1
|
Mastantuoni C, Martin NL, Tessitore E. Symptomatic lumbar Tarlov cyst resolution after computed tomography-guided percutaneous trans-sacral fibrin glue intracystic injection: A case report and literature review. Surg Neurol Int 2024; 15:137. [PMID: 38741984 PMCID: PMC11090592 DOI: 10.25259/sni_139_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
Background Perineural Tarlov cysts are extrathecal cerebrospinal fluid-filled cavities in the perineural recesses around dorsal spinal nerve roots. They are mostly asymptomatic but may occasionally cause back pain, radiculopathy, neurological deficits, and idiopathic intracranial hypotension. Case Description A 40-year-old female presented with a partial left foot drop attributed to a symptomatic L5 Tarlov cyst with an extension anterior to the sacrum. Following a computed tomography (CT)-guided percutaneous trans-sacral fibrin glue intracystic injection, the cyst was markedly reduced in size, and the patient's symptoms resolved. Conclusion Rarely, patients may present with symptomatic lumbar Tarlov cysts located anterior to the sacrum. Here, we present a patient whose left-sided foot drop resolved following the percutaneous trans-sacral CT-guided L5 intracyst injection of fibrin glue.
Collapse
Affiliation(s)
- Ciro Mastantuoni
- Division of Neurosurgery, P.O. Santa Maria Delle Grazie, Naples, Italy
| | | | - Enrico Tessitore
- Department of Neurology, Neurosurgery, Acute Medicine, Intensive Care Unit, Division of Neuroradiology (MIV), and EEG and Epilepsy Unit (SV), Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
2
|
Jiang Y, Dong L, Pan YQ, Zhao J, Li WF, Zhang TF, Zhang T, Dai DW. Efficacy of neuroendoscopic-assisted surgery in the management of symptomatic sacral perineural (Tarlov) cysts: a technical report. Front Surg 2024; 11:1307460. [PMID: 38486796 PMCID: PMC10937351 DOI: 10.3389/fsurg.2024.1307460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction The Tarlov cysts are pathological enlargements of the cerebrospinal fluid spaces between the endoneurium and perineurium, which can cause intolerable sciatic pain, motor impairment of lower limbs, and bladder/bowel dysfunction. Currently, the treatment results are unsatisfactory due to the low cure rates and extensive surgical trauma. Thus, there is an ongoing exploration of surgical techniques for Tarlov treatment. In the current study, we present a novel neuroendoscopic-assisted technique that combines the fenestration, leakage sealing, and tamponade of the Tarlov cyst. Methods Between January 2020 and December 2021, a total of 32 Tarlov patients were enrolled and received neuroendoscopic-assisted surgery. Their pre- and post-surgical Visual Analogue Scale (VAS) scores, major complaints, and MR imaging were recorded for comparison. Results 27 of 32 patients (84.4%) patients demonstrated immediate pain relief as their VAS scores decreased from 5.6 ± 1.5 to 2.5 ± 1.1 (p < 0.01) on the first day after surgery. At the 3-month follow-up, the patients' average VAS score continued to decrease (1.94 ± 0.8). Meanwhile, saddle paresthesia, urinary incontinence, and constipation were relieved in 6 (50%), 4 (80%), and 5 (41.7%), respectively, according to patients self-report. No surgical-related complication was observed in any of the cases. Discussion We conclude that neuroendoscopic-assisted surgery is an effective surgical method for symptomatic Tarlov cysts with minimized complications.
