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Management of symptomatic sacral perineural cysts with microsurgery and a vascularized fasciocutaneous flap
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2018 (English)In: Journal of spine surgery (Hong Kong), ISSN 2414-469X, Vol. 4, no 3, p. 602-609Article in journal (Refereed) Published
Abstract [en]

Background: The optimal treatment of symptomatic perineural (Tarlov) cysts is controversial. Numerous surgical techniques have been proposed with conflicting results. A series of Tarlov cysts treated with a novel surgical approach is presented.

Methods: Patients with surgically treated symptomatic perineural cysts during 2013-2016 were included. The main indications for surgery were persistent radicular symptoms, pelvic pain, urinary and/ or bowel disturbances. At surgery, the cyst was opened and fenestrated. The cyst wall was then closed with packing, fibrin glue and a pedicled vascularized fasciocutaneous flap rotated into the area for obliteration of the dead space. Patients were followed-up with clinical visits and repeat magnetic resonance imaging (MRI) scans.

Results: Seven consecutive patients were included. The mean age was 50.3 years (range, 25-80 years) and the mean duration of symptoms was 49.3 months (range, 3-130 months). With one exception, all patients had urine and/or bowel problems (incontinence) preoperatively. A lumbar drain was inserted in five patients. The mean follow-up period was 15.4 months. Symptoms improved in 4/7 patients, in two cases no clinical difference was noted while one patient deteriorated. In two cases, a spinal cord stimulator was eventually implanted. In all seven cases, a significantly decreased cyst size was noted on MRI.

Conclusions: Cyst fenestration and the use of a vascularized fasciocutaneous flap successfully obliterated all cysts, with satisfactory clinical efficacy. Larger and comparative studies are warranted to clarify the long-term effects of this surgical technique in patients with symptomatic Tarlov cysts.

Place, publisher, year, edition, pages
2018. Vol. 4, no 3, p. 602-609
Keywords [en]
Perineural sacral cysts, Tarlov cysts, complications, fasciocutaneous flap, muscle flap, outcome, surgical management
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-397514DOI: 10.21037/jss.2018.07.02PubMedID: 30547125OAI: oai:DiVA.org:uu-397514DiVA, id: diva2:1371884
Available from: 2019-11-21 Created: 2019-11-21 Last updated: 2020-01-15Bibliographically approved

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Mani, Maria

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