Method of Cyst-Subarachnoid Shunt for Symptomatic Sacral Cyst: A Technical Case Report

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  • シャント術を施行した仙骨嚢腫の１例

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A cyst-subarachnoid shunt was recently developed by Morio et al. (Spine 26. 2001) and by Aoki et al. (Surgical Technique for Spine and Spinal Nerves 6. 2004) as a treatment of symptomatic sacral cysts. The hydrostatic and pulsatile forces of cerebrospinal fluid are attributed to the growth of the cyst and their becoming symptomatic. The Morios technique consisted of insertion of a shunt tube via the check-valve aperture. We performed Aokis method on a sacral cyst in a 40-year-old woman who had left-sided sciatica and low back pain. A cyst-subarachnoid shunt was set to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and the cyst. The shunt tube (1.4mm in outer diameter; Create Medic, Yokohama, Japan) was placed outside the aperture and fixed to the dura and the cyst wall with a 6-0 nylon suture. Immediately after surgery, the patient had no pain and experienced substantial resolution of her symptoms in the 8 months after surgery. The advantages of Aokis technique are the prevention of nerve root injury during insertion of the tube into the check-valve aperture and enabling the surgeon to use a thicker tube than that used in a Morios technique.

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