Abstract
ObjectiveThere 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.MethodsIn 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.ResultsIn all cases, chief complaints disappeared immediately postoperatively and no deterioration of clinical symptoms has been seen after a mean follow-up of 27 months.ConclusionsThe presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts.
Highlights
The presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts
A sacral meningeal cyst is often found incidentally, and no specific surgical method has been established for most cases [9, 14]
With large and/or sacral meningeal cysts with a check-valve mechanism, surgery must occasionally be performed [5]
Summary
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. 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. Myelography, computed tomography (CT) myelography, and magnetic resonance imaging (MRI) were performed preoperatively in all the cases. Multiple cysts were observed in all cases, and myelography and CT myelography were required to identify the primary cyst.
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