Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases

Surgical Treatment of Sacral Perineural Cyst -Case Report-

“…6,13) Depending on the location, size, and relationship to the nerve roots, perineural cysts may cause local or radicular pain, sensory disturbance, motor deficits, neurogenic claudication, bowel and bladder dysfunction, or sexual impotence. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Specific radicular pain may be the result of distortion, compression, or stretching of the nerve root by the space-occupying features of cysts. Symptoms can be exacerbated by changes in posture, coughing, Valsalva maneuvers, standing, lifting, and climbing stairs, all of which increase CSF pressure.…”

“…However, whether patients with symptomatic perineural cysts should be treated surgically remains under discussion. 2,3,16,18) In fact, the majority of symptomatic perineural cysts have been treated surgically, but conservative treatment with steroid or gabapentin has been reported. 8,9) Successful surgical treatment of perineural cysts depends on appropriate patient selection.…”

“…Several surgical procedures for perineural cysts have been reported, [1][2][3][4][5][6][7][10][11][12][13][14][15][16]18,19) but no consensus exists of the most appropriate. The procedures are of three types: procedures to lower CSF hydrostatic and pulsatile pressures, such as external CSF drainage 1) or lumbar peritoneal shunt 1) ; procedures to decompress cysts, such as simple decompressive laminectomy, 15) CT-guided percutaneous aspiration, 7,13) or cyst-subarachnoid shunt 5,10) ; and direct surgical procedures such as bipolar cautery to shrink cysts, 14) total cyst removal, 2,12) partial cyst removal with neck ligation, 4,18) or cyst wall imbrication.…”

“…The procedures are of three types: procedures to lower CSF hydrostatic and pulsatile pressures, such as external CSF drainage 1) or lumbar peritoneal shunt 1) ; procedures to decompress cysts, such as simple decompressive laminectomy, 15) CT-guided percutaneous aspiration, 7,13) or cyst-subarachnoid shunt 5,10) ; and direct surgical procedures such as bipolar cautery to shrink cysts, 14) total cyst removal, 2,12) partial cyst removal with neck ligation, 4,18) or cyst wall imbrication. 3,6,11,16,19) These surgical options are summarized in Table 1.…”

“…However, no consensus exists regarding the appropriate surgical procedures. 2,3,16,18) We describe a case of sacral perineural cyst treated successfully with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the communication between the cyst and the arachnoid space with absorbable collagen sponge and fibrin glue.…”