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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (2): 303-308. doi: 10.19723/j.issn.1671-167X.2025.02.013

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Significance of precise classification of sacral meningeal cysts by multiple dimensions radiographic reconstruction MRI in guiding operative strategy and rehabilitation

Jianjun SUN1,2,*(), Qianquan MA1, Xiaoliang YIN1, Chenlong YANG1, Jia ZHANG1, Suhua CHEN1, Chao WU1, Jingcheng XIE1, Yunfeng HAN1, Guozhong LIN1, Yu SI1, Jun YANG1, Haibo WU3, Qiang ZHAO3   

  1. 1. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
    2. Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
    3. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-01-18 Online:2025-04-18 Published:2025-04-12
  • Contact: Jianjun SUN E-mail:sunjianjun@bjmu.edu.cn
  • Supported by:
    the Innovation Transfer Fund of Peking University Third Hospital(Y74496-05)

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Abstract:

Objective: To precise classify sacral meningeal cysts, effective guide minimally invasive neurosurgery and postoperative personalized rehabilitation by multiple dimensions radiographic reconstruction MRI. Methods: From March to December 2021, based on the original 3D-fast imaging employing steadystate acquisition (FIESTA) scanning sequence, 92 patients with sacral meningeal cysts were pre-operatively evaluated by multiple dimensional reconstruction MRI. The shape of nerve root and the leakage of cyst were reconstructed according to the direction of nerve root or leakage track showed on original MRI scans. Sacral canal cysts were accurately classified as including nerve root and without nerve root, so as to accurately design the incision of skin and formulate corresponding open range of the posterior wall of the sacral canal. Under the microscope intraoperation, the shape of the nerve roots inside cysts or leakage track of the cysts without nerve roots were verified and explored. After the reinforcement and shaping operation, several reexaminations of multiple dimensional reconstruction MRI were performed to understand the deformation of the nerve root and hydrops in the operation cavity, so as to formulate a persona-lized rehabilitation plan for the patients. Results: Among the 92 patients with sacral mengingeal cyst, 58 (63.0%) cysts with nerve root cyst, 29 (31.5%) cysts without nerve root cyst, and 5 (5.4%) cysts with mixed sacral canal cyst. In 58 patients with nerve root cysts, the accuracy of preoperative clinical classification on MRI image reached 96.6% (56/58) through confirmation by operating microscope. Only 2 cases of large single cyst with nerve root on the head of cyst were mistaken for without nerve root type. In 29 patients with sacral cyst without nerve root, the accuracy of preoperative image reached 100% through confirmation by operating microscope. The accuracy of judging the internal nerve root and leakage of 12 cases with recurrent sacral cyst was also 100%. Two cases of delayed postoperative hydrops were found one month after operation. After rehabilitation treatment by moxibustion and bathing, the hydrops disappeared 4-6 months after operation. Conclusion: Multiple dimensional reconstruction MRI can precisely make clinical classification of sacral meningeal cysts before operation, guide minimally invasive neurosurgery effectively, and improve the rehabilitation effect.

Key words: Sacral meningeal cysts, Clinical classification, Spinal nerve roots, Magnetic resonance imaging, Image reconstruction

CLC Number: 

  • R739.42

Table 1

Basic information of 92 patients with sacral meningeal cysts"

Classification of sacral cysts Gender Age/years, ${\bar x}$±s Numbers of cysts Maximum diameter of cyst/cm,
${\bar x}$±s
Male
(n=27, 29.3%)		 Female
(n=65, 70.6%)
With nerve root fiber 18 (31.0%) 40 (69.0%) 40.0±15.1 137 4.0±5.9
Without nerve root fiber 8 (27.6%) 21 (72.4%) 41.0±12.5 30 5.0±2.0
Mixture type 1 (20.0%) 4 (80.0%) 46.0±14.5 14 (8+6)* 3.0±1.2

Figure 1

Different types of sacral meningeal cysts within nerve fiber roots A, one single nerve root fiber enter into the cyst and one branch through out (construction MRI scan); B, one single nerve root fiber inside the cyst (confirmed under microscope); C, two nerve root fibers enter into the cyst and two branches through out (construction MRI scan); D, two nerve root fibers inside and two branches through out the cyst (confirmed under microscope); E, three nerve root fibers enter into the cyst and three branches through out (construction MRI scan); F, three nerve root fibers and three branches inside the cyst (confirmed under microscope)."

Figure 2

Different types of sacral meningeal cysts without nerve fiber roots A, not closed dural sac formed a fistula was showed onto the sacral meningeal cyst without nerve root fiber on MRI scan; B, the fistula connec-ted cyst with the end of dural sac was found under microscope intraoperation; C, the weak lateral wall of the end of the long and narrow dural sac and giant sacral cyst without nerve root fiber was showed on MRI scan, there is no structures such as terminal filament, fistula and arachnoid hernia; D, the weak lateral wall at the end of the dural sac and the seepage, which becomes the source of cyst fluid."

Table 2

Basic information of 5 patients of sacral meningeal cyst combined with presacral cyst"

Items Gender Maximum diameter of cyst/cm
Sacral canal Presacral
With nerve root fiber
  Case 1 Male 4.4 6.2
  Case 2 Female 5.5 8.6
Without nerve root fiber
  Case 1 Male 4.0 8.0
  Case 2 Female 3.6 14.0
  Case 3 Female 2.5 1.0

Figure 3

Special cases of sacral meningeal cyst combined with presacral cyst A, the giant presacral cyst was connected with the sacral meningeal cyst; B, the sacral meningeal cyst was connected by the inside "line" with the end of the dura mater; C, the nerve sleeve reconstruction and wrapping with 3D-dura were performed around the involved nerve root fiber intraoperation; D, half a year after operation, the cyst disappeared completely and there was almost no trace of operation; E, the wide neck leak between the end of dural sac and sacral meningeal cyst as well as presacral cyst was showed on coronal MRI scan; F, a giant presacral cyst connected with the end of dura mater through the leak of sacral canal on the sagittal MRI scan, there is no nerve root fiber inside; G, the defect of presacral bone showed on sagittal CT scan; H, a large amount of cerebrospinal fluid gushing out of the leak mean high pressure at the end of dura meter intraoperation; I, no verve root fiber inside the leak canal was confirmed intraoperation; J, the leak neck was sutured and bind; K, three months after operation, the leak was firmly tied, and the presacral cyst shrinks completely."

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