Management of Symptomatic Thoracic Perineural Cysts

Diagnostic Imaging

• MRI of the thoracic spine without IV contrast is the imaging modality of choice for evaluating suspected perineural cysts, assessing cyst location, size, number, and presence of associated structural abnormalities, as recommended by the American College of Radiology 1
• CT myelography may be used as a complementary imaging modality when MRI findings are equivocal or for presurgical planning, according to the American College of Radiology 1

Surgical Indications and Techniques

• Surgery should be considered for patients with progressive neurological deficits or myelopathy, as stated by the American College of Radiology 1
• The American College of Radiology recommends microsurgical cyst fenestration or wrapping surgery for symptomatic thoracic perineural cysts that fail conservative management, as these techniques provide safe and effective symptom relief with minimal complications 1

Conservative Management and Follow-up

• Observation with serial MRI at 6-month intervals to document cyst stability is a recommended conservative management approach, as suggested by the Praxis Medical Insights 2
• Postoperative monitoring should include clinical assessment of symptom improvement and repeat MRI to confirm cyst reduction and nerve root decompression, with long-term surveillance for cyst recurrence, according to the Praxis Medical Insights 2