Accurate diagnosis and treatment of sacral meningeal cysts without spinal nerve root fibres: identifying leakage orificium using high-resolution spherical arbitrary-dimensional reconstructing magnetic resonance imaging

Chenlong Yang; Xiaohui Lou; Lina Huang; Qianquan Ma; Xiaoliang Yin; Qiang Zhao; Chao Wu; Haibo Wu; Jianjun Sun

doi:10.3389/fneur.2024.1298477

Accurate diagnosis and treatment of sacral meningeal cysts without spinal nerve root fibres: identifying leakage orificium using high-resolution spherical arbitrary-dimensional reconstructing magnetic resonance imaging

Front Neurol. 2024 Jan 31:15:1298477. doi: 10.3389/fneur.2024.1298477. eCollection 2024.

Authors

Chenlong Yang^#¹, Xiaohui Lou^#^{1

2}, Lina Huang^{3

4}, Qianquan Ma¹, Xiaoliang Yin¹, Qiang Zhao⁵, Chao Wu¹, Haibo Wu⁵, Jianjun Sun^{1

6}

Affiliations

¹ Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China.
² Department of Neurosurgery, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
³ Department of Pain, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁴ Department of Radiology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁵ Department of Radiology, Peking University Third Hospital, Peking University, Beijing, China.
⁶ Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

Objective: This study aimed to develop an arbitrary-dimensional nerve root reconstruction magnetic resonance imaging (ANRR-MRI) technique for identifying the leakage orificium of sacral meningeal cysts (SMCs) without spinal nerve root fibres (SNRFs).

Methods: This prospective study enrolled 40 consecutive patients with SMCs without SNRFs between March 2021 and March 2022. Magnetic resonance neural reconstruction sequences were performed for preoperative evaluation. The cyst and the cyst-dura intersection planes were initially identified based on the original thin-slice axial T2-weighted images. Sagittal and coronal images were then reconstructed by setting each intersecting plane as the centre. Then, three-dimensional reconstruction was performed, focusing on the suspected leakage point of the cyst. Based on the identified leakage location and size of the SMC, individual surgical plans were formulated.

Results: This cohort included 30 females and 10 males, with an average age of 42.6 ± 12.2 years (range, 17-66 years). The leakage orificium was located at the rostral pole of the cyst in 23 patients, at the body region of the cyst in 12 patients, and at the caudal pole in 5 patients. The maximum diameter of the cysts ranged from 2 cm to 11 cm (average, 5.2 ± 1.9 cm). The leakage orificium was clearly identified in all patients and was ligated microscopically through a 4 cm minimally invasive incision. Postoperative imaging showed that the cysts had disappeared.

Conclusion: ANRR-MRI is an accurate and efficient approach for identifying leakage orificium, facilitating the precise diagnosis and surgical treatment of SMCs without SNRFs.

Keywords: leakage orificium; magnetic resonance imaging; sacral cyst; sectional reconstruction; spinal nerve root.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Natural Science Foundation of China (42293324 to JS; 82371319 to CY), Beijing Nova Program (20230484356 to CY), Beijing Natural Science Foundation (7222217 to CY), the Capital Health Research and Development of Special (2022-4-40918 to CY), AO Spine Research Start-up Grant (AOS-Startup-21-016 to CY), and Peking University Third Hospital Clinical Key Project (BYSYZD2021023 to CY).