Acute subdural hematoma secondary to sacral arachnoid cyst surgery: a case report / 中华神经科杂志

Sacral cyst usually occurs around the nerve root, which is the accumulation of cerebrospinal fluid between the intima and the perineurium at the junction of the posterior spinal nerve root and the dorsal root ganglion. Its typical clinical manifestations include low back pain, lower limb radiation pain, rectal/bladder dysfunction and so on. Complications of acute subdural hematoma with cerebral hernia after posterior midline cystectomy of sacral cyst are rare. A middle-aged female patient with sacral cyst was admitted to Gansu Provincial Hospital. After the operation, acute subdural hematoma occurred in the right frontoparietal temporal occipital region, and cerebral herniation was formed. After the operation, the patient was given rehabilitation exercise and discharged well. No neurological deficits were observed during follow-up.

Reinforced radiculoplasty for the treatment of symptomatic sacral Tarlov cysts: A clinical analysis of 71 cases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the safety and efficacy of reinforced radiculoplasty in the treatment of symptomatic sacral Tarlov cysts (TCs).@*METHODS@#A retrospective analysis was performed on the clinical data and follow-up data of 71 patients with symptomatic sacral TCs who underwent reinforced radiculoplasty in the Neurosurgery Department of Peking University Third Hospital from June 2018 to March 2021. All the operations were performed under neuroelectrophysiological monitoring. Intraoperative cyst exploration, partial resection of the cyst wall, narrowing of the leak, nerve root sleeve radiculoplasty and artificial dural reinforcement were performed. The incidence of postoperative complications and new neurological dysfunction was analyzed. Visual analogue scale (VAS) was used to assess the changes of pain before and after surgery. The Japanese Orthopedics Association (JOA) low back pain score was used to evaluate the changes in nerve function before and after surgery.@*RESULTS@#In the study, 71 patients had 101 TCs, 19 (18.8%) TCs originated from the left S1 nerve, 26 (25.7%) originated from the left S2 nerve, 3 (3.0%) originated from the left S3 nerve, 14 (13.9%) originated from the right S1 nerve, 33 (32.7%) originated from the right S2 nerve, 6 (5.9%) originated from the right S3 nerve, all the TCs underwent reinforced radiculoplasty. Deep infection (1 case), subcutaneous effusion (1 case), fat li-quefaction (1 case) and urinary tract infection (4 cases) were recorded postoperatively. The patients were followed up for 12-43 months (median, 26 months). Two cases had new urinary retention after operation, and the catheter was removed at the end of the first and second months respectively. One case had new fecal weakness, which improved after 3 months. Compared with preoperation, VAS decreased significantly at the last follow-up [median, 6 (4-9) vs. 1 (0-5), Z=-7.272, P < 0.001], JOA score increased significantly [median, 20 (16-25) vs. 27 (18-29), Z=-7.265, P < 0.001]. There were 18 cured cases (25.4%), 41 excellent cases (57.7%), 8 effective cases (11.3%), and 4 invalid cases (5.6%). The total efficiency was 94.4% (67/71). Two (1.98%) cysts recurred.@*CONCLUSION@#For patients with symptomatic sacral TCs, reinforced radiculoplasty can significantly improve the pain and nerve function, which is safe and reliable.

The relationship between the cystic fluid characteristics of symptomatic sacral canal cyst and the interventional therapeutic prognosis / 介入放射学杂志

Objective To investigate the relationship between the cystic fluid characteristics of symptomatic sacral canal cyst and the interventional therapeutic prognosis.Methods A total of 114 patients with symptomatic sacral canal cyst were enrolled in this study.Clinically,all patients complained of discomfort at lumbosacral area.Among the 114 patients,86 were primary sacral canal cyst and 28 were recurrent sacral canal cyst.Under DSA guidance,percutaneous puncturing of the cyst was performed,2-5 ml cerebrospinal fluid (CSF) was aspirated and sent for laboratory tests.Then a small amount of nonionic contrast agent was injected into the cyst to determine whether the cyst was communicated with the subarachnoid space or not.Finally,double-needle method was used to aspirate the cyst fluid.Results Radiography showed that communication between the cyst and subarachnoid space was detected in 66 patients (group A),while no communication between the cyst and subarachnoid space was observed in 48 patients (group B).In patients with primary symptomatic sacral canal cyst,the differences in the sugar and chloride levels of CSF between group A and group B were statistically significant.In patients with recurrent symptomatic sacral canal cyst,the differences in the sugar,protein and chloride levels of CSF between group A and group B were also statistically significant.Statistically significant correlation existed between the single or multiple CSF changes and the interventional therapeutic prognosis.Conclusion Sacral canal cysts can be classified into two types:cyst-subarachnoid space communicating type and cyst-subarachnoid space non-communicating type.The characteristics of CSF in patients with primary symptomatic sacral canal cyst are different from those in patients with recurrent symptomatic sacral canal cyst.Multiple CSF changes,the increased sugar level and decreased chloride level in CSF are well correlated with the interventional therapeutic prognosis.

