title: Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note.
abstract: OBJECTIVE
  There is agreement that symptomatic sacral meningeal cysts with a check-valve mechanism and/or large cysts representing space-occupying lesions should be treated surgically. This study investigated factors indicating a need for surgical intervention and surgical techniques for sacral meningeal cysts with a check-valve mechanism.
  
  
  METHODS
  In ten patients presenting with sciatica and neurological deficits, myelography, computed tomography (CT) myelography, and magnetic resonance imaging (MR imaging) detected sacral meningeal cysts with a check-valve mechanism. One patient had two primary cysts. Ten cysts were type 2 and one cyst was type 1. Nine of the ten patients had not undergone previous surgery, while the remaining case involved recurrent cyst. For the seven patients with normal (i.e., not huge or recurrent) type 2 cysts and no previous surgery (eight cysts), suture after collapse of the cyst wall was performed. For the recurrent type 2 cyst, duraplasty and suture with collapse of the cyst wall were performed to eliminate the check-valve mechanism. For the remaining type 2 cyst, a primary root was sacrificed because of the huge size of the cyst. For the type 1 cyst, the neck of the cyst was ligated.
  
  
  RESULTS
  In all cases, chief complaints disappeared immediately postoperatively and no deterioration of clinical symptoms has been seen after a mean follow-up of 27 months.
  
  
  CONCLUSIONS
  The presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts.
authors.affiliation: Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minatoku, Tokyo, 108-8329, Japan. spine-asm@iuhw.ac.jp
authors.forename: Shunji
authors.initials: S
authors.lastname: Asamoto
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Fukui
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishiyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Fujita
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakamura
authors.forename: Jun
authors.initials: J
authors.lastname: Muto
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shiono
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Doi
authors.forename: Motoo
authors.initials: M
authors.lastname: Kubota
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ishii
mesh_terms: D000293:Adolescent; D000328:Adult; D020863:Central Nervous System Cysts / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D004210:Dissection; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D008875:Middle Aged; D009192:Myelography; D012447:Sacrum; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D055815:Young Adult