Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: Technical note

Shunji Asamoto, Yasuyuki Fukui, Makoto Nishiyama, Masayuki Ishikawa, Nobuyuki Fujita, Satoshi Nakamura, Jun Muto, Yuta Shiono, Hiroshi Doi, Motoo Kubota, Kazuhiko Ishii

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: There is agreement that symptomatic sacral meningeal cysts with a check-valve mechanism and/or large cysts representing space-occupying lesions should be treated surgically. This study investigated factors indicating a need for surgical intervention and surgical techniques for sacral meningeal cysts with a check-valve mechanism. Methods: In ten patients presenting with sciatica and neurological deficits, myelography, computed tomography (CT) myelography, and magnetic resonance imaging (MR imaging) detected sacral meningeal cysts with a check-valve mechanism. One patient had two primary cysts. Ten cysts were type 2 and one cyst was type 1. Nine of the ten patients had not undergone previous surgery, while the remaining case involved recurrent cyst. For the seven patients with normal (i.e., not huge or recurrent) type 2 cysts and no previous surgery (eight cysts), suture after collapse of the cyst wall was performed. For the recurrent type 2 cyst, duraplasty and suture with collapse of the cyst wall were performed to eliminate the check-valve mechanism. For the remaining type 2 cyst, a primary root was sacrificed because of the huge size of the cyst. For the type 1 cyst, the neck of the cyst was ligated. Results: In all cases, chief complaints disappeared immediately postoperatively and no deterioration of clinical symptoms has been seen after a mean follow-up of 27 months. Conclusions: The presence or absence of a check-valve mechanism is very important in determining the need for surgical intervention for sacral meningeal cysts.

Original languageEnglish
Pages (from-to)309-313
Number of pages5
JournalActa Neurochirurgica
Volume155
Issue number2
DOIs
Publication statusPublished - 2013 Feb

Keywords

  • Check-valve mechanism
  • Sacral meningeal cyst
  • Surgical strategy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Asamoto, S., Fukui, Y., Nishiyama, M., Ishikawa, M., Fujita, N., Nakamura, S., Muto, J., Shiono, Y., Doi, H., Kubota, M., & Ishii, K. (2013). Diagnosis and surgical strategy for sacral meningeal cysts with check-valve mechanism: Technical note. Acta Neurochirurgica, 155(2), 309-313. https://doi.org/10.1007/s00701-012-1550-7