title: Microsurgical fenestration of idiopathic intramedullary cysts in adult patients.
abstract: OBJECTIVE
  The aim of this study is to describe the findings in one of the largest series of microsurgically treated intramedullary cysts investigated by magnetic resonance imaging (MRI), focusing on the peri- and intraoperative setup including detailed neurological and radiological outcome analyses.
  
  
  METHODS
  Retrospective analysis of patients with intramedullary cyst who had undergone microsurgical fenestration at our department between 2006 and 2011. Preoperative three-dimensional constructive interference of steady-state MRI was conducted to optimize surgical planning. Intraoperative electrophysiological monitoring included motor-evoked potentials, somatosensory-evoked potentials, and electromyogram. Clinical outcome as well as pre-, postoperative and long-term MRI scans were evaluated.
  
  
  RESULTS
  Eight female patients (median age 58.0 years, range 32-72 years) with a median clinical follow-up of 48.0 months (range 2-69 months) were included. Seven cysts were located in the conus medullaris, one in the cervical spine. Overall, 25.0% (2/8) showed complete remission of preoperative symptoms, 62.5% (5/8) improved, and 12.5% (1/8) asymptomatic patients remained unchanged. Pain syndromes (4/4) as well as motor deficits (2/2) improved in all affected patients and bladder dysfunction (3/4) displayed a high tendency for improvement. Postoperative MRI scans showed permanently decreased cyst volumes by ~80%.
  
  
  CONCLUSIONS
  Microsurgical fenestration of intramedullary cysts using preoperative high-resolution imaging and intraoperative electrophysiological monitoring is a safe and effective treatment option for symptomatic patients.
authors: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany, christoph.schwartz@med.uni-muenchen.de.
authors: Christoph
authors: C
authors: Schwartz
authors: Jürgen
authors: J
authors: Lutz
authors: Alexander
authors: A
authors: Romagna
authors: Jörg-Christian
authors: JC
authors: Tonn
authors: Stefan
authors: S
authors: Zausinger
authors: Karsten
authors: K
authors: Schöller
mesh_terms: D000328:Adult; D000368:Aged; D003560:Cysts / Q000473:pathology / Q000601:surgery*; D004576:Electromyography; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome