Neonatal Ovarian Cysts with Torsion: Correlation Between Preoperative Ultrasound Classification and Ovarian Preservation Outcomes

Objective: We aimed to evaluate the association between preoperative ultrasound features, dynamic changes, and ovarian outcomes in neonatal ovarian torsion, and to compare ovarian survival across ultrasound subgroups. Methods: This retrospective study included 58 neonates with prenatally or postnatally diagnosed ovarian cysts who had surgically confirmed ovarian torsion and were treated at our institution between June 2015 and July 2025. Results: Of the 58 cases, 45 (77.6%) underwent oophorectomy and 13 (22.4%) underwent ovary-sparing surgery. Ovarian survival was achieved in 44.4% (4/9) of simple cysts compared with 0% (0/49) of complex cysts (RD +44.4%, 95% CI: +14.8% to +74.1%; p < 0.001). Among the 9 simple cysts, only 2 (22.2%) had preoperative sonographic signs of torsion; the other 7 underwent surgery due to size-related indications, of whom 4 (57.1%) had necrosis at surgery. In the 50 cases with serial follow-up, observation window, cyst size changes, morphological shifts, and age at surgery did not differ significantly between the oophorectomy and ovary-sparing surgery groups (all global p > 0.05). Conclusions: In neonatal ovarian cysts with torsion, the overall ovarian survival rate was low (6.9%, 4/58). However, a salvageable subgroup was identified: simple cysts had a 44.4% (4/9) survival rate, whereas complex cysts had 0% (0/49), indicating that ovarian salvage is rarely achievable in complex cysts. The conclusions are limited to surgically confirmed ovarian torsion cases and should not be generalized to other neonatal ovarian cysts.