Novel wrapping surgery for symptomatic sacral perineural cysts
Taku Sugawara1, Naoki Higashiyama1, Shinya Tamura2
11Department of Spinal Surgery, Akita Cerebrospinal and Cardiovascular Center.
Journal of Neurosurgery. Spine
|October 1, 2021
Summary
A new surgical wrapping technique effectively treated symptomatic sacral perineural (Tarlov) cysts, relieving pain and nerve compression. This method offers a promising solution for patients with intractable symptoms from these spinal cysts.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Radiology
Background:
- Sacral perineural cysts (SPCs), or Tarlov cysts, are common but often asymptomatic.
- Symptomatic SPCs can cause severe low-back pain, radicular symptoms, and dysfunction, necessitating surgical intervention.
- Current surgical strategies for symptomatic SPCs are debated.
Purpose of the Study:
- To evaluate a novel surgical wrapping technique for symptomatic sacral perineural cysts (SPCs).
- To test the hypothesis that SPCs cause symptoms by irritating adjacent nerve roots.
Main Methods:
- Seven patients with severe medial thigh pain and SPCs underwent surgery.
- A partial sacral laminectomy was performed, followed by cyst puncture, CSF aspiration, and nerve root dissection.
- Cysts were wrapped with a Gore-Tex membrane to prevent reexpansion.
Main Results:
- All 7 patients reported significant pain reduction (average NRS score decreased from 7.9 to 0.6).
- Postoperative MRI confirmed cyst size reduction and nerve root decompression.
- No cyst regrowth or symptom recurrence was observed during 39-90 months of follow-up.
Conclusions:
- The Gore-Tex wrapping technique effectively relieved radicular symptoms in patients with symptomatic SPCs.
- Findings support the theory that symptoms arise from adjacent nerve root compression by SPCs.
- This technique provides a safe and effective treatment option for symptomatic SPCs.
