Turkish Neurosurgery 2003 , Vol 13 , Num 3-4
A DIFFERENT OPERATIVE APPROACH FOR THE EXCISION OF AN INCIDENTAL SACRAL PERINEURAL CYST: CASE REPORT
Serhat ERBAYRAKTAR1, Bülent TEKİNSOY2, Ümit Dursun ACAR1
1Dokuz Eylül University School of Medicine, Departments of Neurosurgery, İzmir, Turkey
2Dokuz Eylül University School of Medicine, Departments of Radiology, İzmir, Turkey
Perineural cysts are usual1y asymptomatic and rarely require surgical treatment. This report describes a case that required surgical removal and an innovative method of defect closure. A sacral foraminal perineural cyst was detected incidentally on magnetic resonance imaging in a patient with a symptomatic L5-S1 disc herniation. At surgery, the cyst was found to be restricting normal movement of the right S1 nerve root, and compressing the root during lumbar spine extension. The cyst was incised to identify its contents, and was subsequently excised; however, the dural defect was on the anteromedial side of the nerve root and it was impossible to adequately secure watertight closure by suturing. To address this problem, the two edges of the defect were approximated and three small titanium clips were applied. The patient was symptom-free postoperatively, and the clips did not reduce the diagnostic value of repeat magnetic resonance images of the lumbosacral spine. This report illustrates that some cases of perineural cyst require innovative intraoperative strategies. The use of small titanium clips during spinal surgery does not necessarily compromise postoperative magnetic resonance imaging. Keywords : Magnetic resonance imaging, perineural cyst, surgical treatment
Corresponding author : Serhat Erbayraktar