Sacral cyst is a kind of dural cyst located in the sacral canal, and the cyst is filled with watery and clear cerebrospinal fluid. This causes pain in the lumbosacral region, tingling in the perineum of the buttocks, radiating pain in the lower limbs and intermittent claudication; sexual dysfunction and urinary and fecal incontinence gradually appear as the disease progresses. Sacral cyst is a common disease with similar incidence to lumbar disc herniation and is one of the main causes of lumbosacral lower extremity pain, yet its treatment options are very different. According to the types of sacral cysts, different treatment options should be selected in a targeted manner. Firstly, it can be divided into asymptomatic sacral cysts and symptomatic sacral cysts according to the presence or absence of symptoms. Asymptomatic sacral cysts found during physical examination are usually very small in size and have no obvious pressure on nerve roots, so dynamic observation is sufficient and surgical treatment is not required. Magnetic resonance imaging should be performed for symptomatic sacral cysts, especially to analyze the relationship between the cyst and the nerve root. If the cyst is a simple hydatid cyst with no internal nerve root, this type is called Nabors IB type sacral duct cyst, and surgical treatment is usually not necessary, or CT-guided cyst puncture, cyst fluid aspiration + biogel injection can be considered, which is not curative but can still be repeatedly injected after recurrence; even if radical surgery is performed, the surgical risk is minimal with suture ligation of the cyst neck. On the contrary, if the cyst contains nerve root fibers (Nabors type II), the symptoms will be more serious and persistent, and since the sacral nerve roots cannot be damaged, the surgical treatment must not be lanced in one go. For Nabors II sacral cyst, the traditional surgical strategy is to peel off the cyst wall along the nerve root, remove the excess cyst wall and then suture the residual cyst wall around the nerve root, which is a very difficult operation but has poor efficacy and high recurrence rate. Therefore, many neurosurgeons are becoming reluctant to perform this surgery, preferring observation. This technique focuses on the neuroendoscopic sealing of the cyst neck without removing the cyst wall, thus fundamentally reducing the complications of cerebrospinal fluid leak surgery, greatly improving safety, and significantly improving the surgical efficacy. Dr. Zheng Xuesheng of the neurosurgery group of Xinhua Hospital took the lead in introducing and carrying out this operation in China, and achieved good results. After analyzing the current situation of sacral cyst treatment in China, a tendency was found: no distinction was made between the types of lesions, and as long as they were sacral cysts, CT-guided aspiration and gel injection was performed. Although this can alleviate the symptoms in the short term (not completely relieved, much less cured), this palliative treatment sets obstacles for future radical surgery; because endoscopic surgery requires clear vision and operating space, and biogel injection leads to serious adhesions within the cyst, making endoscopic operation very difficult; therefore, for Nabors II type sacral cysts, especially wide neck cysts, it is not advisable to easily do CT-guided aspiration and gum injection.