Objective：To explore the curative effect and clinical applicability of microsurgical repair of spinal extradural meningeal cysts（SEMC）fistulas combined with cyst tail end technique in the thoracolumbar spine. Methods：Data from 12 patients who underwent thoracolumbar SEMC fistula repair combined with the cyst tail end technique（removal of the cystic sac at the tail end of the cyst，followed by a small incision at the junction of the cyst tail end and the normal dura mater to connect with cerebrospinal fluid，and then routine suturing）under electrophysiological monitoring microsurgery were retrospectively reviewed，and analyzed in conjunction with traditional surgical methods from the literature. Results：During an average follow-up of 14 months，complete cyst disappearance was observed in 9 cases，partial disappearance in 1 case，and residual cysts in the intervertebral foramen in 2 cases. No cases exhibited dural sac compression，and there were no recurrences. Among the 11 patients who had preoperative lower back pain and/or lower extremity pain，pain was relieved or disappeared upon discharge，and no significant differences in pain were observed 3 months of follow -up compared to discharge. Paitents with lower limb weakness and dysuria showed gradual recovery，and no new neurological deficits were noted postoperatively. The anatomical reduction of lamina spinous processes was good，with no cases of spinal stenosis and deformity. Conclusion：Electrophysiological monitoring microsurgical thoracolumbar SEMC fistula repair combined with cyst tail end technique effectively solve the problem of living flap and close cyst，with no significant complications，demonstrating clinical feasibility.