• Albert E Telfeian, Cody Doberstein, Adetokunbo A Oyelese, Jared Fridley, John E Donahue, and Ziya Gokaslan.
• The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. Electronic address: albert.telfeian@nts-online.net.
• World Neurosurg. 2019 Jul 1; 127: 85-91.

ObjectivePerineural cysts are a benign spine pathology but, when they become symptomatic and require surgical treatment, represent a significant challenge to the spine surgeon. Here we describe our experience with a novel endoscopic approach to the biopsy, drainage, resection of the cyst wall, and direct cyst fenestration to the subarachnoid space.MethodsA transforaminal endoscopic approach to a large lumbar 2-3 perineural cyst is presented here in a 25-year-old patient. A step-by-step technique for the biopsy, drainage, and resection of the cyst wall is presented.ResultsThe patient underwent cyst resection and fenestration into the subarachnoid space without complication, with immediate relief of his preoperative symptoms and after 1 year remains symptom-free.ConclusionsSurgical treatment of perineural cysts in the spine represent a significant challenge to the surgeon, principally due to the risk of spinal fluid leak in the postoperative period. Transforaminal endoscopic surgical access to this disease pathology is a novel minimally invasive surgical approach presented here that allows diagnosis and treatment of a perineural cyst and can be performed in an awake patient.Copyright © 2019. Published by Elsevier Inc.

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