The value of pedicled fat and capsule-packed nerve root in operation of sacral canal cysts / 西安交通大学学报(医学版)

Objective To evaluate the value of pedicled fat and capsule-packed nerve root in operation of sacral canal cysts.Methods We collected the information of 14 cases of sacral canal cysts for operation in our department and analyzed the operation indications and skills as well as the prognosis.Results All the operations were performed with the help of the microscope and the electrophysiological monitor.The capsules were removed in 9 cases and wrapped in 6 cases,with the total resection rate of 64.3%.The clinical symptoms were improved markedly after the operation.Conclusion The operation with pedicled fat and the capsule-packed nerve root is valuable in treating sacral canal cysts because it can protect the nerve root and get lower recurrence rate.

Morphometrical study of sacral hiatus in dry human sacra.

Background: The sacral hiatus is the site for caudal epidural anaesthesia during perineal surgery and also for a painless delivery. It is also used for three dimensional colour visualization of lumbosacral epidural space in orthopaedic practice for diagnosis and treatment. Sacrum is one of the bones which exhibit variations. Therefore the importance of the normal sacral hiatus and its variations is of great clinical significance. The reliability of caudal epidural anaesthesia is 70% - 80% in the literatures. The objective of the study was to examine, measure and record the morphometry of sacral hiatus under the following headings in order to study the anatomical variations which would be useful for caudal epidural anaesthesia and improve the reliability of the same. a) Shape of sacral hiatus, b) level of apex, c) level of base, d) length of the sacral hiatus, e) transverse width at the base, and f) anteroposterior depth at the apex. Methods: A total of 200 dry, complete, undamaged human sacra of unknown sex were used in this study. Measurements were taken using vernier calipers. In this study six parameters were taken. All the readings were tabulated and subjected to analysis. Results: Various shapes of sacral hiatus were observed which included Inverted-U (50%), Inverted-V (27.5%), Irregular (15.5%), Dumb bell (2%), and Bifid (2%). The mean anteroposterior depth of sacral canal at the level of apex of sacral hiatus was 4.25mm. The mean length of sacral hiatus was 19.63 mm and the mean transverse width of sacral hiatus at the level of base was 11.42 mm. There was complete spina bifida in 4 (2%) and absence of sacral hiatus in 2 (1%) cases. Conclusion: The sacral hiatus has anatomical variations. Understanding of these variations may improve the reliability of caudal epidural anaesthesia.

Study of Sacral Hiatus in Dry Human Sacra in Nepal, Parsa Region.

Introduction: The sacrum is a large triangular bone, formed by the fusion of five sacral vertebrae. The opening at the caudal end of sacral canal is known as sacral hiatus. It is formed due to the failure of fusion of laminae of the fifth (occasionally fourth) sacral vertebra. Sacrum is one of the bones which exhibit variations and the variation of sacral hiatus is of great clinical significance because it may also leads tomechanical low back pain. Previousworks on themorphometrical study on the sacral hiatus is limited, especially in Nepal, Parsa population. The present study was undertaken to help in filling this gap at least to a certain extent and also made an attempt to find out the variations of sacrum. Materials: One hundred dry human sacra were collected from the Department of Anatomy of National medical college & Teaching Hospital, Nepal. Methods& Observations: Themorphometrical studieswere done, and the parameters (Shape, length, Transverse width & Antero-posterior width of sacral hiatus and level of apex & base of sacral hiatus) were measured with the help of divider, the observations were recorded, tabulated & analyzed. Result: The study showed a significant co-relation between anatomical variations of sacral hiatus with the previous studies.

Incomplete development of second sacral lamina: a case report.

