Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note
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.
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.
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.
The presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts.
- Bartels, RH, Overbeeke, JJ (1997) Lumbar cerebrospinal fluid drainage for symptomatic sacral nerve root cysts: an adjuvant diagnostic procedure and/or alternative treatment? Technical case report. Neurosurgery 40: pp. 861-864 CrossRef
- Caspar, W, Papavero, L, Nabhan, A, Loew, C, Ahlhelm, F (2003) Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases. Surg Neurol 59: pp. 101-105 CrossRef
- Doi, H, Sakurai, S, Ida, M, Sora, S, Asamoto, S, Sugiyama, H (1999) A case of sacral meningeal cyst with Marfan syndrome. No Shinkei Geka 27: pp. 847-850
- Doi, H, Toyoda, I, Matsumoto, K, Imai, S, Sekimizu, M (1995) Occult intrasacral meningocele with tethered cord—case report. Neurol Med Chir (Tokyo) 35: pp. 321-324 CrossRef
- Guo, D, Shu, K, Chen, R, Ke, C, Zhu, Y, Lei, T (2007) Microsurgical treatment of symptomatic sacral perineurial cysts. Neurosurgery 60: pp. 1059-1065 CrossRef
- Iwasaki, Y, Yamauchi, R, Akino, M, Isu, T, Abe, H, Tashiro, K, Kenmotsu, O (1992) Sacral nerve root cysts manifesting as localized unilateral perineal pain—case report. Neurol Med Chir (Tokyo) 32: pp. 96-99 CrossRef
- Mummaneni, PV, Pitts, LH, McCormack, BM, Corroo, JM, Weinstein, PR (2000) Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery 47: pp. 74-78
- Nabors, MW, Pait, TG, Byrd, EB, Karim, NO, Davis, DO, Kobrine, AI, Rizzoli, HV (1988) Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68: pp. 366-377 CrossRef
- Prevedello, DM, Tatsui, CE, Koerbel, A, Grande, CV, Cordeiro, JG, Araujo, JC (2005) Ventral extradural spinal meningeal cyst causing cord compression: neurosurgical treatment. Arq Neuropsiquiatr 63: pp. 855-858 CrossRef
- Ramsbacher, J, Schilling, AM, Wolf, KJ, Brock, M (1997) Magnetic resonance myelography (MRM) as a spinal examination technique. Acta Neurochir (Wien) 139: pp. 1080-1084 CrossRef
- Schreiber, F, Haddad, B (1951) Lumbar and sacral cysts causing pain. J Neurosurg 8: pp. 504-509 CrossRef
- Tanaka, M, Nakahara, S, Ito, Y, Nakanishi, K, Sugimoto, Y, Ikuma, H, Ozaki, T (2006) Surgical results of sacral perineural (Tarlov) cysts. Acta Med Okayama 60: pp. 65-70
- Tarlov, IM (1970) Spinal perineurial and meningeal cysts. J Neurol Neurosurg Psychiatry 33: pp. 833-843 CrossRef
- Tiel, RL, Harkey, HL (2008) Microsurgical treatment of symptomatic sacral perineurial cysts. Neurosurgery 63: pp. E376 CrossRef
- Voyadzis, JM, Bhargava, P, Henderson, FC (2001) Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg 95: pp. 25-32
- Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note
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Volume 155, Issue 2 , pp 309-313
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- Sacral meningeal cyst
- Check-valve mechanism
- Surgical strategy
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- Author Affiliations
- 1. Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minatoku, Tokyo, 108-8329, Japan
- 2. Department of Neurosurgery, Tokyo Metropolitan Ebara Hospital, Tokyo, Japan
- 3. Department of Neurosurgery, Kameda General Hospital, Kamogawa, Japan
- 4. Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan