Tarlov cysts: a controversial lesion of the sacral spine

Abstract

<jats:p>The primary aim of our study was to provide a comprehensive review of the clinical, imaging, and histopathological features of Tarlov cysts (TCs) and to report operative and nonoperative management strategies in patients with sacral TCs. A literature review was performed to identify articles that reported surgical and nonsurgical management of TCs over the last 10 years. Tarlov cysts are often incidental lesions found in the spine and do not require surgical intervention in the great majority of cases. When TCs are symptomatic, the typical clinical presentation includes back pain, coccyx pain, low radicular pain, bowel/bladder dysfunction, leg weakness, and sexual dysfunction. Tarlov cysts may be revealed by MR and CT imaging of the lumbosacral spine and must be meticulously differentiated from other overlapping spinal pathological entities. They are typically benign, asymptomatic lesions that can simply be monitored. To date, no consensus exists about the best surgical strategy to use when indicated. The authors report and discuss various surgical strategies including posterior decompression, cyst wall resection, CT-guided needle aspiration with intralesional fibrin injection, and shunting. In operative patients, the rates of short-term and long-term improvement in clinical symptoms are not clear. Although neurological deficit frequently improves after surgical treatment of TC, pain is less likely to do so.</jats:p>

Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature

“…With respect to microsurgical treatment, many previous studies have reported successful relief of symptoms in up to 80%-90% of patients (Table 1). 3,9,11 However, these results have been derived from relatively small case series given the relative rarity of TCs. From these studies, an anecdotal set of surgical indications have emerged to include 1) a cyst diagnosed by imaging; 2) symptoms consistent with a cyst, including radicular pain, lumbosacral pain, and/or bowel or bladder dysfunction; 3) a cyst size greater than 1-1.5 cm; and 4) no contraindications for surgery.…”

“…11 Described treatment options include antiinflammatory medications, percutaneous cyst drainage, external cerebrospinal (CSF) drainage, percutaneous fibrin glue injection, insertion of cyst-subarachnoid shunts, lumboperitoneal shunts, cystperitoneal shunts, as well as microsurgical options (resection of the cyst neck or wall, cyst imbrication, or cauterization).…”

Pelvic pain from a giant presacral Tarlov cyst successfully obliterated using aneurysm clips in a patient with Marfan syndrome

“…9,12 Surgical treatment strategies conceptually involve either diversion of CSF flow (aspiration or shunt procedures) or a direct microsurgical approach. 10 Several authors have observed that surgical treatment may accomplish better clinical outcome in patients with radicular symptoms, bladder/bowel dysfunction, and cyst diameters exceeding 1-1.5 cm. 7,13,16,25 Such surgical methods consist of decompressive laminectomy, cyst neck or wall resection, cyst fenestration and imbrication, or cyst shrinkage via bipolar cautery.…”

“…15 Although the majority of Tarlov cysts are asymptomatic, a small subset of these sacral perineural cysts may become symptomatic and warrant treatment. 10 Clinical symptoms include radicular pain, sensory disturbances, motor deficits, abdominal pain, impotence, bladder/bowel dysfunction, and intracranial hypotension if the cyst ruptures. 10,20 Currently, there are no established guidelines or consensus with regard to the best management option for symptomatic Tarlov cysts.…”

“…10 Clinical symptoms include radicular pain, sensory disturbances, motor deficits, abdominal pain, impotence, bladder/bowel dysfunction, and intracranial hypotension if the cyst ruptures. 10,20 Currently, there are no established guidelines or consensus with regard to the best management option for symptomatic Tarlov cysts. Nonsurgical treatment includes medical therapy (analgesic, nonsteroidal antiinflammatory medications, and steroids) and physical therapy.…”