Regional Service of Neurosurgery, "Virgen de la Arrixaca" University Hospital, El Palmar, E-30120, Murcia, Spain.
Neurosurgery Unit, Hospital Quiron Torrevieja, Torrevieja, Spain.
Acta Neurochir (Wien). 2021 Oct;163(10):2769-2776. doi: 10.1007/s00701-021-04817-z. Epub 2021 Mar 24.
The authors report their experience with 44 consecutive patients who underwent cyst fenestration and wall repair or cerebrospinal fluid communication closure for the management of sacral Tarlov cysts.
The procedure was performed on 32 women and 12 men with a mean age of 42 years. Clinical complaints in all patients included lumbar-sacral aching, sphincter dysfunction perineal pain, and sexual intercourse pain. The patients' symptoms had developed within a mean time period of 45 months. Five patients had a previous cyst puncture. In all patients, the cyst was exposed through a sacral laminectomy. In 30 patients, the cyst was partially resected its wall repaired, and in the remaining patients, the cyst was fenestrated, and the cerebrospinal fluid communication was located and tamponaded. Thirty-seven patients had intraoperative EMG monitoring. While the perineal pain, urinary, or sexual dysfunction improved in all patients, eleven patients reported lasting pain control following surgery. The cyst was reduced in all resected cases and seven of 14 patients with CSF tamponade. The mean length of the follow-up period was 57 months.
Either cyst repair or CSF tamponade can be sufficient for alleviating symptoms in patients with Tarlov cyst. Advice should be given to patients regarding expectations for pain improvement after surgery.
作者报告了他们为治疗骶骨 Tarlov 囊肿对 44 例连续患者进行囊肿开窗和壁修补或脑脊液沟通关闭的经验。
该手术在 32 名女性和 12 名男性患者中进行，平均年龄为 42 岁。所有患者的临床症状均包括腰骶部疼痛、括约肌功能障碍、会阴疼痛和性交疼痛。患者的症状在平均 45 个月的时间内发展。5 例患者曾行囊肿穿刺。所有患者均通过骶骨椎板切除术暴露囊肿。在 30 例患者中，囊肿部分切除，壁修补，在其余患者中，囊肿开窗，定位并填塞脑脊液沟通。37 例患者进行术中肌电图监测。虽然所有患者的会阴疼痛、尿失禁或性功能障碍均有所改善，但 11 例患者术后仍持续疼痛控制。在所有切除病例中，囊肿均减小，在 14 例 CSF 填塞病例中，有 7 例减小。平均随访时间为 57 个月。
囊肿修复或 CSF 填塞都可以缓解 Tarlov 囊肿患者的症状。应向患者提供关于术后疼痛改善的预期建议。
