Surgical excision of symptomatic multiple nerve root perineural cysts in thoracic intervertebral foramen: A case report

• Presents a rare case with symptomatic multiple thoracic nerve root perineural cysts. • Describes a safe and effective surgical treatment approach for perineural cysts. • Discusses the pathogenesis and pathophysiology of perineural cysts. A 68-year-old female patient was admitted to our outpatient clinic with back and low back pain. There were no remarkable physical or neurological findings of the patient. Imaging workup revealed two cystic lesions of the right T8 and left T11 nerve root at the level of the foramen. Conservative treatment for this patient was ineffective in a half-year follow-up period. We performed laminectomies at the level of interests and cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found there is an internal fistula at the communication between the cyst and the dura mater and nerve root passing through it. The cysts were excised and the nerve roots were preserved. Surgical resection resulted in significant improvement in patient symptoms, and pathology revealed a perineural cyst. We conclude that back pain may be generated when distention of the cyst activates neural, dural, or bone nociceptors. And surgical treatment can be curative.