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Findings MRT from 12.03.2014. Recording parameters: An intraspinal cyst conglomerate consisting of several parts is sacrally demarcated. The largest finding at height S2/3 has a diameter of 2.5 x 1.4 cm and a craniocaudal extent of 3 cm. Compression of the S3 root on both sides. Pressure of the bone. After craniolateral dandelion cysts of 10 x 10 mm in diameter and a craniodaudal extent of 15 mm, the right S2 root is displaced to the anterior direction. In the included section of the lower spinal column, osteochondrosis L3 / 4 and L4 / 5 with bony discus protrusions, in L3/4 postoperative residuals in anam. Bek. Z ,. N. Disc surgery. Evaluation: Large sacral arachidic cyst to height S2/S3 with connection to dural tube. Compression of the bone, especially posterior. In addition, root canal cyst right height S2 with oppression of the root. Report with critical assessment Macroscopy: Sacral cyst S2 / 3. 0.5 g heavy 2.6 x 1.1 x 0.5 cm large, beige-brownish, moderately coarse amount. Methods used: Paraffin embedding: HE, PAS staining, ECG staining, immunohistochemistry for CD68, LCA Microscopy: The transferred material shows abundant fractions of a fibrosis-thickening, cystic-structured tissue without essential epithelial structures. Blood vessels are isolated. Furthermore, there are isolated lymphocyte collections. The other special dyes show abundant fiber fractions. In PAS staining, only sparse PAS-positive material is detectable. CD68 clearly markedly increased macrophages. LCA also represents single lymphocytes. Critical report: Cystic fibrotically altered connective tissue with secondary inflammatory changes. Release report Diagnosis: Perineural sacral cysts in height S2 right to S3 left. Findings: As an admission, we saw a 52-year-old patient in a very painful general condition and normosome nutritional condition without cardiopulmonary decompensation signs. Blood pressure 110/70. The abdomen was soft, no pathological resistance renal lesions free on both sides. The patient was awake, fully oriented, and cooperative. Neurological: No Meningism. Pupils round, wide and isocor. Nerve leakage points free on both sides. Cerebral nerves on both sides inconspicuous. On the lower extremities, Laseque left positive at 40 °, right negative. No motor deficits. Sensory disturbances in the sense of hypaesthesia and hypalgesia corresponding to Dermatom S2 and S3 ventral and dorsal. Gear and stand safe. At the vertebral column, there is no tingling or pressure pain over the lumbar vertebral and paravertebral region. Iliosacral joint both sides negative, no congestive pain. On the upper extremities no manifest sensomotor deficits. Therapy: On 13.3.14 Endoscopy, Thecaloscopy, Adhesiolysis of the Fila radicularia in Leptomeningopatihie, Subarachnoepiduostomy in four places to improve the CSF, endoscopically assisted microsurgical sacrotomy via a transverse occlusion in the area of the middle os sacrum, microsurgical endoscopically assisted cyst resection, fistula reconstruction, reconstruction of the Os sacrum, free fat transplant into the area of the sacral spinal canal, reconstruction of the bony os sacrum with a plate screw system, wound closure. Therapy and progress: An MRI of the lumbar spine on 12.03.14 as well as a CT of the basin on 11.03.14 were performed within the framework of the preoperative diagnosis. This revealed indications of perineural cysts with considerable compressions in the S2 and S3 root as well as a pressure on the passage of the roots S4 and S5. Preoperatively a sonography of the bladder was performed. The postoperative course was very satisfactory. In the further course, the patient became increasingly mobilized under physiotherapy. She gave less pain in the lumbosacral junction. The symptoms slowly receded until the time of discharge. The pain medication with tramadol could be reduced gradually. A postoperative ultrasound control of the bladder also showed an inconspicuous finding. Postoperative imaging diagnostics in the sense of an MRI of the os sacrum and an x-ray of the os sacrum in two planes on 17.03.14 showed a regular postoperative finding with cyst reduction and reconstruction of the os sacrum with a plate-screw system. On 21.03.14 we release the patient with subjective sensitivity with residual sensory disturbances in the dermatomes S2 and S3 into the domestic environment. The wound conditions developed until the day of the dismissal, and healed by primam intentionem.