Collapse
Affiliation(s)
- Ying Jiang
- Cerebrovascular Diseases Center, Department of Neurosurgery, Renji Hospital, Shanghai, China
| | - Lan Dong
- Department of Emergency, Shanghai Chang Zheng Hospital, Shanghai, China
| | - Yi-Qi Pan
- Department of Otorhinolaryngology, Shanghai Jiao-Tong University School of Medicine Ruijin Hospital, Shanghai, China
| | - Jun Zhao
- Department of Neurosurgery, Shanghai University of Medicine & Health Science Affiliated Zhoupu Hospital, Shanghai, China
| | - Wen-Fang Li
- Department of Emergency, Shanghai Chang Zheng Hospital, Shanghai, China
| | - Teng-Fei Zhang
- Department of Emergency, Shanghai Chang Zheng Hospital, Shanghai, China
| | - Ting Zhang
- Department of Emergency, Shanghai Chang Zheng Hospital, Shanghai, China
| | - Da-Wei Dai
- Department of Neurosurgery, Renji Hospital, Shanghai, China
| |
Collapse
|
3
|
Murphy K, Nasralla M, Pron G, Almohaimede K, Schievink W. Management of Tarlov cysts: an uncommon but potentially serious spinal column disease-review of the literature and experience with over 1000 referrals. Neuroradiology 2024; 66:1-30. [PMID: 37828278 PMCID: PMC10761484 DOI: 10.1007/s00234-023-03226-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Tarlov cysts were thought to be anatomic variants of uncertain etiology and clinical significance when initially described over 80 years ago. They are often detected in routine lumbosacral imaging and generally not reported in a differential diagnosis. There is increasing evidence that at least some Tarlov cysts are symptomatic and can have a significant adverse impact on patients' health and well-being. Women are disproportionately affected with this condition, often presenting with long-standing pain and neurological dysfunctions. Significant gender bias has been a concern in the management of these patients. Unfortunately, there is no consensus on patient selection or management approaches for symptomatic Tarlov cysts. This review article updates information on the prevalence, diagnosis, clinical significance, and treatments of these cysts. Based on these findings and experience with over 1000 patient referrals, a treatment decision algorithm for symptomatic Tarlov cysts was constructed to provide guidance for appropriate management of patients with these complex cysts.
Collapse
Affiliation(s)
- Kieran Murphy
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
| | - Mehran Nasralla
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Gaylene Pron
- Dalla Lana School of Public Health, Institute Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Khaled Almohaimede
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Wouter Schievink
- Department of Neurosurgery, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, 6Th Floor, Los Angeles, CA, 90048, USA
| |
Collapse
|
4
|
Boyle NS, Chang EL. Intraoperative use of indocyanine green and trypan blue mixed with fibrin glue in the excision of periocular cystic lesions. Am J Ophthalmol Case Rep 2020; 20:100990. [PMID: 33251377 PMCID: PMC7683233 DOI: 10.1016/j.ajoc.2020.100990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/11/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022] Open
Abstract
Purpose This case series describes the use of tissue fibrin glue mixed with dye to facilitate the excision of eight orbital and periorbital cystic lesions of various complexity. Observations The fibrin glue was colored with indocyanine green dye (ICG) or trypan blue and injected intraoperatively into the lesions. The glue was then allowed to harden, and the lesions were excised. The dyed glue outlined the wall of the cysts, kept them formed and allowed for complete excision with ease. None of the cases had recurrence. As an observation, ICG showed superior delineation than trypan blue. Conclusionsand importance The use of colored fibrin glue is a helpful technique in the delineation and excision of cystic lesions. Delineating the wall of the cyst with the dyed glue simplified the surgery and prevented complications such as injury to surrounding vital structures and reduced the likelihood of recurrence. ICG may be superior to trypan blue but a comparative controlled study is needed to assess the difference.
