title: Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases.
abstract: BACKGROUND
  The widespread use of magnetic resonance imaging (MRI), now the first line investigation for back and leg pain, reveals cystic sacral lesions more often than myelography did in the past. There is agreement that symptomatic perineurial sacral cysts should be treated surgically. However, it is still debated whether the preference should be given to the curative option, consisting of excision of the cyst with duraplasty, or to drainage of the cyst to relieve symptoms. In this retrospective study the efficacy of microsurgical cyst resection with duraplasty is evaluated.
  
  
  METHODS
  In 15 patients presenting with pain and neurologic deficits, myelography and/or MRI detected sacral cysts. The clinical features suggested that the space-occupying lesions caused the disturbances. Microsurgical excision of the cyst along with duraplasty or plication of the cyst wall was performed in all the cases. Postoperative care included bed rest and CSF drainage for several days.
  
  
  RESULTS
  In 13 out of 15 patients the preoperative radicular pain disappeared after surgery. The 2 patients with motor deficits and the 6 patients with bladder dysfunction recovered completely. In all except 1 of the 10 patients complaining of sensory disturbances a significant improvement was achieved. No complications were observed.
  
  
  CONCLUSIONS
  Microsurgical excision of the cyst combined with duraplasty or plication of the cyst wall is an effective and safe treatment of symptomatic sacral cysts and, in the view of the authors, the method of choice.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Saarland University, Homburg-Saar, Germany.
authors.forename: Wolfhard
authors.initials: W
authors.lastname: Caspar
authors.forename: Luca
authors.initials: L
authors.lastname: Papavero
authors.forename: Abdullah
authors.initials: A
authors.lastname: Nabhan
authors.forename: Cornelius
authors.initials: C
authors.lastname: Loew
authors.forename: Frank
authors.initials: F
authors.lastname: Ahlhelm
mesh_terms: D000293:Adolescent; D000328:Adult; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009192:Myelography / Q000379:methods; D011182:Postoperative Care; D011187:Posture; D011677:Punctures / Q000379:methods; D012447:Sacrum; D052958:Tarlov Cysts / Q000473:pathology / Q000601:surgery*