PMC9345110_01
Magnetic resonance image showing intestinal and bladder distension.
SNI-13-317-g001.jpg
PMC9345110_01_SNI-13-317-g001.jpg
F1
The MRI showed intestinal and bladder distension, suggesting severe bowel and bladder dysfunction [Figure 1] with perineural cysts, originating in both the S3 nerve roots at the S2 vertebral level [Figure 2].
Findings on preoperative magnetic resonance images. (a) T2-weighted image showing high-intensity cysts (arrows), compressing S2 roots (arrowheads) on both sides. (b) T1-weighted image showing a low-intensity cyst (arrow) with scalloping of the S2 vertebra (arrowheads).
SNI-13-317-g002.jpg
PMC9345110_01_SNI-13-317-g002.jpg
F2
The MRI showed intestinal and bladder distension, suggesting severe bowel and bladder dysfunction [Figure 1] with perineural cysts, originating in both the S3 nerve roots at the S2 vertebral level [Figure 2]. The intensity of the cysts was the same as that of cerebrospinal fluid [Figure 2].
Preoperative myelogram and computed tomography myelogram. (a) Myelogram showing bilateral sacral cysts (arrows) with immediate influx of contrast medium. (b) Computed tomography myelogram obtained 3 h after injection shows contrast medium in the cysts that originated from the S3 roots (arrowheads).
SNI-13-317-g003.jpg
PMC9345110_01_SNI-13-317-g003.jpg
F3
Myelography revealed an immediate influx of contrast medium into the cysts, indicating influx of cerebrospinal fluid [Figure 3].
Intraoperative photographs. (a) Photograph showing the perineural cyst (arrowheads), dural tube, and nerve roots after bilateral S1-2 partial laminectomy. (b) The right S3 root is seen within the cyst after the cyst wall incision. The proximal end of the S3 root in the cyst (arrowhead). (c) Sealing of the proximal end of the S3 root in the cyst using autologous fat tissue (arrowheads) and fibrin glue. (d) Cyst wall was sutured.
SNI-13-317-g004.jpg
PMC9345110_01_SNI-13-317-g004.jpg
F4
The cysts, dural tube, and nerve roots were detected [Figure 4a]. The cyst wall was incised and the S3 nerve root was detected inside the cyst [Figure 4b]. Moreover, then, the autologous fat tissue and fibrin glue were used to seal the proximal end of the S3 nerve root in the cyst [Figure 4c]. The cyst wall was sutured continuously along the S3 nerve root [Figure 4d], and the epidural space was packed with fat tissue and fibrin glue.
Magnetic resonance image showing no recurrence in the 5 years since surgery. Arrows indicate shrunk perineural cysts.
SNI-13-317-g005.jpg
PMC9345110_01_SNI-13-317-g005.jpg
F5
Moreover, there has been no recurrence until 5 years after her surgery [Figure 5].