Sacrum is made up of large fused 5 sacral vertebra forming posterior wall of pelvis. On routine examination of the bones present in the bone bank of our department we noticed a sacrum in which sacral canal was incompletely formed due to imperfect formation of second sacral laminae. Knowledge of such type of variation may be of importance to the clinicians in dealing with patients presenting with bladder and or bowel disturbances or presenting with some neurological deficit of the lower limb. Orthopaedic surgeons should also be aware of this anomaly while operating in the sacral region.

An anatomical study of variations of sacral hiatus in sacra of north Indian origin and its clinical significance / Estudio anatómico de las variaciones del hiato sacro en sacros del norte de la India y su significancia clínica

Sacrum is formed by the fusion of five sacral vertebrae and forms the lower part of vertebral column. The opening present at the lower end of sacral canal is known as sacral hiatus. Anatomical variations in morphology and morphometry of sacral hiatus are important clinically as well as surgically. 159 dry clean human Sacra were taken from Department of Anatomy, Sri Guru Ram Das Institute of Medical Sciences and Research Vallah (Amritsar). Various shapes of sacral hiatus were observed which included inverted U (42.95%), inverted V (27.51%), irregular (16.10%), dumbbell (11.40%) and bifid (2.01%). The apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 56.36%. The mean length of sacral hiatus was 22.69 mm. The mean anteroposterior diameter of sacral canal at the apex of sacral hiatus was 6.49 mm. Narrowing of sacral canal at the apex of sacral hiatus (diameter less than 3 mm) was observed to be high (5.36%). The knowledge of anatomical variations of dimensions of sacral hiatus is important while doing caudal epidural block and it may help to improve its success rate.

El sacro está conformado por la fusión de las cinco vértebras sacras, y forma la parte inferior de la columna vertebral. La abertura presente en el extremo inferior del canal sacro se conoce como hiato sacro. Las variaciones anatómicas en la morfología y la morfometría del hiato sacro son importantes clínica y quirúrgicamente. Fueron utilizados 159 sacros humanos, limpios y secos, del Departamento de Anatomía, Sri Guru Ram Das Instituto de Ciencias Médicas e Investigación Vallah (Amritsar). Fueron observadas varias formas de hiato sacro: U invertida (42,95%), V invertida (27,51%), irregular (16,10%), de pesa (11,40%) y bífida (2,01%). El ápice del hiato sacro se encuentra comúnmente a nivel de la cuarta vértebra sacra en el 56,36%. La longitud media de hiato sacro fue 22,69 mm. El diámetro medio anteroposterior del canal sacro en el ápice del hiato sacro fue 6,49 mm. El estrechamiento del canal sacro en el ápice del hiato sacro (diámetro inferior a 3 mm) fue alto (5,36%). El conocimiento de las variaciones anatómicas de las dimensiones del hiato sacro es importante para el bloqueo epidural caudal y puede ayudar a mejorar su tasa de éxito.

Approach for Epiduroscopic Laser Neural Decompression in Case of the Sacral Canal Stenosis

Epiduroscopy is very useful in the treatment of not only low back pain caused by failed back surgery syndrome, epidural scar or herniated disc but also by chronic refractory low back pain which does not respond to interventional conservative treatment including fluoroscopically-directed epidural steroid injections and percutaneous adhesiolysis. Because cauterization using a laser fiber has become recently available, a wider opening is required to enter into the sacral canal in the case of epiduroscopic laser neural decompression (ELND). However, in a few patients, it is difficult to insert a device into the epidural space due to stenosis around the opening, and there is no alternative method. Herein, we report a case where a hiatus rasp specially designed for such patients was used to perform the operation.

Morphometric analysis of lumbosacral canal in human foetuses / Análisis morfométrico del canal lumbosacro en fetos humanos