Collapse
Affiliation(s)
- Nariman S Boyle
- State University of New York, Stony Brook, Department of Ophthalmology, USA
| | | |
Collapse
|
5
|
Akahori S, Nishimura Y, Eguchi K, Nagashima Y, Ando R, Awaya T, Hara M, Natsume A. Spontaneous Rupture of a Huge Presacral Tarlov Cyst Leading to Dramatic Neurologic Recovery. World Neurosurg 2020; 145:306-310. [PMID: 32987170 DOI: 10.1016/j.wneu.2020.09.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This manuscript discusses the case of huge presacral Tarlov cysts (TCs) and the substantial neurologic recovery noted in the patient following spontaneous rupture of the most prominent cyst. Perineural or TCs are nerve root cysts, which are usually incidental findings on magnetic resonance imaging (MRI) and are most frequently observed in the sacral spine. Symptomatic lesions are rarely encountered. CASE DESCRIPTION In this case, a 44-year-old woman presented with anal and vulva pain on the right side, and bladder and bowel dysfunction. MRI of the lumbosacral spine showed multiple huge bilateral TCs located within the presacral space from S1-3. There was a substantially large right-sided S3 cyst that was presumed to be responsible for her symptoms. Surgical intervention was considered; however, her symptoms improved significantly during the waiting period for surgery because of spontaneous rupture of the right-sided S3 cyst, as confirmed on follow-up MRI. On follow-up over a 1-year period, the patient had been very well with no recurrent symptoms. CONCLUSIONS To our knowledge, this is the first report of spontaneous cyst rupture and resultant neurologic improvement in a case of symptomatic presacral TCs.
Collapse
Affiliation(s)
- Sho Akahori
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | | | - Kaoru Eguchi
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | | | - Ryo Ando
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Takayuki Awaya
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University School of Medicine, Aichi, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University, Nagoya, Japan
| |
Collapse
|
6
|
Yang K, Tao H, Feng C, Xu J, Duan C, Yang W, Su W, Li H, Li H. Surgical management of sacral meningeal cysts by obstructing the communicating holes with muscle graft. BMC Musculoskelet Disord 2019; 20:635. [PMID: 31888578 PMCID: PMC6937820 DOI: 10.1186/s12891-019-2998-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The surgical indication and treatment of sacral meningeal cyst have not been well established and current methods are usually accompanied by complications and recurrence. The aim of this study is to discuss the treatment of symptomatic sacral meningeal cyst, by investigating the surgical results of our surgically treated patients, and minimize the complications and recurrence. METHODS We retrospectively reviewed all patients with symptomatic sacral meningeal cysts who were surgically treated by a single surgeon in the same institution from 2002 to 2017. All patients underwent the same operation by incising the cyst wall and obstructing the communicating hole with muscle graft, while the cyst wall was left untreated instead of resected or imbricated. The obstruction was verified by doing a Valsalva-like maneuver. The preoperative symptoms and signs, and the outcomes at most recent follow-up were rated and compared by Neurological Scoring System. RESULTS A total of 18 patients (7 male patients and 11 female patients, average age 42.3 years) were followed up for an average of 51.7 months. All patients had communicating holes linking the cysts and the dural sacs. The average preoperative neurological score was 19.7 ± 2.2, and it was improved to 23.2 ± 2.8 at the most recent follow-up (p < 0.01). CONCLUSIONS The sacral meningeal cyst originated from the communication with the dural sac. Surgical treatment of symptomatic sacral meningeal cysts can yield a long-term resolution of the appropriately selected patient's symptoms. Obstructing the communicating hole with muscle graft is an effective and simple method to obliterate the cyst. The incised cyst wall can be left untreated instead of resected or imbricated.
Collapse
Affiliation(s)
- Kai Yang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Huiren Tao
- Department of Orthopaedics, Shenzhen University General Hospital, 1098th Xueyuan Road of Xili University Town, Shenzhen, 518055, Guangdong Province, China.
| | - Chaoshuai Feng
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Jiawei Xu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Chunguang Duan
- Department of Orthopaedics, Shenzhen University General Hospital, 1098th Xueyuan Road of Xili University Town, Shenzhen, 518055, Guangdong Province, China
| | - Weizhou Yang
- Department of Orthopaedics, First Affiliated Hospital of Xi'an Jiaotong University, 277th Yanta West Road, Xi'an, 710061, Shaanxi Province, China
| | - Wei Su
- Department of Orthopaedics, First Affiliated Hospital of Xi'an Jiaotong University, 277th Yanta West Road, Xi'an, 710061, Shaanxi Province, China
| | - Huan Li
- Department of Cardiology, Xijing Hospital, Military Medical University of PLA Airforce (Former Fourth Military Medical University), 127th Changle West Road, Xi'an, 710032, Shaanxi Province, China
| | - Haopeng Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China.
