Neck transfixion for sacral extradural spinal meningeal cysts without spinal nerve root fibers

Sun, Jianjun; Wang, Zhenyu; Liu, Bin; Li, Zhendong; Wu, Haibo; Yen, Ru-yu; Ma, Zheng; Teo, Mario; Liu, Isabelle Yisha

doi:10.1007/s00586-014-3471-z

Cited by 12 publications

(8 citation statements)

References 16 publications

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“…In 2013, we summarized our previous clinical experience in the treatment of type I and type II SMCs ( 2 , 3 ). In 2016, we proposed a distinct subtype of smooth muscle cells (SMCs), filum terminale cysts without SNRFs, which are usually accompanied by spinal cord tethering ( 4 ). For these patients, the surgical strategy should not be limited to suturing or ligating the cyst neck but should include releasing the tethered spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Accurate diagnosis and treatment of sacral meningeal cysts without spinal nerve root fibres: identifying leakage orificium using high-resolution spherical arbitrary-dimensional reconstructing magnetic resonance imaging

Yang,

Lou,

Huang

et al. 2024

Front. Neurol.

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ObjectiveThis study aimed to develop an arbitrary-dimensional nerve root reconstruction magnetic resonance imaging (ANRR-MRI) technique for identifying the leakage orificium of sacral meningeal cysts (SMCs) without spinal nerve root fibres (SNRFs).MethodsThis prospective study enrolled 40 consecutive patients with SMCs without SNRFs between March 2021 and March 2022. Magnetic resonance neural reconstruction sequences were performed for preoperative evaluation. The cyst and the cyst-dura intersection planes were initially identified based on the original thin-slice axial T2-weighted images. Sagittal and coronal images were then reconstructed by setting each intersecting plane as the centre. Then, three-dimensional reconstruction was performed, focusing on the suspected leakage point of the cyst. Based on the identified leakage location and size of the SMC, individual surgical plans were formulated.ResultsThis cohort included 30 females and 10 males, with an average age of 42.6 ± 12.2 years (range, 17–66 years). The leakage orificium was located at the rostral pole of the cyst in 23 patients, at the body region of the cyst in 12 patients, and at the caudal pole in 5 patients. The maximum diameter of the cysts ranged from 2 cm to 11 cm (average, 5.2 ± 1.9 cm). The leakage orificium was clearly identified in all patients and was ligated microscopically through a 4 cm minimally invasive incision. Postoperative imaging showed that the cysts had disappeared.ConclusionANRR-MRI is an accurate and efficient approach for identifying leakage orificium, facilitating the precise diagnosis and surgical treatment of SMCs without SNRFs.

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Section: Discussionmentioning

confidence: 99%

Accurate diagnosis and treatment of sacral meningeal cysts without spinal nerve root fibres: identifying leakage orificium using high-resolution spherical arbitrary-dimensional reconstructing magnetic resonance imaging

Yang,

Lou,

Huang

et al. 2024

Front. Neurol.

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“…In 2013, based on our preliminary clinical experience, we classified SCs into two types: nerve root type (Tarlov cyst) and non-nerve root type (meningeal diverticula) [1][2][3]. This classification system provides guidance on the relevant surgical strategy and clinical prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Sacral cysts (SCs) are cerebrospinal fluid (CSF)-filled extradural meningeal cysts within the sacral canal that are most commonly found in patients with lower back/lower extremity/perineal pain, paresthesia, paresis, and bowel/bladder/ sexual dysfunction [1][2][3]. Persistent standing/sitting, coughing, and sneezing result in elevated subarachnoid hydrostatic pressure and drive the more rapid CSF flow into the cyst, which ultimately aggravates relevant symptoms [4].…”

Section: Introductionmentioning

confidence: 99%

“…In our previous study, we divided SCs into two cohorts after careful intraoperative exploration. Cysts with nerve root passage (Tarlov cyst) received standardized surgical nerve root sheath reconstruction; cysts without nerve roots (meningeal diverticula) received standardized neck transfixion [1][2][3]. Tarlov cyst can be singular or multiple with an uneven size.…”

Section: Introductionmentioning

confidence: 99%

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Multiple dimensions of radiographic reconstruction for the optimal operative strategy of sacral meningeal cysts

Xie

Yang

et al. 2022

Eur Spine J

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Background and purpose The contents and subtypes of sacral cysts are sophisticated in many cases. We applied multiple dimensional magnetic resonance imaging (MRI) reconstruction to preoperatively clarify the specific subtype of sacral meningeal cysts. Materials and methods We preoperatively used multimodal neural reconstruction MRI sequences to evaluate 76 patients with sacral cysts. The linear nerve roots were precisely traced based on sagittal or coronal images processed at various angles and levels which was conducive to the design of the operation strategy. Results Cysts with nerve passage were detected in 47 cases (62%, 47/76), whereas cysts without nerve roots were detected in 24 cases (32%, 24/76). Five patients had mixed cysts with or without nerve roots. Intraoperative exploration results proved the high accuracy of image reconstruction; only one cyst without a nerve root was misdiagnosed prior to surgery. Conclusion MRI reconstruction based on the three-dimensional fast imaging employing steady-state acquisition T2 sequence precisely tracked the nerve roots of sacral cysts and guided the optimal strategy during surgery.

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“…They also noted that when cysts are small, the pressure inside may still become critical. Therefore, even very small cysts can be symptomatic, and the initial symptoms in such cases are pain and paresthesia, which can be severely debilitating [19,24,43].…”

Section: Pathogenesismentioning

confidence: 99%

Electromyography and A Review of the Literature Provide Insights into the Role of Sacral Perineural Cysts in Unexplained Chronic Pelvic, Perineal and Leg Pain Syndromes

Hulens¹,

Frans²,

Alix³

et al. 2017

Int J Phys Med Rehabil

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Neck transfixion for sacral extradural spinal meningeal cysts without spinal nerve root fibers

Abstract: Most patients experienced significant improvement in their neurological function after surgery. The most significant area of neurological improvement was bowel/bladder dysfunction, however, preoperative stool or urine incontinence did not recover completely.

Cited by 12 publications

References 16 publications

Accurate diagnosis and treatment of sacral meningeal cysts without spinal nerve root fibres: identifying leakage orificium using high-resolution spherical arbitrary-dimensional reconstructing magnetic resonance imaging

Accurate diagnosis and treatment of sacral meningeal cysts without spinal nerve root fibres: identifying leakage orificium using high-resolution spherical arbitrary-dimensional reconstructing magnetic resonance imaging

Multiple dimensions of radiographic reconstruction for the optimal operative strategy of sacral meningeal cysts

Electromyography and A Review of the Literature Provide Insights into the Role of Sacral Perineural Cysts in Unexplained Chronic Pelvic, Perineal and Leg Pain Syndromes

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