Management of symptomatic sacral perineural cysts with microsurgery and a vascularized fasciocutaneous flap
Tsitsopoulos, Parmenion P ; Marklund, Niklas LU
; Salci, Konstantin
; Holtz, Anders
and Mani, Maria
(2018)
In Journal of spine surgery (Hong Kong)
4(3).
p.602-609
- Abstract
Background: The optimal treatment of symptomatic perineural (Tarlov) cysts is controversial. Numerous surgical techniques have been proposed with conflicting results. A series of Tarlov cysts treated with a novel surgical approach is presented.
Methods: Patients with surgically treated symptomatic perineural cysts during 2013-2016 were included. The main indications for surgery were persistent radicular symptoms, pelvic pain, urinary and/ or bowel disturbances. At surgery, the cyst was opened and fenestrated. The cyst wall was then closed with packing, fibrin glue and a pedicled vascularized fasciocutaneous flap rotated into the area for obliteration of the dead space. Patients were followed-up with clinical visits and repeat... (More)
Background: The optimal treatment of symptomatic perineural (Tarlov) cysts is controversial. Numerous surgical techniques have been proposed with conflicting results. A series of Tarlov cysts treated with a novel surgical approach is presented.
Methods: Patients with surgically treated symptomatic perineural cysts during 2013-2016 were included. The main indications for surgery were persistent radicular symptoms, pelvic pain, urinary and/ or bowel disturbances. At surgery, the cyst was opened and fenestrated. The cyst wall was then closed with packing, fibrin glue and a pedicled vascularized fasciocutaneous flap rotated into the area for obliteration of the dead space. Patients were followed-up with clinical visits and repeat magnetic resonance imaging (MRI) scans.
Results: Seven consecutive patients were included. The mean age was 50.3 years (range, 25-80 years) and the mean duration of symptoms was 49.3 months (range, 3-130 months). With one exception, all patients had urine and/or bowel problems (incontinence) preoperatively. A lumbar drain was inserted in five patients. The mean follow-up period was 15.4 months. Symptoms improved in 4/7 patients, in two cases no clinical difference was noted while one patient deteriorated. In two cases, a spinal cord stimulator was eventually implanted. In all seven cases, a significantly decreased cyst size was noted on MRI.
Conclusions: Cyst fenestration and the use of a vascularized fasciocutaneous flap successfully obliterated all cysts, with satisfactory clinical efficacy. Larger and comparative studies are warranted to clarify the long-term effects of this surgical technique in patients with symptomatic Tarlov cysts.
(Less)
- author
- Tsitsopoulos, Parmenion P
; Marklund, Niklas
LU
; Salci, Konstantin
; Holtz, Anders
and Mani, Maria
- organization
- publishing date
- 2018-09
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of spine surgery (Hong Kong)
- volume
- 4
- issue
- 3
- pages
- 602 - 609
- publisher
- AME Publishing Company
- external identifiers
-
- pmid:30547125
- ISSN
- 2414-469X
- DOI
- 10.21037/jss.2018.07.02
- language
- English
- LU publication?
- yes
- id
- fbf93925-a74e-487f-9bc8-bbd2d5de102d
- date added to LUP
- 2019-02-05 11:41:26
- date last changed
- 2019-02-26 12:43:52
@article{fbf93925-a74e-487f-9bc8-bbd2d5de102d,
abstract = {{<p>Background: The optimal treatment of symptomatic perineural (Tarlov) cysts is controversial. Numerous surgical techniques have been proposed with conflicting results. A series of Tarlov cysts treated with a novel surgical approach is presented.</p><p>Methods: Patients with surgically treated symptomatic perineural cysts during 2013-2016 were included. The main indications for surgery were persistent radicular symptoms, pelvic pain, urinary and/ or bowel disturbances. At surgery, the cyst was opened and fenestrated. The cyst wall was then closed with packing, fibrin glue and a pedicled vascularized fasciocutaneous flap rotated into the area for obliteration of the dead space. Patients were followed-up with clinical visits and repeat magnetic resonance imaging (MRI) scans.</p><p>Results: Seven consecutive patients were included. The mean age was 50.3 years (range, 25-80 years) and the mean duration of symptoms was 49.3 months (range, 3-130 months). With one exception, all patients had urine and/or bowel problems (incontinence) preoperatively. A lumbar drain was inserted in five patients. The mean follow-up period was 15.4 months. Symptoms improved in 4/7 patients, in two cases no clinical difference was noted while one patient deteriorated. In two cases, a spinal cord stimulator was eventually implanted. In all seven cases, a significantly decreased cyst size was noted on MRI.</p><p>Conclusions: Cyst fenestration and the use of a vascularized fasciocutaneous flap successfully obliterated all cysts, with satisfactory clinical efficacy. Larger and comparative studies are warranted to clarify the long-term effects of this surgical technique in patients with symptomatic Tarlov cysts.</p>}},
author = {{Tsitsopoulos, Parmenion P and Marklund, Niklas and Salci, Konstantin and Holtz, Anders and Mani, Maria}},
issn = {{2414-469X}},
language = {{eng}},
number = {{3}},
pages = {{602--609}},
publisher = {{AME Publishing Company}},
series = {{Journal of spine surgery (Hong Kong)}},
title = {{Management of symptomatic sacral perineural cysts with microsurgery and a vascularized fasciocutaneous flap}},
url = {{http://dx.doi.org/10.21037/jss.2018.07.02}},
doi = {{10.21037/jss.2018.07.02}},
volume = {{4}},
year = {{2018}},
}