Caspar Wolfhard, Papavero Luca, Nabhan Abdullah, Loew Cornelius, Ahlhelm Frank
Department of Neurosurgery, Faculty of Medicine, Saarland University, Homburg-Saar, Germany.
Surg Neurol. 2003 Feb;59(2):101-5; discussion 105-6. doi: 10.1016/s0090-3019(02)00981-3.
The widespread use of magnetic resonance imaging (MRI), now the first line investigation for back and leg pain, reveals cystic sacral lesions more often than myelography did in the past. There is agreement that symptomatic perineurial sacral cysts should be treated surgically. However, it is still debated whether the preference should be given to the curative option, consisting of excision of the cyst with duraplasty, or to drainage of the cyst to relieve symptoms. In this retrospective study the efficacy of microsurgical cyst resection with duraplasty is evaluated.
In 15 patients presenting with pain and neurologic deficits, myelography and/or MRI detected sacral cysts. The clinical features suggested that the space-occupying lesions caused the disturbances. Microsurgical excision of the cyst along with duraplasty or plication of the cyst wall was performed in all the cases. Postoperative care included bed rest and CSF drainage for several days.
In 13 out of 15 patients the preoperative radicular pain disappeared after surgery. The 2 patients with motor deficits and the 6 patients with bladder dysfunction recovered completely. In all except 1 of the 10 patients complaining of sensory disturbances a significant improvement was achieved. No complications were observed.
Microsurgical excision of the cyst combined with duraplasty or plication of the cyst wall is an effective and safe treatment of symptomatic sacral cysts and, in the view of the authors, the method of choice.
磁共振成像（MRI）如今已广泛应用于腰腿痛的一线检查，相较于过去的脊髓造影，其更常发现骶部囊性病变。对于有症状的神经束膜性骶管囊肿应行手术治疗，这一点已达成共识。然而，对于是选择包括囊肿切除及硬脊膜成形术的根治性手术，还是选择囊肿引流以缓解症状，仍存在争议。在这项回顾性研究中，我们评估了显微手术囊肿切除联合硬脊膜成形术的疗效。
15例有疼痛和神经功能缺损的患者，经脊髓造影和/或MRI检查发现骶管囊肿。临床特征提示占位性病变导致了这些功能障碍。所有病例均行囊肿显微切除联合硬脊膜成形术或囊肿壁折叠术。术后护理包括卧床休息和脑脊液引流数天。
15例患者中有13例术后术前的神经根性疼痛消失。2例有运动功能缺损的患者和6例有膀胱功能障碍的患者完全康复。在10例主诉感觉障碍的患者中，除1例之外，其余患者均有显著改善。未观察到并发症。
囊肿显微切除联合硬脊膜成形术或囊肿壁折叠术是治疗有症状骶管囊肿的一种有效且安全的方法，作者认为这是首选方法。
