Surgical evaluation and management of symptomatic lumbosacral meningeal cysts.

Sacral meningeal cysts are a fairly common finding in the workup of sciatica. In most instances, a cyst causes no symptoms. Occasionally, a symptomatic sacral cyst may present with chronic low back pain (radiculopathy), sensory loss in sacral dermatomes, perineal pain, or bowel or bladder dysfunction. Compared with computed tomography, magnetic resonance imaging shows meningeal cysts more often and allows better localization of sacral cysts. In this article, we present clinical guidelines that may be used to distinguish symptomatic cysts from asymptomatic cysts. We conclude that surgical treatment of a symptomatic cyst may include laminectomy with fenestration and imbrication of the cyst--or percutaneous treatment methods. Surgery for sacral meningeal cysts can lead to successful improvement of pain and function in activities of daily living in more than 80% of cases.