1 0 0 0 OA 症候性Tarlov囊胞に対する自家脂肪片を用いたball valve閉鎖術の手術成績
- 著者
- 宮尾 泰慶 佐々木 学 青木 正典 梅垣 昌士 嶋田 延光
- 出版者
- 日本脊髄外科学会
- 雑誌
- 脊髄外科 (ISSN:09146024)
- 巻号頁・発行日
- vol.32, no.1, pp.56-60, 2018 (Released:2018-06-20)
- 参考文献数
- 23
Introduction : Lumbosacral perineural (Tarlov) cysts (TCs) are rare and usually asymptomatic. However, these cysts occasionally cause neuralgia or bowel/bladder dysfunction. We surgically treated symptomatic TCs with occlusion of the cyst orifice using autologous fat tissue. This report presents the long-term surgical outcomes using this method. Materials and Methods : Six consecutive cases with symptomatic TCs were included in this study. Patients were initially examined with magnetic resonance imaging (MRI) and treated conservatively for at least 1 month. Preoperative CT myelograms in all patients showed pooling of contrast medium in the cyst. Surgery was performed as follows : after laminectomy at the S1-S2 level, the cyst wall was dissected and penetrated. The orifice of the cyst operated as a ball valve for cerebrospinal fluid and was occluded with autologous fat tissue that was sutured to the cyst wall. The visual analogue scale (VAS) score for pain in the buttock and/or posterior thigh was recorded before and after surgery. Results : All patients were female, and the mean age was 63.3 years. Preoperative symptoms were sacrococcygeal pain in 5 cases, sciatic pain in 2, and bladder dysfunction in 1. The mean duration between onset and definitive diagnosis was 23.7 months. All cysts were located at the sacral level including S2. Three cases had solitary lesions and the other 3 had multiple lesions. Cyst sizes ranged from 7 to 30 mm. The average postoperative follow-up period was 37.8 months. The mean preoperative VAS score was 91.7, and gradually decreased to 33.3 at 6 months. The score was stable from the 6-month examination to the final follow-up. Postoperative MRI showed that the cysts decreased in size. A complication of surgery was mild bowel/bladder dysfunction in 1 case. During follow-up, no recurrence of symptoms or cyst regrowth was observed. Conclusion : For symptomatic TCs, closing the orifice with fat tissue provides good surgical outcomes.