Lumbosacral part of the spinal canal requires special attention because this is the site commonly involved in spina bifida, tethered cord syndrome and some other pathologies like fatty tumours in the spine, cysts and syrinxes. The diagnosis as well as the treatment of neural tube defects mandates an accurate knowledge of morphometry of lumbosacral vertebral canal. There are various reports on radiological morphometric measurements in human foetuses by various authors but these possess inherent variability due to imaging techniques, patient positioning, observer's measuring techniques and normal and pathological variations. To overcome all these limitations, direct measurements by vernier calliper were preferred. 30 Formalin preserved human foetuses, of all age groups and both sexes, free of congenital craniovertebral anomalies, were obtained from the museum of Dept. of Anatomy, J. N. Medical College AMU Aligarh for the present study. Foetuses were divided into five groups (I-V) based on their gestational ages. Group I foetuses were of less than 17 weeks, II of 17-20 weeks, III of 21-25 weeks, IV of 26-30 weeks and V of more than 30 weeks. Each group contained 6 foetuses having both male and female, 3 each. Morphometric parameters taken into account were length of lumbar canal, maximum transverse diameters of lumbar vertebral canal at different vertebral levels, heights of the posterior surfaces of bodies of all lumbar vertebrae and length of sacral canal. Readings of adjacent groups were compared and results were analyzed by using Student's 't' test. Lumbar canal starts growing in length significantly in group III foetuses onward. There was consistency in the growth of lumbar canal diameters with gestational age at all levels. Heights of vertebral bodies of Ist two lumbar vertebrae showed variability in some adjacent groups. The same in the next three grew constantly with the growth of foetuses. Sacral canal showed variable growth in lengths in different grou...

La porción lumbosacra del canal espinal requiere una atención especial; es un sitio frecuentemente implicado en la espina bífida, el síndrome de médula anclada y algunas otras patologías como tumores de grasa en la columna vertebral, quistes y siringomelia. El diagnóstico y el tratamiento de los defectos del tubo neural requieren de un conocimiento preciso de la morfometría del canal vertebral lumbosacro. Existen diversos informes radiológicos sobre mediciones morfométricas en fetos humanos por parte de diversos investigadores, pero estos poseen una variabilidad inherente debido a las técnicas de imagen, posicionamiento del paciente, técnicas de medición del observador y, las variaciones normales y patológicas. Para superar todas estas limitaciones, para las mediciones directas se utilizó un caliper vernier. 30 fetos humanos conservados en formalina, de todas las edades y de ambos sexos, sin anomalías congénitas craneovertebrales, fueron obtenidos del museo del Departamento de Anatomía, J. N. Facultad de Medicina de la UMA, Aligarh. Los fetos fueron divididos en cinco grupos (I-V) sobre la base de su edad gestacional. El grupo I de fetos fueron los menores de 17 semanas, el II de 17-20 semanas, el III de 21-25 semanas, IV de 26 a 30 semanas, V de más de 30 semanas. Cada grupo contenía 6 fetos de ambos sexos (1:1/H:M)). Los parámetros morfométricos tomados en cuenta fueron la longitud del canal lumbar, el diámetro transversal máximo del canal vertebral lumbar en diferentes niveles, la altura de las superficies posteriores de los cuerpos de todas las vértebras lumbares y la longitud del canal sacro. Las mediciones de los grupos fueron comparadas y analizadas mediante el uso de la prueba de "t". El canal lumbar comenzó a aumentar en longitud significativamente desde el grupo de fetos III en adelante. No hubo consistencia en el crecimiento de los diámetros del canal lumbar con la edad gestacional en todos los niveles. Las alturas de los primeros dos cuerpos verte...

Analysis of Anterior-posterior Distance of Sacral Canal on MRI to See the Possibility of Sacral Laminar Hook Insertion

OBJECTIVE: Achieving successful posterolateral fusion across the lumbosacral junction is particularly problematic. In our hospital, bilateral S2 laminar hooks coupled with bilateral S1 screws have been appeared to provide successful posterolateral fusion of lumbosacral junction in high non-fusion risk patients. Therefore we study about the safety of sacral lamina hooks insertion. METHODS: We measured the anterior-posterior(A-P) diameter of sacral canal at a point where median sacral crest of S1 and S2 meet on lumbar magnetic resonance(MR) sagittal images. The number of analyzed subjects was one hundred and minimum A-P diameter of sacral canal to insert laminar hooks safely was thought to be 9mm. RESULTS: In 78% of study cases, the sacral canal diameter was 9mm or more. There were no statistically significant difference of sacral canal diameter with age, sex, weight and height. CONCLUSION: Preoperative analysis of the sagittal MR image may be helpful for the safe insertion of the sacral laminar hooks to enhance posterolateral fusion of lumbosacral junction in high non-fusion risk patients. And, safe sacral laminar hooks insertion may be possible in about 78% of study cases.