| |
Collapse
|
7
|
Yamagami K, Shono T, Iihara K. Multiple Sacral Perineurial Cysts Presented Symptoms Triggered by Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage. NMC Case Rep J 2019; 6:57-60. [PMID: 31016102 PMCID: PMC6476817 DOI: 10.2176/nmccrj.cr.2018-0242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 11/20/2022] Open
Abstract
The origin and pathogenesis of perineurial cysts remain unclear. Here, we report a rare case of multiple sacral perineurial cysts presented symptoms triggered by nonaneurysmal perimesencephalic subarachnoid hemorrhage (SAH). A 48-year-old male presented with a severe headache of sudden onset. Brain computed tomography revealed a SAH in the basal cistern; however, no abnormal vascular lesion was detected. Four days after the onset of the SAH, he suffered from left buttock pain, followed by urinary dysfunction and paresthesia in the left S2 and S3 dermatomes. Magnetic resonance (MR) imaging demonstrated multiple cystic lesions at the left S1 and bilateral S2 sacral roots. The two cysts at the S2 level exhibited high signal intensity on both T1- and T2-weighted images, suggesting the content of the cysts included a hematoma. He was treated with intravenous injections of steroids, and the symptoms recovered completely within 2 months. Follow-up MR imaging revealed remarkable shrinkage of the cysts. Sacral perineurial cysts should be listed in the differential diagnosis if the patient suffers from low back pain or sacral radiculopathy after the onset of SAH.
Collapse
Affiliation(s)
- Keitaro Yamagami
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Fukuoka, Japan.,Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| |
Collapse
|
8
|
Wang B, Pu F, Wu Q, Zhang Z, Shao Z. Presacral Tarlov Cyst as an Unusual Cause of Abdominal Pain: New Case and Literature Review. World Neurosurg 2018; 110:79-84. [DOI: 10.1016/j.wneu.2017.10.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
|
9
|
Chokshi FH, Law M, Gibbs WN. Conventional and Advanced Imaging of Spine Oncologic Disease, Nonoperative Post-treatment Effects, and Unique Spinal Conditions. Neurosurgery 2017; 82:1-23. [DOI: 10.1093/neuros/nyx491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 09/07/2017] [Indexed: 01/19/2023] Open
Abstract
Abstract
In this review, we discuss the imaging features of diseases and conditions ranging from neoplastic to nonoperative post-treatment effects to unique conditions of the spine. Additionally, advanced imaging may increase diagnostic certainty in cases where conventional imaging characteristics of benign lesions and malignant pathology are variable.
Collapse
Affiliation(s)
- Falgun H Chokshi
- Department of Radiology and Imaging Sciences, Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Meng Law
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
- Department of Radiology, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
- Department of Neurology, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
- USC Viterbi School of Engineering, Los Angeles, California
| | - Wende N Gibbs
- Department of Neurosurgery, University of Southern California, Keck School of Medicine, Healthcare Consultation Center II, Los Angeles California
| |
Collapse
|
10
|
Jiang W, Qiu Q, Hao J, Zhang X, Shui W, Hu Z. Percutaneous fibrin gel injection under C-arm fluoroscopy guidance: a new minimally invasive choice for symptomatic sacral perineural cysts. PLoS One 2015; 10:e0118254. [PMID: 25706639 PMCID: PMC4338299 DOI: 10.1371/journal.pone.0118254] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/06/2015] [Indexed: 11/20/2022] Open
Abstract
Background Symptomatic sacral perineural cysts are a common cause of chronic pain. Surgery is one choice for symptom relief but has a high risk of cyst recurrence and complications. As a simple and safe method to manage symptomatic sacral perineural cysts, C-arm fluoroscopy-guided fibrin gel injection may represent a new minimally invasive alternative. To evaluate the efficacy of this new method, we conducted a retrospective study of 42 patients. Methods and Findings From June 2009 to August 2012, a total of 42 patients with symptomatic sacral perineural cysts underwent C-arm fluoroscopy-guided percutaneous fibrin gel injection therapy. Patient outcomes in terms of improvements in pain and neurologic function were evaluated during a follow-up period of 13–39 months. The preoperative and postoperative pain severity were assessed according to a 10-cm visual analog pain scale, and imaging changes were evaluated by magnetic resonance imaging. We also assessed postoperative complications. Most patients experienced benefit from the procedure: twenty-five patients (59.5%) reported excellent recovery, eleven (26.2%) reported good recovery, three (7.1%) reported fair recovery, and three (7.1%) reported poor recovery. The overall effectiveness rate (excellent and good recoveries) was 85.7%. No serious postoperative complications were observed. Conclusion Percutaneous fibrin gel injection under C-arm fluoroscopy guidance could be a simple, safe and effective treatment option for symptomatic sacral perineural cysts.
