Technical Note - Neurosurgical Techniques

Acta Neurochirurgica

, Volume 155, Issue 2, pp 309-313

Open Access This content is freely available online to anyone, anywhere at any time.

Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: technical note

  • Shunji AsamotoAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital Email author 
  • , Yasuyuki FukuiAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • , Makoto NishiyamaAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • , Masayuki IshikawaAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • , Nobuyuki FujitaAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • , Satoshi NakamuraAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • , Jun MutoAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • , Yuta ShionoAffiliated withSpine and Spinal Cord Center, International University of Health and Welfare Mita Hospital
  • , Hiroshi DoiAffiliated withDepartment of Neurosurgery, Tokyo Metropolitan Ebara Hospital
    • , Motoo KubotaAffiliated withDepartment of Neurosurgery, Kameda General Hospital
    • , Kazuhiko IshiiAffiliated withDepartment of Neurosurgery, Faculty of Medicine, The University of Tokyo

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.

Keywords

Sacral meningeal cyst Check-valve mechanism Surgical strategy