Introduction: Symptomatic sacral Perineural cysts are extremely rare. The aim of this retrospective study is to investigate the outcome of 15 consecutive patients treated by microsurgical resection of the cyst and to review the literature.
Methods: Fifteen patients who were operated on due to symptomatic sacral perineural cysts were enrolled in the study. Patients' symptoms, radiographs, intra-operative findings, and clinical results were evaluated. All 15 patients underwent microsurgical excision of the cyst. Economic (activity) and functional (pain) status were assessed and classified according to the grading system proposed by Prolo, et al. Bladder functions were evaluated using urodynamic study . Magnetic resonance image (MRI) lumbosacral spine with Gadolinium contrast was done preoperatively and repeated in the postoperative stage, six months later, and then for yearly follow-up evaluations. The literature on this topic available in PubMed was also reviewed.
Results: In our study, There were 5 men and 10 women included in the study, with a mean age of 31 years (range 7–60 years). The mean follow-up was 54 months (range 3-160 months). We used the technique of cyst exploration, excision and then closure of the defect by fibrin glue, we had an outcome of 100 % improvement of preoperative symptoms including pain, sensory deficit and bladder dysfunction. According to functional outcome assessment by Prolo scale, we had significant improvement from a mean of 6.2 ± 3.2 at time of presentation, to a mean of 8.4 ± 7.1 postoperatively, and to a mean of 9.5 ± 4.5 one year after surgery.
Conclusions: Cyst excision is an effective and safe technique for symptomatic sacral perineural (Tarlov) cysts. Careful patient selection is vital to the management and treatment of this difficult and controversial pathology.
Patient Care: the research can help in choosing the appropriate surgical apparoch for perineural cysts and decide if the patient is need for surgery or no.
Learning Objectives: By the conclusion of this session, paricipants should be able to: 1) evalaute the surgical outcome for Tarlov cysts, 2)overview of various surgical techniques for tralov cyst