Lumbar cerebrospinal fluid drainage for symptomatic sacral nerve root cysts: an adjuvant diagnostic procedure and/or alternative treatment? Technical case report.
OBJECTIVE
The treatment of symptomatic sacral nerve root cysts is difficult and challenging. A major role has been ascribed to the hydrostatic and pulsatile forces of cerebrospinal fluid (CSF) for the symptomatology of sacral nerve root cysts. Theoretically, lowering those pressures should have a beneficial effect on the symptoms. Lowering the hydrostatic and pulsatile pressures may be achieved by lumbar CSF drainage. The effect of lumbar CSF drainage on the symptomatology of sacral nerve root cysts is described.


METHODS
Three patients suffered from leg and/or low back pain as a result of sacral nerve root cysts.


METHODS
First, CSF was drained through an external lumbar drain that was connected to a CSF bag. Mobilization was not restricted. All patients became free of symptoms. Eventually, a lumboperitoneal shunt was inserted in two patients. Those two patients remained free of complaints for 11 and 9 months, respectively.


CONCLUSIONS
To our knowledge, this is the first report that clearly establishes the role of CSF forces in the symptomatology of sacral nerve root cysts. Lumbar external CSF drainage is a diagnostic tool to investigate the clinical significance of sacral nerve root cyst(s). Lumboperitoneal CSF shunting is a promising alternative in the treatment of symptomatic sacral nerve root cysts.
Bartels
R H
RH
Department of Neurosurgery, University Hospital Nijmegen, The Netherlands.
van Overbeeke
J J
JJ
D001416:Back Pain / Q000209:etiology; D002557:Cerebrospinal Fluid Shunts; D003560:Cysts / Q000175:diagnosis / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery*; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013126:Spinal Nerve Roots; D014549:Urinary Incontinence / Q000209:etiology