Surgical excision of symptomatic sacral perineurial Tarlov cyst: case series and review of the literature

Object

Symptomatic sacral perineural cysts are extremely rare. The aim of this retrospective study is to investigate the outcome of 15 consecutive patients treated by microsurgical resection of the cyst and to review the literature.

Methods

The authors retrospectively reviewed their clinical data archive from 2002 to 2014. Fifteen patients who were operated on due to symptomatic sacral perineural cysts were enrolled in the study. Patients’ symptoms, radiographs, intra-operative findings, and clinical results were evaluated. All 15 patients underwent microsurgical excision of the cyst. The literature on this topic available in PubMed was also reviewed.

Results

There were 5 men and 10 women included in the study, with a mean age of 31 years (range 7–60 years). Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3–160 months). All the patients experienced complete or substantial resolution of the preoperative local and radicular pain after surgery.

Conclusions

Cyst excision is an effective and safe technique for symptomatic sacral perineural (Tarlov) cysts. Careful patient selection is vital to the management and treatment of this difficult and controversial pathology.

     

Primary meningeal osteosarcoma: case report and review of the literature

OBJECTIVE AND IMPORTANCE: Primary meningeal osteosarcomas are extremely rare lesions; before this case report, only five cases had been reported in the literature. We encountered a patient with a meningeal osteosarcoma but no evidence of additional tumor at another remote site. CLINICAL PRESENTATION: A 56-year-old man presented with progressive weakness of the right leg and the right arm. Computed tomography and magnetic resonance imaging revealed an extracerebral frontoparietal tumor on the left side. INTERVENTION: The patient underwent complete resection of the tumor and subsequent radiotherapy of the tumor region. The histological examination showed evidence of the osteosarcoma, which was confined to the meninges. Postoperative adjuvant radiotherapy was administered. There was no tumor recurrence during 3 years of postoperative follow-up. Because the patient had no risk factors or further osteosarcomas, primary meningeal development was assumed. CONCLUSION: Despite their rarity, osteosarcomas must be considered in the differential diagnosis of meningeal tumors.     

Resection of a giant anterior sacral meningocele via an anterior approach: case report and review of literature

BACKGROUND: An anterior sacral meningocele is a rare form of spinal dysraphism that is sometimes associated with syndromes such as Currarino and Marfan syndromes. These lesions rarely cause neurological complications, but meningitis, sepsis, obstetric problems, and bowel and bladder difficulties are common secondary conditions. The lesions can even be fatal. Because these lesions usually do not regress spontaneously, surgical treatment is the standard for symptomatic or growing masses. The dural defect can be repaired with a variety of anterior or posterior approaches. CASE DESCRIPTION: We present a case of a 16-year-old female patient with a giant nonsyndromic anterior sacral meningocele that we successfully treated using an open anterior approach. We discuss the treatment options and present a brief review of the literature. CONCLUSIONS: Although the posterior approach remains the treatment of choice for most lesions, we believe that the anterior laparotomy provides excellent exposure and is a safe alternative approach for the treatment of selected lesions. Patients with these lesions should be cared for by a multidisciplinary team.     

Low-grade primary meningeal lymphoma: case report and review of the literature

Primary meningeal lymphoma is a rare occurrence. We present a case of an immunocompetent patient operated on for a fronto-parietal lesion similar to a meningioma, which the histological examination diagnosed as a mucosa-associated lymphoid tissue (MALT)-type lymphoma. She received no further post-operative treatment and after 36 months showed no evidence of disease. In a review of the literature, we identified 14 similar cases of MALT lymphoma pre-operatively diagnosed as meningioma. Recognition of this rare meningeal location of a lymphoma involving the central nervous system is useful for a proper diagnosis and adequate treatment.     

Cervical synovial cysts: case report and review of the literature

The authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient’s symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1- and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary. Received: 12 January 1998 Revised: 17 September 1998 Accepted: 19 October 1998     

Cervical juxtafacet cysts: case report and literature review.

BACKGROUND: Juxtafacet cysts of the cervical and thoracic spine are rare and often present with myelopathy. Juxtafacet cysts are well recognized entities found commonly in the lumbar spine but are unusual in the cervical and thoracic spine. We present a case of a patient with gait disturbance and early myelopathy who was found to have a juxtafacet cyst at the cervico-thoracic junction. We further review the literature. PURPOSE: To describe a case of a cervico-thoracic juxtafacet cyst and review the literature. STUDY DESIGN: Case report and subject review. METHODS: One patient presenting with early myelopathy and pain underwent surgery for resection of the lesion. Pathologic analysis revealed a juxtafacet cyst. RESULTS: The patient recovered uneventfully with relief of his pain. Pubmed review revealed less than 30 similar cases in the literature. CONCLUSION: Juxtafacet cysts of the cervical spine are rare entities. These lesions comprise both synovial cysts and ganglion cysts. The benign lesions present with myelopathy and should be considered in patients with cystic lesions in the cervical spinal canal.     

Parathyroid cysts, a rare condition: a case report and review of the literature

Parathyroid cysts are a rare medical condition, that is why they represent a diagnostic and therapeutic challenge for the practitioner. The cysts are often small in diameter, measuring a few millimeters, but in some cases they are centimetric in size. There are 2 types of parathyroid cysts, according to their activity: the nonfunctioning (essential) and the functioning (adenomatous) forms, the last one being responsible of hyperparathyroidism. We report a case of nonfunctioning symptomatic parathyroid cyst in a 36-year old woman revealed by an anterior cervical tumefaction focusing on the pre-operative diagnosis and the management of it regarding the various therapeutic methods described in the literature.     

