title: Comparative outcomes of the two types of sacral extradural spinal meningeal cysts using different operation methods: a prospective clinical study.
abstract: This prospective study compares different clinical characteristics and outcomes of patients with two types of sacral extradural spinal meningeal cysts (SESMC) undergoing different means of surgical excision. Using the relationship between the cysts and spinal nerve roots fibers (SNRF) as seen under microscope, SESMCs were divided into two types: cysts with SNRF known as Tarlov cysts and cysts without. The surgical methods were tailored to the different types of SESMCs. The improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological function of the patients. Preoperative IJOA scores were 18.5 ± 1.73, and postoperative IJOA scores were 19.6 ± 0.78. The difference between preoperative and postoperative IJOA scores was statistically significant (t = -4.52, p = 0.0001), with a significant improvement in neurological function after surgery. Among the improvements in neurological functions, the most significant was sensation (z=-2.74, p=0.006), followed by bowel/bladder function (z=-2.50, p=0.01). There was a statistically significant association between the types of SESMC and the number (F=12.57, p=0.001) and maximum diameter (F=8.08, p=0.006) of the cysts. SESMC with SNRF are often multiple and small, while cysts without SNRF tend to be solitary and large. We advocate early surgical intervention for symptomatic SESMCs in view of significant clinical improvement postoperatively.
authors.affiliation: Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
authors.forename: Zhen-Yu
authors.initials: ZY
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom.
authors.forename: Mario
authors.initials: M
authors.lastname: Teo
authors.affiliation: Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Li
authors.affiliation: Department of Neuroradiology, Peking University Third Hospital, Peking University, Beijing, China.
authors.forename: Hai-Bo
authors.initials: HB
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Peking University, Beijing, China.
authors.forename: Ru-Yu
authors.initials: RY
authors.lastname: Yen
authors.affiliation: Department of Neurology, Peking University Third Hospital, Peking University, Beijing, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Zheng
authors.affiliation: Department of Pathology, Peking University Third Hospital, Peking University, Beijing, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Chang
authors.affiliation: Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States of America.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Yisha Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012447:Sacrum; D013127:Spinal Nerves / Q000503:physiopathology; D052958:Tarlov Cysts / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult