Arachnoidal Diverticula of Sacral Extradural Meningeal Cyst: A Novel Definition and Case Series

Ma, Qianquan; Wu, Chujun; Zhang, Jia; Yin, Xiaoliang; Yang, Chenlong; Yu, Shaohua; Wu, Haibo; Qiang, Zhang; Liu, Ying; Yuan, Huishu; Chang, Qing; Xie, Jingcheng; Yang, Jun; Sun, Jianjun

doi:10.1016/j.wneu.2022.03.052

Cited by 3 publications

(6 citation statements)

References 17 publications

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“…For simple fistulas, direct suturing and ligatures were sufficient. For spinal dura mater leakage, after suturing and ligature, the dural sac end was reinforced (1,22). Some SMCs may be accompanied by sacroanterior cysts.…”

Section: Discussionmentioning

confidence: 99%

“…Sacral meningeal cysts (SMCs) are cerebrospinal fluid (CSF)-filled extradural meningeal cysts that are most frequently found within the sacral canal and have a prevalence of 4.6%-13.8% in the adult population (1). SMCs are usually asymptomatic, and conditions are usually encountered during radiological screening for sensory discomfort, such as lumbosacral and lower extremity pain and numbness, in neurosurgical, orthopaedic, pain medicine, sports medicine, neurological, and other outpatient clinics (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…A comprehensive description of the microsurgical procedures has been previously documented in our published articles (14,15). A brief summary of the procedure is as follows: Under general anesthesia, patients were positioned in the prone waist-bridge posture with the head facing downward.…”

Section: Microsurgical Managementmentioning

confidence: 99%

Feasibility and safety of one-stage sacral laminoplasty with autologous sacral laminar reimplantation fixed by absorbable fixation clamps in direct microsurgical treatment of symptomatic sacral extradural spinal meningeal cysts

Yin,

Zhang,

et al. 2023

Front. Surg.

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IntroductionSacral laminoplasty with titanium mesh and titanium screws can reduce symptomatic sacral extradural spinal meningeal cysts (SESMCs) recurrence and operation complications. However, due to a defect or thinning of the sacrum, the screws cannot be securely anchored and there are also problems with permanent metal implantation for titanium mesh and screws. We propose that sacral laminoplasty with absorbable clamps can provide rigid fixation even for a thinned or defected sacrum without leaving permanent metal implants.MethodsIn the direct microsurgical treatment of symptomatic SESMCs, we performed one-stage sacral laminoplasty with autologous sacral lamina reimplantation fixed by absorbable fixation clamps. Retrospectively, we analyzed intraoperative handling, planarity of the sacral lamina, and stability of the fixation based on clinical and radiological data.ResultsBetween November 2021 to October 2022, we performed sacral laminoplasty with the absorbable craniofix system in 28 consecutive patients with SESMCs. The size of the sacral lamina flaps ranged from 756 to 1,052 mm2 (average 906.21 ± 84.04 mm2). We applied a minimum of two (in four cases) and up to four (in four cases) Craniofix clamps in the operation, with three (in 20 cases) being the most common (82.14%, 20/28) and convenient to handle. Excellent sacral canal reconstruction could be confirmed intraoperatively by the surgeons and postoperatively by CT scans. No intraoperative complications occurred.ConclusionsOne-stage sacral laminoplasty with absorbable fixation clamps is technically feasible, and applying 3 of these can achieve a stable fixation effect and are easy to operate. Restoring the normal structure of the sacral canal could reduce complications and improve surgical efficacy.

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“…type, filamentous type and arachnoidal diverticula cyst [10]. The classical meningeal diverticula cysts exclude any nerve root passage inside the cavity and have typical fistulas which are often detected at the end of dural sac and directly facilitate CSF outflow.…”

Section: Introductionmentioning

confidence: 99%

“…Arachnoidal diverticula is another subtype which has distinctive arachnoidal structure at cyst neck. The arachnoidal complex is proved to secret CSF from dural sac into cyst cavity [10].…”

Section: Introductionmentioning

confidence: 99%

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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Arachnoidal Diverticula of Sacral Extradural Meningeal Cyst: A Novel Definition and Case Series

Cited by 3 publications

References 17 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

Feasibility and safety of one-stage sacral laminoplasty with autologous sacral laminar reimplantation fixed by absorbable fixation clamps in direct microsurgical treatment of symptomatic sacral extradural spinal meningeal cysts

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

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