Munir Elias 20-12-2013
Surgical group is like a football team.

Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit  neurosurgery.tv




The patient came to the clinic 20-November-2006  complaining of left sciatica with LBP for 3 years. Exacerbation the last 5 months  down to S1 territory. MRI lumbar spine performed 14-September-2006 showed bulge disc L3-4  with Tarlov cyst in the sacral area. The patient has in anamnesis infective endocarditis with anterior mitral leaflet prolapse.

The patient is Yemeni citizen and he was operated at home 01-November-2006. Excision of Tarlov cyst was performed, after what a huge subcutaneous CSF pocket took place, with headache upon movement, setting and standing.

On examination: the patient has weak left upper limb  with hypalgesia of the median nerve distribution. He had hypalgesia of the left S1 root territory. The collection was not oozing and the silk sutures still in place and compression of the collection caused headache.

MRI of the lumbar spine with contrast with MR Myelography was performed 21-November-2006 which confirmed the presence of huge CSF collection.

2 gm of Rocephine were given with gentamycin 80 mg before the operation. The old incision was opened with the patient in supine and Reverse Trendelenburg position, so that the sacral area was the upper most. Inspection of the wound revealed a dural defect in the right S3 root  about 2 mm in length. Using Nylon 6 zero the dural defect was sutured water-tightly, trying not to touch the running adherent root inside the dural sleeve.  The patient was positioned so that the head is in high position and Valsalva maneuver was performed to check for CSF leak. No CSF leak. The running roots were covered with surgicele and above that chips of bone harvested during exposure were implanted above the sacral defect for future bone formation to close the bone defect. Multilayer water-tight closure of the wound and the skin was trimmed for cosmetic reasons and subcuticular closure performed. Smooth postoperative recovery.


1. In our practice, we usually operate upon Tarlov cysts, when they grow over protracted period of time. Many cases do not need surgery and they stay under observation. Considering that, it was not understandable the indications for such surgery, from the first visit.

2. When surgery was needed for growing Tarlov cysts, during the last 27 years, I usually used the bipolar to shrink the cyst wall, so that the cyst disappear completely without opening it and the root regain normal anatomy. After that, the cavity is filled with fat tissue. Using this technique, there were no such complications in the past.

3. The patient still undiagnosed up to now. When the complication resolve, the patient needs further investigations to know the cause of his complains.



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[2006] [CNS CLINIC - NEUROSURGERY - JORDAN]. All rights reserved