG. Intraoperatively, jejunal loops were found in Landzert's fossa, hindering hernia repair and adhesiolysis. Clinicians must maintain a high index of suspicion for PDH when assessing nonspecific abdominal symptoms to ensure timely diagnosis and management, optimising patient outcomes.

Comprehensive management and classification of first branchial cleft anomalies: An International Pediatric Otolaryngology Group (IPOG) consensus statement.

OBJECTIVE: First branchial cleft anomalies are rare congenital head and neck lesions. Literature pertaining to classification, work up and surgical treatment of these lesions is limited and, in some instances, contradictory. The goal of this work is to provide refinement of the classification system of these lesions and to provide guidance for clinicians to aid in the comprehensive management of children with first branchial cleft anomalies. MATERIALS AND METHODS: Delphi method survey of expert opinion under the direction of the International Pediatric Otolaryngology Group (IPOG) was conducted to generate recommendations for the definition and management of first branchial cleft anomalies. The recommendations are the result of expert consensus and critical review of the literature. RESULTS: Consensus recommendations include evaluation and diagnostic considerations for children with first branchial cleft anomalies as well as recommendations for surgical management. The current Work classification system was reviewed, and modifications were made to it to provide a more cogent categorization of these lesions. CONCLUSION: The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations based on review of the literature for the management of pediatric otolaryngologic disorders. These consensus recommendations are aimed at improving care of children presenting with first branchial cleft anomalies. Here we present a revised classification system based on parotid gland involvement, with a focus on avoiding stratification based on germ layer, in addition to guidelines for management.

Successful Non-operative Management of Unstable Jefferson Fracture With Transverse Atlantal Ligament Injury (Dickman Type I and IIb) in a Pediatric Patient: A Case Report.

This report presents the case of a Jefferson fracture (posterior arch fracture) associated with an unstable avulsion fracture and substance injury of the transverse atlantal ligament (Dickman type I and IIb) in an eight-year-old male child. The patient was managed conservatively with external immobilization using a halo vest and a sternal occipital mandibular immobilizer (SOMI) brace and subsequently made a full recovery. Computed tomography (CT) and dynamic cervical spine radiographs at the final follow-up demonstrated solid reattachment of the avulsed bony fragment of the transverse atlantal ligament and no instability at the C1/2 level. This case report adds to the literature on the optimal non-operative management of the rare pediatric unstable C1-C2 trauma.

Surgical and Medical Management of Pediatric Spine Trauma.

Pediatric spine trauma is rare but presents unique challenges to clinical management. Special considerations include but are not limited to the need to minimize ionizing radiation in this patient population, anatomic immaturity, physiologic variants, and injuries seen only in the pediatric population. Here we review the epidemiology of pediatric spine trauma, presentation, diagnosis, and treatment of the most common injuries and discuss specific medical and surgical strategies for treatment.

Literature review on management of prosthetic graft infections after supra-aortic bypass surgery, based on a case report.

BACKGROUND: Graft infections of supra-aortic bypasses are rare, but often life-threatening. Guidelines for treatment of graft infections recommend systemic antibiotics and complete graft removal, followed by in-situ or extra-anatomic revascularisation. METHODS: Based on case report, literature search was performed on Medline, Google Scholar and Web of Science databases, focussing on infected supra-aortic bypass reconstructions. Inclusion criterium was prosthetic graft infection, excluding stent and carotid patch infections. RESULTS: A 68-year old man with clinically infected subclavian-subclavian bypass with interposition bypass to left carotid bifurcation, presented at emergency department with manifestation of sepsis. A total graft removal and an extra-anatomical prosthetic reconstruction was created, from right common carotid artery to left carotid bifurcation. Defect of prior left subclavian anastomosis was primarily closed, on right subclavian anastomosis per-operative acute bleeding occured, which was controlled by covered stent through right brachial artery. Literature review identified 16 cases. Different approaches ranging from open repair with autologous (six) or allogenic (two) material, to hybrid techniques (eight) have been described. No re-infections were reported. When comparing different types of approaches, no differences are found concerning overall complications. CONCLUSION: Complete graft removal with extra-anatomical reconstruction is challenging, but crucial in supra-aortic graft infections. Preservation of parts of vascular prosthesis depends on case-by-case basis, according to infection site and general condition of the patient. But due to rarity, only case reports are available, so no strong recommendations can be formulated. International registries should be initiated to share experiences and provide data for decent analysis of short, mid and long term outcomes.

Philosophies And Surgical Techniques on Os Odontoideum Treatment with Literature Review.

