A different operative approach for the excision of an incidental sacral perineural cyst: Case report

Perineural cysts are usually asymptomatic and rarely require surgical treatment. This report describes a case that required surgical removal and an innovative method of defect closure. A sacral foraminal perineural cyst was detected incidentally on magnetic resonance imaging in a patient with a symptomatic L5-S1 disc herniation. At surgery, the cyst was found to be restricting normal movement of the right S1 nerve root, and compressing the root during lumbar spine extension. The cyst was incised to identify its contents, and was subsequently excised; however, the dural defect was on the anteromedial side of the nerve root and it was impossible to adequately secure watertight closure by suturing. To address this problem, the two edges of the defect were approximated and three small titanium clips were applied. The patient was symptom-free postoperatively, and the clips did not reduce the diagnostic value of repeat magnetic resonance images of the lumbosacral spine. This report illustrates that some cases of perineural cyst require innovative intraoperative strategies. The use of small titanium clips during spinal surgery does not necessarily compromise postoperative magnetic resonance imaging