Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers

This study analyzed the clinical characteristics and outcomes of sacral extradural spinal meningeal cysts with spinal nerve root fibers treated by reconstruction of the nerve root sheaths.The relationships between the cysts and spinal nerve root fibers were examined microscopically,the cysts were partially excised,and the defects were oversewn to reconstruct the nerve root sheaths.The Improved Japanese Orthopedic Association(IJOA)scoring system was used to evaluate preoperative and postoperative neurological function.Thirty-eight patients were included in this study,with a mean age of 41.4±15.57 years.The mean IJOA score was 18.8±1.32 preoperatively and 19.6±0.65 postoperatively,which was a significant difference(t=–3.77,P=0.001).These results indicate a significant improvement in neurological function after surgery.The most significant improvement in neurological function was sensation(z=–2.86,P=0.004),followed by bowel/bladder function(z=–2.31,P=0.02).

How to locate the dural defect in a spinal extradural meningeal cyst: a literature review

Spinal extradural meningeal cysts(SEMCs)are rare lesions of the spinal canal.Although closure of the dural defect can achieve satisfactory therapeutic effects,locating the fistula is difficult.This review summarizes the methods for locating the fistula of SEMCs and the distribution and features of fistula sites.This was a non-systematic literature review of studies on SEMCs.We searched PubMed for English-language articles to summarize the methods of locating the defect.The search words were“epidural arachnoid cyst,”“dural cyst,”“epidural cyst,”and“epidural meningeal cyst.”For the defect location component of the study,case reports,studies with a sample size less than four,controversial ventral dural dissection(s),and undocumented fistula location reports were excluded.Our review showed that radiography and computed tomography(CT)may show changes in the bony structure of the spine,with the largest segment of change indicating the fistula site.Occasionally,magnetic resonance imaging(MRI)can show a cerebrospinal fluid(CSF)flow void at the fistula site.The middle segment of the cyst on sagittal MRI,the largest cyst area,and cyst laterality in the axial view indicate the fistula location.Myelography can show the fistula location in the area of the enhanced cyst and subarachnoid stenosis.Digital subtraction or delayed CT can be used to observe the location of the initial cyst filling.Cine MRI and time-spatial labeling inversion pulse techniques can be used to observe CSF flow.Steady-state image construction interference sequence MRI has a high spatial resolution.Neuroendoscopy,MRI myelography,and ultrasound fistula detection can be performed intraoperatively.Moreover,the fistula was located most often in the T12–L1 segment.Identifying the fistula location is difficult and requires a combination of multiple examinations and experience for comprehensive judgment.