Lumbosacral perineural cysts

ABSTRACT

The treatment of lumbosacral nerve root cysts is both difficult and challenging because it produces manifestations of nerve root compression which may result from many other sources of pain such as facet joints, discs, and canal stenosis. Different surgical procedures to manage perineural cysts are being used, but a consensus on which methods are best has not been reached. We analysed surgical results for 11 patients, whom we treated between 1997 and 2002 to determine the efficacy of the procedures and factors that influence the outcome. Eleven patients with one or more lumbosacral perineural cysts presented with intractable radicular pain in one or both lower limbs, [which were not responding to medical treatment] underwent surgical decompression and marsupalisation of the cyst. The patients' data was analysed for preoperative clinical and radiological findings. All patients were examined daily, 1-week postoperatively and followed-up for 3 to 60 months to assess the surgical outcome. All patients in this study presented with clinical findings similar to those associated with other spinal epidural lesions at the same locations. Both computed tomography and magnetic resonance imaging aided in an accurate diagnosis of perineural cysts. Surgical results were excellent in 8 patients, and good in 3. There were no major intraoperative complications or new postoperative neurological deficits. Perineural cysts are rare intraspinal epidural cysts filled with CSF, and have inconsistent relation to nerve roots, without communicating with subarachnoid spaces. Surgical excision of the wall of perineural cysts usually results in considerable improvement in the patient's condition