A middle-aged female patient, diagnosed with multiple sacral cysts, came to the outpatient clinic of Dr. Xuesheng Zheng, Xinhua Hospital affiliated with Shanghai Jiao Tong University School of Medicine, due to soreness and weakness in both lower limbs for many years.
Preoperative magnetic resonance imaging showed three sacral cysts, at the level of right sacral 1, sacral 2, and left sacral 2.
After sufficient preoperative planning, Dr. Zheng successfully performed the surgery under the protection of neurophysiological monitoring. Three sacral cysts were successfully sealed through the lumbar sacral space and the sacral 2 small bone window. Apply a thin layer of autologous fat tissue to the gap between nerve roots and the posterior wall of the sacral canal.
Postoperative CT showed that the range of the bone window was consistent with preoperative planning. After titanium mesh repair, the integrity of the sacrum and the closure of the sacral canal were protected.
Due to being a high flow sacral cyst, the patient stayed in bed for 10 days after surgery and then moved around without any discomfort. Preoperative symptoms improved significantly and satisfactory surgical outcomes were achieved.
Dr. Zheng pointed out that compared to a single giant sacral cyst, minimally invasive surgery for multiple sacral cysts is more complex.
Firstly, each sacral cyst has a leak, which requires more time and effort to seal the leak.
Secondly, there is a certain distance between the leaks of multiple sacral canal cysts. In order to reduce the possibility of postoperative adhesion, it is necessary to minimize the bone window range and reduce nerve root exposure. Therefore, image reconstruction, preoperative planning, and precise locating are particularly important to meet the needs of small bone windows and multiple leak closure.
Thirdly, multiple sacral canal cysts often involve the S1 nerve root, and natural lumbar sacral spaces can be utilized to reach the surgical site of S1 cyst, thereby further reducing the range of bone incisions. The smaller the exposure space, the less postoperative adhesions.
Fourthly, laying a thin layer of autologous fat in the nerve root space and the posterior wall of the sacral canal can further reduce adhesion.
Overall, although multiple sacral cysts are more complex, good therapeutic effects can be achieved through careful planning and surgical procedures.