Microsurgical Excision of Symptomatic Sacral Perineurial Cyst with Sacral Recapping Laminectomy : A Case Report in Technical Aspects
This 60-year-old female patient visited our department with 6-year history of increasing lumbosacral pain and right leg radiculopathy. On neurologic examination, she complained right L5 and S1 radiculopathy. The patient rated her pain 9 of 10 on the VAS. She did not have bladder dysfunction. Preoperative MR imaging demonstrated 15×17×22 mm sized sacral cyst with S1 nerve root (). Myelogram and CT showed the contrast-filled bridge between the thecal sac and the cystic mass, and sacral cyst causing compression of adjacent nerve roots (). After careful dissection of the cyst wall, we observed the superior surface of the cyst. The main cyst originated from inferomedial side of right L5 nerve root. We performed surgery the same way but we used miniplate instead of silk for recapping (). The symptoms improved progressively after surgery. MR imaging 4 months later demonstrated complete resolution of the cyst (). At one year follow up, she had only mild back pain (3 of 10 on the VAS).