Microsurgical sealing for symptomatic sacral Tarlov cysts: a series of 265 cases

Author:

Chu Weihua1,Chen Xin1,Wen Zexian2,Xue Xingsen1,He Guangjian1,Zhang Hongyan1,Liu Jingjing1,Zhang Yang1,Feng Hua1,Lin Jiangkai1

Affiliation:

1. Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing; and

2. Department of Cerebrovascular Disease, Dazhou Central Hospital, Dazhou, China

Abstract

OBJECTIVE Tarlov cysts (TCs) are a common cystic entity in the sacral canal, with a reported prevalence between 1.5% and 13.2%; 10%–20% of patients are symptomatic and need appropriate clinical intervention. However, the choice of treatment remains controversial. The goal of this study was to describe a new microsurgical sealing technique for symptomatic sacral TCs (SSTCs) as well as its long-term outcomes. METHODS Microsurgical sealing was performed using a short incision, leakage coverage with a piece of autologous fat, and cyst sealing with fibrin glue. Postoperative data were collected at three stages: discharge, 1-year follow-up, and a follow-up of 3 years or more. According to the improvement in neurological deficits and degree of pain relief, outcomes were divided into four levels: excellent, good, unchanged, and deteriorated. RESULTS A total of 265 patients with SSTCs were treated with microsurgical sealing from January 2003 to December 2020. The mean follow-up was 44.69 months. The percentages of patients who benefited from the operation (excellent and good) at the three stages were 87.55%, 84.89%, and 80.73%, respectively, while those who received no benefit (unchanged and deteriorated) were 12.45%, 15.11%, and 19.27%, respectively. Of the patients with postoperative MRI, the cysts were reduced in size or disappeared in 209 patients (94.14%). CSF leakage from the wound was observed in 15 patients, and 4 patients experienced an infection at the incision. There were no cases of new-onset nerve injury or aseptic meningitis after the operation. CONCLUSIONS SSTC patients undergoing microsurgical sealing had persistently high rates of symptom relief and few postoperative complications. Microsurgical sealing is an effective, simple, and low-risk method for treating SSTCs.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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4. Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts);Paulsen RD,1994

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