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

Abstract

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.

Clinical findings of Tarlov cyst according to its location and level in lumbosacral spine on magnetic resonance imaging

“…These nuanced findings are imperative for clinical practice, as they suggest that even small cysts in critical locations may have significant clinical repercussions (26). The interplay between our findings and established data leads to a more comprehensive understanding of Tarlov cysts (27). Our comparative approach emphasizes the need for clinicians to maintain a high index of suspicion for Tarlov cysts in patients presenting with lower back pain and associated neurological symptoms, especially when such symptoms are disproportionate to findings from common conditions like disc herniation or degenerative disc disease (28).…”

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

“…Moreover, this sequence is a 3D scan that can be reconstructed in any spherical dimension and displays the three-dimensional anatomical relationship between nerve roots and cysts from different angles. Additionally, high-resolution curve planar reformation can reveal the complete nerve pathway that enters the sacral cyst in a curved manner, as well as the possible presence of leakage ( 28 ).…”

“…However, currently, surgical treatment is the exclusive approach for relieving symptoms in a considerable proportion of patients (26, 27). 3D-FIESTA imaging is highly valuable for identifying nerve roots and leakage orificia (28). This sequence can compensate for the deficiencies of T1-FLAIR and T2WI, and the nerve roots often exhibit clear hypointensity, resulting in a sharp contrast with the hyperintensity of the cystic fluid.…”