What Is a Ganglion Cyst?
Sacral cysts are a type of meningeal cysts and are roughly divided into two types:
- Western Medicine Name
- Sacral cyst
- Affiliated Department
- Surgery-Neurosurgery
- Disease site
- tail
- The main symptoms
- Chronic lower back pain, Chronic palate tail pain, Chronic perineal pain
- Main cause
- Most are congenital, some are acquired
- Multiple groups
- Adults
- Contagious
- Non-contagious
| Xie Jingcheng | (Chief physician) | Department of Neurosurgery, Beijing Third Hospital |
- Sacral cysts belong to spinal cysts and originate from the spinal cord capsules. Therefore, "spinal cysts in the spinal canal" are collectively referred to as such diseases. There is no exact statistics on the incidence of sacral cysts in the population. Since the widespread use of magnetic resonance imaging in clinical practice, the detection rate of sacral cysts has been increasing, causing great concern for patients. In fact, understanding the causes and treatment of sacral cysts can greatly reduce this concern.
Classification of sacral cyst disease
- Sacral cysts are a type of meningeal cysts and are roughly divided into two types:
Nabors IB Sacral cyst Nabors type IB
- Epidural spinal cysts (Nabors type IB), which do not contain spinal nerve root fibers, are arachnoid hernias caused by congenital diverticulum or congenital dural defects, mostly at the S1-3 level of the sacral canal, which is common in adults There is no significant difference between men and women.
Nabors II Sacral cyst Nabors type II
- Epidural spinal cysts containing spinal nerve root fibers, also known as Tarlov nerve bundle cysts or spinal nerve root diverticulum (Nabors type II), form cysts due to abnormal expansion of the distal end of the spinal nerve root sleeve, generally located at the S2-3 level Spinal ganglia or its distal end are more common in adults. [1-2]
Causes of sacral cysts
- Sacral cysts belong to spinal cysts and originate from the spinal cord capsules. Therefore, "spinal cysts in the spinal canal" are collectively referred to as such diseases. Most spinal canal cysts are considered to be congenital, and some are acquired, and the causes of each type are different. Regardless of the cause, the formation of a cyst is always due to its initial communication with the subarachnoid space. The cerebrospinal fluid enters with the pulse of the arteries, and eventually expands due to poor flow or hydrostatic pressure. [3]
Symptoms of sacral cyst disease
- Most patients with epidural spinal cysts that do not contain spinal nerve root fibers are asymptomatic; 25% of patients with epidural spinal cysts that contain spinal nerve root fibers have symptoms. Inside the sacral canal, there are sensory and motor nerves that innervate the saddle area, dorsal thighs, and perineal area, as well as parasympathetic nerve fibers that innervate urine. Therefore, the clinical manifestations of sacral cysts are mainly chronic pain in the lower back, sacral tail, and perineum; it can also be accompanied by back thigh pain, sciatica, and even neurogenic claudication.
Sacral cyst complications
- As mentioned above, sacral cysts are meningeal cysts, not tumors, and no malignancy is possible. Increased cerebrospinal fluid pressure inside the cyst, which compresses the peripheral sacral nerve and bone, which can cause bone destruction in severe cases. If the cyst continues to compress the peripheral nerve fibers, severe patients will experience sensory, motor dysfunction, and even dysfunction. Rare cysts cause chemical inflammation. [2]
Sacral cyst auxiliary examination
X X-ray examination of sacral cyst
- It can be found that the erosion of the sacrum bone is mainly manifested by the enlargement of the sacral canal, and the erosion of the posterior edge of the vertebral body has a fan-like lace change. Congenital malformations of the lumbosacral region, such as recessive spina bifida, spondylolisthesis, and kyphosis, can also be found at the same time.
CT CT scan of sacral cyst
- It can clearly show bone destruction and space occupying lesions, especially for the sacrum.
MRI MRI of sacral cyst
- It is the most reliable examination method for the diagnosis of spinal meningeal cysts in the spinal canal. The cysts are elongated sac-shaped, oval, irregular, etc. The signal of cystic fluid is similar to the signal of cerebrospinal fluid. Type IB is located in the sacral canal, with fat separation from the dural sac. Type is located on the side of the dura mater with nerve roots.
Differential diagnosis of sacral cyst
Sacral cyst lumbar disc herniation
- Spinal canal cysts have a slow course, mild clinical symptoms, and are atypical. The clinical manifestations and signs are similar to those of lumbar disc herniation. Features of sacral cysts: cysts are benign lesions, grow slowly, have a longer course, and may have intermediate remission; symptoms are characterized by lumbosacral pain, perineum sensation, and chronic processes; cysts are dilated lesions, and spinal X-ray The plain film showed that the spinal cavity in the lesion area was enlarged, the pedicle was thinned, and the pedicle spacing was widened; MRI can clearly identify.
Sacral cyst
- Tumors are mostly solid tumors, and MRI enhancement scans show tumor enhancement; Tarlov's cysts are located outside the dura mater of the palate, presenting multiple cystic masses of varying sizes, and MRI enhancement scans have no enhancement. [3]
Treatment of sacral cyst disease
- Sacral cysts are common and most are asymptomatic. Treatment for asymptomatic patients generally does not require treatment and can be observed first. Symptomatic patients should be actively treated on the premise of excluding disc herniation, spinal canal stenosis, or tumors in the sacral canal.
Sacral cyst surgery indications
- In general, the following conditions are feasible surgery: conservative treatment of lumbar and leg pain or intermittent claudication is ineffective and affects normal life or work; lumbar and leg pain with lower limb muscle strength and decreased sensation; perineal pain or decreased sensation, urine or sex disfunction.
Sacral cyst surgery
- The operation should be performed under a microscope, and the cyst wall is trimmed. Use microscissors to remove the cyst wall sharply. It should not be bluntly stripped to avoid damage to the nerve root. Do not force the complete removal of the cyst wall. Cerebrospinal fluid leaks should be found during surgery, closed with vascular anastomosis (type IA), or nerve root sleeve remodeling (type II).
Calyx cysts precautions
- The postoperative patient should take the prone position with the head and hips as low as possible. The wound should be compressed with sandbags. The activity of going down to the ground should be 1 week later, wear a girdle after the operation, and perform functional exercises after 3 weeks. [3]
Prognosis of sacral cyst disease
- With the widespread use of MRI in clinics, clinicians' awareness and diagnosis of spinal canal cysts have greatly improved. As long as the surgical indication is selected, the effect of the surgical treatment is satisfactory.
Calyx cyst disease prevention
- Because the cause of sacral cysts is unclear, no preventive measures are currently available.
Sacral cyst expert opinion
- At present, the most reasonable and reliable treatment is still microsurgery. The use of "minimal invasive" methods such as cyst aspiration and injection of drugs can not eliminate the occupancy effect of the cyst, nor can it relieve the impact of the cerebrospinal fluid on the tissue around the cyst. Recommended.