CONTEXT: Meningeal abnormalities such as dural ectasia are seen in Marfan 
syndrome, but spinal meningeal cysts are rarely seen. These cysts usually 
asymptomatic and often found incidentally on magnetic resonance imaging, large 
cysts may cause neurological deficits and pain secondary to nerve root 
compression.
DESIGN: Case reports.
FINDINGS: Two patients with Marfan syndrome presented with urinary symptoms 
secondary to dural ectasia and sacral cysts. Patient 1 had a history of low back 
pain, erectile dysfunction, and occasional urinary incontinence and groin pain 
with recent symptom worsening. He underwent L5 partial laminectomy and S1-S2 
laminectomy with sacral cyst decompression. Nine weeks later, he underwent 
drainage of a sacral pseudomeningocele. Pain and urinary symptoms resolved, and 
he remains neurologically normal 2 years after surgery. Patient 2 presented 
after a fall on his tailbone, complaining of low back pain and difficulty 
urinating. Physical therapy was implemented, but after 4 weeks, urinary 
retention had not improved. He then underwent resection of the sacral cyst and 
S1-S3 laminectomy. Pain and paresthesias resolved and bowel function returned to 
normal. Other than needing intermittent self-catheterization, all other 
neurologic findings were normal 30 months after surgery.
CONCLUSION/CLINICAL RELEVANCE: Surgical goals for sacral cysts include resection 
as well as closure of the dura, which can be challenging due to thinning from 
ectasia. Neurosurgical intervention in Marfan syndrome is associated with a high 
risk of dural tears and osseous complications, and should be performed only when 
symptoms are severe.