Cysts Resection And EC Glue Treatment Of Sacral Never Root Cysts

Objections: Sacral nerve root cyst is one of the reason for low back pain. Denomination of sacral nerve root cyst is controversial. It was always been named Tarlov cyst, sacral perineural cyst, sacral extradural cysts ,sacral arachnoid cyst, and so on. The sacral nerve root cyst was first described by Tarlov in 1938 as an incidental finding at autopsy. It was been named sacral nerve root cyst in 1972. The prevalence of patients who had lumbosacral pain estimated to be 1%—4.6%. The patients always presented with low back pain, sciatic pain and urinary dysfunction. About 70% patients were asymptomatic, only one point five of them need to operation. The pathophysiology of these cysts has been described as a"ball-valve"mechanism that allow fluid to enter but not leave, presumable in a gravitational .The cysts communicate with the subarachnoid space and are therefore filled with cerebrospinal fluid. Nabors classed the cyst 3 types (1)Type I extradural cysts without spinal nerve root fibers;(2) Type II extradural cysts with spinal nerve root fibers ;(3)Type III intradural cysts . Lumbosacral MRI would show their location and size, was the best diagnosis methods. 12 patients of sacral nerve root cyst, five male and seven female ,aged from 17 to 56, were admit to our hospital from November ,1999 to October,2005. All patients presented with lumbosacral pain ,8 cases presented with sciatic pain,4 cases presented with decreased sensation on leg, 2 cases presented weakness of leg, 2 cases presented with urinary dysfunction. All patients were given MRI excises and found 10 single cyst, 2 multiple cyst, that measured from 2cm*0.8cm*0.6cm—7cm*5cm*3cm. We treated 12 cases with cyst resection and used EC glue to conglutination the leak. We routinely scheduled for clinical follow-up and studied the clinical effect.Methods : After induction with general anesthesia, the patient positioned ventral decubitus. We performed sacral laminectomies with microsurgical cyst resection and EC glue to conglutination the leak for all patients. During the operation , we find that cysts were sky-blue and content in cysts was clear liquid. We found obviously leak in 9 cases.Results : After operation, 12 patients with lumbosacral pain were all released; within 8 cases of sciatic pain 5 cases released and others partly released. The patients were routinely scheduled for clinical follow-up 5 months to 3 years after surgery. NO recrudescence, no leakage of cerebrospinal fluid ,lumbosacral pain was not recrudescence. Nerve dysfunction was partly released in all cases.Conclusion :Denominate and treatment of sacral nerve root cysts were controversial. Cysts resection and EC glue treatment of sacral nerve root cysts was effective , and it may reduce the ratio of leakage of cerebrospinal fluid and the recrudescence, but the long-term effect should be follow-up.