Surgical Excision of a Symptomatic Thoracic Nerve Root Perineural Cyst Resulting in Complete Resolution of Symptoms: A Case Report

Abstract

Tarlov (perineural) cysts of the nerve root are common and usually incidental findings during magnetic resonance imaging (MRI) of the lumbosacral spine. There are a few case reports where symptomatic thoracic perineural cysts have been described in the literature. We report a case of a high thoracic nerve root perineural cyst that failed conservative therapy, requiring surgical intervention. Our patient presented with radicular symptoms involving the left hand. Imaging workup revealed a cystic lesion of the left T1 nerve root at the level of the foramen. Surgical resection resulted in significant improvement in patient symptoms, and pathology revealed a perineural cyst. We conclude that a thoracic perineural (Tarlov) cyst can be symptomatic by causing nerve root compression and can be mistaken as a nerve root sheath tumor on imaging. Surgical treatment can be curative.

Giant Tarlov Cyst presenting as pelvic mass: Often doing less is better

“…Tarlov cysts are rare at thoracic level with only few case reports. [ 2 ] Authors have done a literature review[ 9 , 11 - 13 , 15 , 17 , 21 , 24 , 25 , 27 ] in Table-1 for all cases of Tarlov cysts published with emphasis on clinical parameters, treatment, and recurrence. Total of 39 cases were reported of which only 10 were males.…”

Spinal Perineural Cysts among European Patients

“…Rare cases of chest, abdominal, or pelvic pain have also been reported. [9][10][11][12][13][14][15] The gold standard in the diagnosis of perineural cysts is magnetic resonance imaging (MRI), which allows the assessment of the relation between the cyst, the spinal nerve root, and the neighboring structures.…”