Carcinoid tumor in a presacral teratoma associated with an anterior sacral meningocele: case report and review of the literature

We report a case of a presacral teratoma containing a malignant carcinoid component associated with an anterior sacral meningocele that presented in a 35-year-old woman. The clinical, radiographic, and pathological features of these rare tumors, of presacral meningoceles, and of the hereditary presacral teratoma syndrome are discussed.     

A rare anterior sacral osteochondroma presenting as sciatica in an adult: a case report and review of the literature

Background contextOsteochondroma is the most common primary benign bone tumor and is usually located in the metaphyses of long bones and rarely in the spine or anterior sacrum. To the best of our knowledge, en bloc excision of a solitary osteochondroma of the anterior sacrum in an adult patient has not been previously reported in a peer-reviewed journal.PurposeThe purposes of this study were to document the first report of an osteochondroma of the anterior sacrum along with the clinical course and operative management and review the literature on solitary osteochondroma of the sacrum.Study design/settingThe study setting is an academic institution. This is a case report and review of the literature.Patient sampleThe patient is an adult female.Outcome measuresThe outcome measure is the visual analog score for pain.MethodsA 54-year-old woman presented with 9/10 disabling low back and radicular pain in the left lower extremity. Radiologic studies showed a pedunculated mass occurring from the anterior sacrum thought to be causing nerve root compression. The patient received en bloc excision of the mass through an abdominal retroperitoneal approach. We also conducted a literature review of solitary sacral osteochondroma in peer-reviewed journals.ResultsHistologic studies confirmed the mass to be an osteochondroma without pathologic signs of malignant transformation. The patient complained of dysesthesia in the left leg after surgery, which progressively improved completely over 8 months after the operation. At the 2-year follow-up, there was no evidence of local recurrence and she was pain free. A literature review revealed one previous case of en block resection of a solitary osteochondroma, but it involved the posterior sacrum.ConclusionsSolitary osteochondroma can rarely present in the sacrum as low back pain and sciatica. In general, when osteochondroma causes pain in an adult, we should think that some structure is impinged or that it could have initiated a malignant transformation, so en bloc excision should be used to remove the tumor and histologic studies performed to assess for malignant transformation. Battered nerve root syndrome may take up to 8 months to resolve.     

Idiopathic fibrosclerosis of bilateral orbits, bilateral ureters, thyroid: A case report and review of the literature

Introduction: Idiopathic multifocal fibrosclerosis is a rare disorder which is usually misdiagnosed in the clinics. We try to make a review of the literature about this large spectrum syndrome and treatment modalities other than surgery. Our patient interestingly have both fibrosclerosis of bilateral ureters, orbits and thyroid. Steroids, radiotherapy, tamoxifen, vitaminD3, colchisine was found to be in effective in treatment of progressive fibrosis.     

Traumatic extradural spinal cysts: a case report and review of the literature

Extradural spinal cysts, although unusual, are well-documented entities. The majority are of congenital origin while only a few with a clear cut traumatic pathogenesis are reported. We present a case of a traumatic extradural spinal cyst which presented as a progressive radiculopathy following a penetrating injury. We also review the literature concerning traumatic extradural spinal cysts and show that they can occur following a wide variety of spinal trauma. The trauma must involve sufficient force to cause a dural rent and iatrogenic causes are included. The differences and similarities between traumatic and congenital cysts are shown, and treatment is discussed. The prognosis following surgical resection is shown to be excellent.     

Post-traumatic bilateral facial palsy: a case report and literature review

Bilateral facial paralysis due to basilar skull fracture involving the temporal bone is rare and, unlike unilateral facial palsy, it can be difficult to recognize because of a lack of facial asymmetry. Thorough clinical history and physical exam, high-resolution CT scan and electrodiagnostic tests can help to make the diagnosis of bilateral facial nerve palsy and early detection, evaluation and intervention may be important for optimal functional recovery. A 16-year-old male sustained closed head injury after motor vehicle collision. The initial head CT scan showed bilateral temporal bone fractures. On admission to the neurotrauma intensive care unit, his Glasgow Coma Score was 9T. On post-injury day 4, the patient was noted to have incomplete closure of both eyes and 3 days later he had difficulty with bilateral facial muscle movement during a feeding trial. Electrodiagnostic testing confirmed the diagnosis of bilateral facial nerve injury without evidence of significant distal axonal degeneration. A high-resolution CT scan showed bilateral temporal bone fractures without involvement of the fallopian canals. There was no surgical intervention based on the high-resolution CT scan and the delayed onset of facial palsy. A short course of prednisone was administered. By 10 months, the patient showed nearly complete recovery of his bilateral facial nerve function. Early detection, evaluation and intervention are important for optimal functional recovery after facial nerve injury. When the temporal bone is fractured, high suspicion for facial nerve injury, either unilateral or bilateral, is warranted.     

Adult gastric duplication cysts: a case report and review of literature

In this report, we present the rare case of a 53-year-old white female with a gastric duplication cyst. Diagnosis was made with a combination of CT scan and endoscopic ultrasound. The cyst was removed by using a seromuscular incision and enucleation. A review of English literature was performed to help define the etiology, workup, and treatment of adult patients. Theories of origin include embryologic enteric diverticula, incomplete notochordal plates separation, and embryonic longitudinal folds that fuse with a bridge. The essential features of duplication are that the cyst wall is contiguous with the stomach, is surrounded by smooth muscle, has a common blood supply, and is lined with epithelium. Few duplication cysts are diagnosed after the age of 12 and in adults present a diagnostic dilemma. In the past, preoperative diagnosis of gastric duplications was the exception, but with advances in imaging, most importantly endoscopic ultrasound, the diagnosis is established before surgery in a majority of the cases. Gastric duplication cysts have been removed using various methods; however, as enucleation can be performed easily with little disruption of normal anatomy, it should be considered the procedure of choice.