Spontaneous Rupture of a Huge Presacral Tarlov Cyst Leading to Dramatic Neurologic Recovery

Large presacral Tarlov cysts in pregnancy

“…Asymptomatic TCs are common 7 , 16 ; however, presacral TCs that protrude into the endopelvic space are very rare. 7 , 17 Enlarged lesions may cause abdominal pain and hydronephrosis, 18 , 19 and in the practice of gynecology, they are often first recognized as adnexal cysts by transvaginal echography and eventually diagnosed as presacral TCs by MRI or CT. 14 , 20 , 21 , 22 , 23 , 24 The posterolateral location of TCs, the presence of a normal ovary detected on the ipsilateral side, and immobility on respiration are features that identify presacral TCs vs. adnexal cysts via transvaginal echography. 14 , 20 Invasive procedures to treat presacral TCs based on their misdiagnosis as adnexal cysts have the potential to cause severe complications.…”

“…In addition to direct cyst compression by the head of the baby, obstetrical interventions such as vacuum delivery or uterine fundal compression may increase the risk of cyst rupture. TC rupture has the potential to trigger dramatic symptom improvement 17 ; however, chronic numbness and pain in the sacral nerve area and headache due to low intracranial pressure may occur. 3 , 9 , 12 , 13 Moreover, chronic pain and discomfort associated with TCs often lead to mood disorders.…”

“…Asymptomatic TCs are common 7,16 ; however, presacral TCs that protrude into the endopelvic space are very rare 7,17 . Enlarged lesions may cause abdominal pain and hydronephrosis, 18,19 and in the practice of gynecology, they are often first recognized as adnexal cysts by transvaginal echography and eventually diagnosed as presacral TCs by MRI or CT 14,20–24 …”

Management of Tarlov cysts: an uncommon but potentially serious spinal column disease—review of the literature and experience with over 1000 referrals

“…Cysts may also become large enough to erode surrounding bony tissue causing irritation of periosteal pain fibers and in rare cases have been responsible for sacral insufficiency fractures [ 59 , 60 ]. Although cysts rarely become large enough to spontaneously rupture, they have been reported in case reports to rupture with CSF leakage resulting in intracranial hypotension [ 16 , 61 ]. Two unusual case reports dealt with a cerebral fat embolism after a traumatic rupture of a Tarlov cyst secondary to a sacral fracture after a fall with a low back injury [ 62 , 63 ].…”

“…Although acquired conditions of cyst formation have previously been proposed to involve inflammation or trauma [7,14,15], the currently accepted cause of cyst development has been cited as a disruption of the CSF-venous drainage mechanism at the perineurial-epineurium junction [6,7,15]. There is also a general view that cyst enlargement occurs because a microcommunication exists between the cyst and the subarachnoid space and that a ball-valve-type mechanism allows CSF influx and restricts efflux leading to an expansion of the cyst [5,[16][17][18].…”