Leshko M. Diagnostics and surgical treatment of sacral channel cysts

Dissertation is devoted to improvement of results of sacral cysts surgical treatment and is based on materials of diagnostics and treatment of 68 patients (26 men and 42 women) with sacral cysts at age from 21 to 71 years. 36 patients were operated, 32 - were treated conservatively.Patients were distributed according to the cyst's type of: perineural or Tarlov cysts - at 46 (67.7%) patients, extradural meningeal cysts - at 5 (7.4%), meningeal diverticula - at 11 (16.2%), intradural (arachnoid) cysts - at 3 (4/4%) and cysts in composition of Currarino triad - at 3 (4/4%) patients.The patients were observed using standard questionnaires, roentgenography of sacral part of the spine in 2 projections and MRI of the same area, MR-myelography and electroneuromyography in the purpose of radiculopathy verification.Surgical treatment was performed using back access by laminectomy of aitchbone. If it was possible, cysts were deleted fully. At presence of nervous fibers in the wall of Tarlov cyst we carried out the resection of it's walls at the level of spinal ganglium, nervous counterfoils were covered with haemostatic sponge or plates of tachocomb. The cavity was filled out by autofat tissue.Directly after operation the improvement of neurological status was marked at 33 (91,7%) patients. Complete regress of neurological symptoms was reached at 26 (72,2%) patients. In a remote postoperative period the relapse of cysts was not observed. At conservative treatment there was a considerable positive dynamics of neurological symptoms, especially pain syndrome. However in a remote period at all of patients returning of previous pathological symptoms was marked. Consequently, conservative therapy gives only a temporal effect.