Urgent surgery is needed when cyst enlarges in terminal myelocystoceles

The phenomenon of cyst enlargement in terminal myelocystocele (TMC) patients has been mentioned in the literature. However, its clinical significance has not been clarified in depth. We reviewed TMC patients who had experienced cyst enlargement during the preoperative period to determine the correlation with symptomatic progression. We sought to determine the optimal surgical strategy for such patients.

Of eight patients who were operated on for TMC from 1991 to 2009, four patients that showed cyst enlargement before the operation were reviewed. A retrospective review of medical recordings, radiological imaging, and other evaluations for neurologic status was done, focusing on the temporal neurological changes that correlated with the cyst enlargement.

Each of the four patients with cyst enlargement showed concurrent progression of neurologic symptoms, two by motor weakness and two by neurogenic bladder. In only one case, early detection and prompt surgery were possible, and this patient showed dramatic improvement in muscle strength after the surgery. The progression of neurologic deterioration was arrested postoperatively for the other three patients.

Hence, cyst enlargement in a TMC patient should be considered as a warning for neurologic deterioration, and the operation should be performed expediently to prevent impairment in neurologic function.