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A large multilobulated T2-hyperintense lesion consistent with perineural/Tarlov cyst is seen in the center to left side of the sacrum, extending along from the left S1 and S2 neural foramina. (A) Sagittal T1 of the first MRI, (B) sagittal T2 of the most recent MRI , (C) axial T1 of the first MRI, and (D) axial T2 of the most recent MRI showing growth of the cyst.
Source publication
Background:
Tarlov cysts (TC), also known as perineural cysts are meningeal dilations of the posterior nerve root sheath that typically affect sacral nerve roots. TC are usually asymptomatic and found incidentally. We present the case of a patient with an enlarging sacral TC causing pain from spinopelvic instability secondary to extensive bone ero...
Context in source publication
Context 1
... patient had a known sacral TC, first discovered incidentally on an MRI obtained 5 years before. Repeat MRI a few years later demonstrated growth of the cyst ( Fig. 1 ). Latest imaging revealed a large, multilobulated lesion consistent with TC adjacent to the left side of the sacrum, extending outward from the left S1 and S2 neural foramina. ...
Citations
... The surgical goal for treating SMCs without SNRFs is to restore the normal anatomical structure of the terminal cisterna and the nerve root sleeve and to suture or ligate the neck or fistula of the cyst (14). ...
Objective
This 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).
Methods
This 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.
Results
This 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.
Conclusion
ANRR-MRI is an accurate and efficient approach for identifying leakage orificium, facilitating the precise diagnosis and surgical treatment of SMCs without SNRFs.
... Driven by pulsatile and hydrodynamic forces, cerebrospinal fluid flows in one direction, resulting in the formation and continuous expansion of SESMCs (3, 5). The enlargement of the SESMCs can exert a significant mass effect due to their elevated internal pressure, resulting in compression of the surrounding neural tissue and gradual damage to the adjacent bone (6)(7)(8). ...
Introduction
Sacral 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.
Methods
In 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.
Results
Between 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 mm ² (average 906.21 ± 84.04 mm ² ). 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.
Conclusions
One-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.
