Multiple bilateral sacral perineural cysts unusually distal to the exit foramina
Abstract
British Journal of Neurosurgery, October 2007; 21(5): 521 â 535 CASE REPORTS Multiple bilateral sacral perineural cysts unusually distal to the exit foramina A. P. DIMITROULIAS1, R. C. STENNER1, P. M. CAVANAGH2, P. MADHAVAN1 & P. J. WEBB1 1 Department of Orthopaedic Surgery, Musgrove Park Hospital, Taunton, Somerset, UK and 2Department of Radiology, Musgrove Park Hospital, Taunton, Somerset, UK Key words: Perineural cysts, sacral nerve root cysts, Tarlovâs cysts, arachnoid cysts, sciatica, low back pain. Perineural cysts (described by Tarlov1 in 1938 as an incidental ï¬nding, while he was conducting autopsy studies of ï¬lum terminale) are uncommon lesions of the nerve roots. They are found most often in the sacrum close to the central canal at or just distal to the junction of posterior root and dorsal root ganglion. The cavities of the cysts lay between the arachnoid and pia mater of the root. Most of these cysts are asymptomatic and are incidental ï¬ndings on imaging.2 We describe a case of a 59-year-old woman presented with an acute exacerbation of lower back pain and left sciatica. Magnetic resonance imaging revealed a small disc protrusion at L5/S1 level (Fig. 1A) and multiple bilateral anterior sacral cysts with typical imaging