Collapse
Affiliation(s)
- Wei Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - QuanHe Qiu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Hao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - XiaoJun Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Shui
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - ZhenMing Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- * E-mail:
| |
Collapse
|
11
|
Belfi LM, Bartolotta RJ, Loftus ML, Wladyka C, Hentel KD. Benign osseous and articular abnormalities of the pelvis: a review of CT imaging findings. Clin Imaging 2014; 39:186-93. [PMID: 25433854 DOI: 10.1016/j.clinimag.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/09/2014] [Indexed: 11/29/2022]
Abstract
Computed tomography (CT) has become the standard of care for evaluation and follow-up for a wide range of abdominal and pelvic pathology. Many incidental osseous and articular abnormalities of the pelvis are detected on these studies, most of which have a benign etiology. However, most of these studies are interpreted by nonmusculoskeletal radiologists, who may not be familiar with the CT appearances of these benign musculoskeletal abnormalities. Uncertainty often leads to mischaracterization or unnecessary follow-up, resulting in increased health care costs and patient anxiety. This article reviews the CT appearance of the benign musculoskeletal entities that occur in pelvis.
Collapse
Affiliation(s)
- Lily M Belfi
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA.
| | - Roger J Bartolotta
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
| | - Michael L Loftus
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
| | - Christopher Wladyka
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
| | - Keith D Hentel
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065, USA
| |
Collapse
|
12
|
A novel technology: percutaneous injection of fibrin glue as a treatment for frontal sinus cerebrospinal fluid rhinorrhea. J Craniofac Surg 2014; 24:1646-9. [PMID: 24036713 DOI: 10.1097/scs.0b013e3182902de6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this study, we examined the effectiveness of percutaneous injected fibrin glue as a treatment for frontal sinus cerebrospinal fluid (CSF) rhinorrhea in a series of 4 cases. All 4 patients had fracture in the posterior wall of the frontal sinus. The anterior wall of the frontal sinus was punctured following high-resolution computed tomography imaging. In 3 out of 4 patients with defective skull due to prior frontal craniotomy, direct percutaneous puncture of the frontal sinus was used. Fibrin glue was injected to close the fistula and to seal the rhinorrhea. Surgery procedures lasted for 15-35 minutes (average 27.6 min). Rhinorrhea was stopped in all patients after the surgery, with no recurrence at a 10-month follow-up visit. In 1 case, the glue was expelled by coughing at 2 days after the surgery but was completely stopped with no recurrence after a second attempt. One patient with no recurrence at a 10-month follow-up died of tumor relapse at 12 months. In summary, fibrin glue could be used as a novel treatment for frontal sinus CSF rhinorrhea.
Collapse
|
13
|
Jung KT, Lee HY, Lim KJ. Clinical experience of symptomatic sacral perineural cyst. Korean J Pain 2012; 25:191-4. [PMID: 22787551 PMCID: PMC3389325 DOI: 10.3344/kjp.2012.25.3.191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 05/02/2012] [Accepted: 05/31/2012] [Indexed: 11/25/2022] Open
Abstract
Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.
Collapse
Affiliation(s)
- Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
| | | | | |
Collapse
|