Zhang Bin, Dou Qingyu, Feng Pin, Kong Qingquan
Department of Orthopedics, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu Sichuan, China.
Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu Sichuan, China.
World Neurosurg. 2018 Aug;116:390-393. doi: 10.1016/j.wneu.2018.05.177. Epub 2018 Jun 1.
Symptomatic sacral Tarlov cysts have been associated with perineal or sacral pain, radiculopathy, and urinary dysfunction. The ideal treatment of symptomatic sacral Tarlov cysts remains a matter of discussion. Various open surgical procedures have been proposed, varying from placement of shunts and clipping to laminectomy and fenestration; however, those procedures are often associated with recurrence, cerebrospinal fluid leakage, infection, and other complications. A percutaneous endoscopic surgical procedure to address this problem has not been described to date.
A 21-year-old man presented with perineal and left lower extremity pain. Magnetic resonance imaging demonstrated a sacral Tarlov cyst protruding through the left S2 canal. Through a small laminectomy at S2, the posterolateral wall of the cyst was exposed. The incision was continued from the neck to caudal of the cyst. The cyst wall was resected step by step. The fenestration was performed at the neck of the cyst with scissors. His lower extremity and perineal pain improved progressively during the first day postoperatively, and there were no signs of cerebrospinal fluid leakage, infection, or other complications. No further cyst formation or complications were recorded after 6 months.
In this case report, we describe a percutaneous endoscopic approach to surgical resection of a Tarlov cyst that was performed safely and effectively. This novel minimally invasive strategy may have broad prospects for symptomatic sacral Tarlov cysts; however, due to the limitations of a single case, more reported cases and further controlled studies of this novel technique are needed.
有症状的骶部塔尔洛夫囊肿与会阴或骶部疼痛、神经根病及排尿功能障碍有关。有症状的骶部塔尔洛夫囊肿的理想治疗方法仍存在争议。已提出了各种开放性手术方法，从分流管置入、夹闭到椎板切除术和开窗术不等；然而，这些手术常伴有复发、脑脊液漏、感染及其他并发症。迄今为止，尚未描述过用于解决此问题的经皮内镜手术方法。
一名21岁男性出现会阴及左下肢疼痛。磁共振成像显示一个骶部塔尔洛夫囊肿经左侧S2椎管突出。通过S2处的小椎板切除术，暴露囊肿的后外侧壁。切口从囊肿颈部向尾部延伸。逐步切除囊肿壁。用剪刀在囊肿颈部进行开窗。术后第一天其下肢及会阴疼痛逐渐改善，且无脑脊液漏、感染或其他并发症的迹象。6个月后未记录到进一步的囊肿形成或并发症。
在本病例报告中，我们描述了一种经皮内镜手术方法用于安全有效地切除塔尔洛夫囊肿。这种新型微创策略对于有症状的骶部塔尔洛夫囊肿可能具有广阔前景；然而，由于单个病例的局限性，需要更多的报道病例及对该新技术进行进一步的对照研究。