Introduction: Os-odontoideum is a rare condition described radiographically and clinically as a congenital anomaly of the second cervical vertebra (axis). It is a smooth, independent ossicle of variable size and shape separated from the base of a shortened odontoid process by an obvious gap, with no osseous connection to the body of C2. Materials and Methods: This study reviewed the literature on OO to evaluate its etiology, clinical presentations, differential diagnosis, imaging modalities, and outcomes in the management of asymptomatic and symptomatic cases of Os Odontoideum. Key articles from PubMed, EMBASE, Google Scholar, and Cochrane were searched. Discussion: Considering etiology, the traumatic hypothesis is favoured over the congenital hypothesis as per recent literature on OO. Clinical presentation varies from asymptomatic to mild neck pain to severe myelopathy and neurodeficit. Various C1-C2 instrumentation and fusion techniques like wiring, trans articular screw and laminar screws have been described with success rates. Conclusion: Os odontoideum is a rare condition with limited existing literature. Considering the significant risks involved if conservative management opts, like severe neuro deficit to sudden death on trivial trauma and the recent improvement of imaging tools helping to understand the pathology of the disease, surgery can be indicated even in an incidentally detected os odontoideum. However, a case-by-case approach can be considered for stable asymptomatic patients depending on factors such as age, activity level, comorbidities, syndromic association, and radiographic findings.

Orbital hydatid cyst and its successful treatment: A case report from Afghanistan.

Purpose: This study aims to underscore the rarity of intraorbital hydatid disease caused by Echinococcus granulosus, emphasizing the importance of comprehensive exploration and documentation for effective management. Observations: Clinical presentations include proptosis, visual deterioration, ocular motility disruptions, and chemosis. A case study of an 8-year-old boy with a retroorbital hydatid cyst successfully resected through a right transcaruncular orbitotomy approach is presented, highlighting surgical complexities and the efficacy of pre and post-operative albendazole therapy. Conclusion and Importance: The successful excision and management of the intraorbital hydatid cyst underscore the significance of accurate diagnosis and precise surgical intervention. This case emphasizes the importance of expanding knowledge about this rare manifestation, contributing to enhanced diagnostic and treatment strategies for optimal outcomes in managing global health concerns.

Septoplasty versus non-surgical management for deviated nasal septum: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of septoplasty versus non-surgical management for patients experiencing nasal obstruction due to deviated nasal septum (DNS). METHODS: We conducted a comprehensive search of PubMed, Scopus, Embase, Web of Science, Cochrane Library, Clinicaltrials.gov, ICTRP, and ISRCTN for relevant RCTs. The primary outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, Sino-Nasal Outcome Test (SNOT-22), Peak Nasal Inspiratory Flow (PNIF), surgical complications, and quality of life. Data were synthesized using RevMan 5.4 and STATA 18, with effect estimates presented as mean differences (MD) or risk ratios (RR) with 95% confidence intervals (CI). The study protocol was registered with PROSPERO (ID: CRD42024538373). RESULTS: Our search identified 537 studies, of which 3 RCTs involving 721 participants met the inclusion criteria. The meta-analysis revealed that septoplasty significantly improved NOSE and SNOT-22 scores compared to non-surgical interventions at 6 and 12 months of follow-up, despite no notable differences at 3 months post-treatment. No significant difference was observed regarding nasal flow assessed by PNIF. The rate of complications was low, ranging from 0.31% (revision rate) to 4.12% (bleeding and infection rates). Additionally, our qualitative synthesis showed an improvement in the quality of life at 6 and 12 months in the septoplasty group compared with the non-surgical group. CONCLUSIONS: This systematic review and meta-analysis of 721 patients revealed the efficacy of septoplasty, with or without turbinate surgery, in improving nasal obstruction symptoms at 6 and 12 months. Additionally, septoplasty consists of a relatively low rate of complications such as bleeding, infection, and septal perforation. Furthermore, a low revision rate was found. Septoplasty improved the quality of life, especially after 6 and 12 months. However, our findings should be interpreted with caution, and further research is needed to consolidate our results.

Shunt, endoscopic, and microsurgical management of trapped temporal horn following resection of lateral ventricle trigonal or peritrigonal tumors: A retrospective multicenter study.

OBJECTIVE: To investigate the surgical management and outcomes of trapped temporal horn (TTH) following resection of lateral ventricle trigonal or peritrigonal tumors. METHODS: Patients who underwent surgical treatment for TTH in three different tertiary centers between 2012 and 2022 were retrospectively studied. The primary outcome was reoperation rate. RESULTS: Thirty-one patients were included for analysis. The underlying pathology was meningioma in 17 patients, central neurocytoma in 7, glioma in 4, ependymoma in 2, and cavernous malformation in 1. The median KPS score was 50 (range 10-90) and the mean volume of TTH was 53.1 ± 29.9 cm³ (range 14.8-118.6). Six patients (19.3 %) required multiple operations. A total of 39 procedures were performed, including 28 CSF shunting, 2 endoscopic septostomy, 3 microsurgical fenestration or temporal tip lobectomy via craniotomy, 2 decompressive craniectomy (DC), and 4 shunt revisions. Reoperation rates according to procedure were as follows: 10.7 % (3/28) for CSF shunting, 50 % (1/2) for endoscopic septostomy, 100 % (2/2) for DC, and 0 (0/3) for microsurgical fenestration or temporal tip lobectomy. CSF shunting tended to have a lower reoperation rate compared to other surgical approaches (p = 0.079). The reoperation rate was significantly higher for DC than for other surgical techniques (p = 0.025). CONCLUSION: CSF shunting was the most frequently used technique with a relatively low revision rate. Long-term patency can be achieved through endoscopic septostomy in selected patients. Microsurgical fenestration or temporal tip lobectomy should be reserved for refractory cases. DC has limited effectiveness and should not be recommended.