Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases.
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.
Caspar
Wolfhard
W
Department of Neurosurgery, Faculty of Medicine, Saarland University, Homburg-Saar, Germany.
Papavero
Luca
L
Nabhan
Abdullah
A
Loew
Cornelius
C
Ahlhelm
Frank
F
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*