显微镜下神经袖套成形术治疗Tarlov囊肿

目的 探讨显微镜下神经袖套成形术治疗Tarlov囊肿的疗效。方法 回顾性分析2018年1月至2022年2月采用显微镜下行神经袖套成形术治疗的21例Tarlov囊肿的临床资料。21例术后随访6~37个月，中位数16个月。结果 21例均手术成功，其中20例术后症状改善，1例无改善。3例术后出现下肢、会阴区麻木，无肢体运动障碍，无性功能减退，无脑脊液漏，无切口愈合不良。术后1周内复查骶尾部CT及MRI平扫+增强扫描，20例囊肿全切除，1例次全切除。术后1、3、12个月（或末次随访）疼痛视觉模拟量表评分、改良日本骨科协会腰痛量表评分较术前明显改善（P<0.05）。治愈8例（38.1%），显效7例（33.3%），有效5例（23.8%），无效1例（4.8%）；总体有效率为95.2%（20/21）。术后半年复查腰骶部MRI未见囊肿复发。结论 显微镜下神经袖套成形术治疗Tarlov囊肿，是安全有效的；而术中交通孔的处理、神经根的松解和神经根包裹是关键。

Outcomes of nerve root sheath plasty under microscope for patients with Tarlov cyst

Objective To explore the clinical efficacy of nerve root sheath plasty under a microscope for patients with Tarlov cyst. Methods A retrospective analysis was performed on the clinical data of 21 patients with Tarlov cyst who underwent microscopic nerve root sheath plasty from January 2018 to February 2022. The patients were followed up for 6~37 months. Results The operations were successfully performed on all the patients. The symptoms were significantly improved in 20 patients and did not 1 patient. Postoperative numbness in the lower extremities or perineal area occurred in 3 patients. There was no limb movement disorder, sexual dysfunction, cerebrospinal fluid leakage, or poor incision healing. The postoperative MRI showed complete resection of cysts in 20 patients and subtotal in 1. The VAS and M-JOA scores significantly improved 1, 3, and 12 months after the operation (P<0.05). Of 21 patients, 8 patients were cured, 7 patients were markedly effective, 5 patients were effective, and 1 patient was ineffective. The overall effective rate was 95.2%. No recurrence of the cyst was found on the follow-up MRI. Conclusions Nerve root sheath plasty under microscope is safe and effective for the treatment of patients with Tarlov cyst, which can effectively improve the patients' symptoms. Intraoperative treatment of the communication hole, the release of the nerve roots, and wrapping of the nerve roots are the key points.