Spinal perineurial and meningeal cysts

Area of Science:

• Neurosurgery
• Radiology
• Neurology

Background:

• Perineurial cysts, arising at posterior root ganglia, can cause clinical symptoms.
• Meningeal diverticula, proximal to ganglia, usually fill on initial myelography and are rarely symptomatic.
• Distinguishing between perineurial cysts, meningeal diverticula, and arachnoidal prolongations is crucial for diagnosis.

Purpose of the Study:

• To investigate the diagnostic utility of delayed myelography for sacral perineurial cysts.
• To differentiate between perineurial cysts and meningeal diverticula.
• To establish criteria for surgical intervention in cases of perineurial cysts and meningeal abnormalities.

Main Methods:

• Utilized Pantopaque contrast medium for myelography.
• Performed delayed myelography days or weeks after initial contrast instillation.
• Correlated imaging findings with clinical symptoms and surgical outcomes.

Main Results:

• Perineurial cysts may fill with Pantopaque during delayed myelography, even if not seen initially.
• Meningeal diverticula typically fill on initial myelography and are often asymptomatic.
• Some perineurial cysts and meningeal abnormalities are asymptomatic and do not require surgery.

Conclusions:

• Delayed myelography with Pantopaque is valuable for diagnosing sacral perineurial cysts.
• Surgical intervention for perineurial cysts and meningeal abnormalities should be reserved for progressive or disabling symptoms.
• Careful interpretation of myelography is essential to differentiate pathological cysts from incidental findings.