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Liu Y, Sun D, Gao Z, Wang Z, Jin B. Tarlov Cysts and Premature Ejaculation. Arch Sex Behav 2024; 53:1591-1594. [PMID: 38366312 PMCID: PMC10954956 DOI: 10.1007/s10508-024-02815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/18/2024]
Abstract
Tarlov cysts adjacent to the spinal cord are usually asymptomatic and found incidentally via magnetic resonance imaging. On rare occasions, they increase in size to produce symptoms resembling disk herniation. We report a rare case of a sacral cyst resulting in premature ejaculation in a 32-year-old man who presented with pelvic pain and acquired premature ejaculation. Spinal nerve root decompression, excision of intraspinal Tarlov cyst, and spinal nerve root adhesion release surgery significantly improved his pain and premature ejaculation at a six-month follow-up.
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Affiliation(s)
- Yuanyuan Liu
- Southeast University School of Medicine, Nanjing, China
| | - Dalin Sun
- Andrology Department of Integrative Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | | | - Zhongjiang Wang
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nangjing, China
| | - Baofang Jin
- Andrology Department of Integrative Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
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2
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Paredes Mogica JA, Feigenbaum F, Pilitsis JG, Schrot RJ, Oaklander AL, De EJB. Sacral Tarlov perineurial cysts: a systematic review of treatment options. J Neurosurg Spine 2024; 40:375-388. [PMID: 38100766 DOI: 10.3171/2023.9.spine23559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 12/17/2023]
Abstract
Tarlov perineurial spinal cysts (TCs) are an underrecognized cause of spinal neuropathic symptoms. TCs form within the sensory nerve root sleeves, where CSF extends distally and can accumulate pathologically. Typically, they develop at the sacral dermatomes where the nerve roots are under the highest hydrostatic pressure and lack enclosing vertebral foramina. In total, 90% of patients are women, and genetic disorders that weaken connective tissues, e.g., Ehlers-Danlos syndrome, convey considerable risk. Most small TCs are asymptomatic and do not require treatment, but even incidental visualizations should be documented in case symptoms develop later. Symptomatic TCs most commonly cause sacropelvic dermatomal neuropathic pain, as well as bladder, bowel, and sexual dysfunction. Large cysts routinely cause muscle atrophy and weakness by compressing the ventral motor roots, and multiple cysts or multiroot compression by one large cyst can cause even greater cauda equina syndromes. Rarely, giant cysts erode the sacrum or extend as intrapelvic masses. Disabling TCs require consideration for surgical intervention. The authors' systematic review of treatment analyzed 31 case series of interventional percutaneous procedures and open surgical procedures. The surgical series were smaller and reported somewhat better outcomes with longer term follow-up but slightly higher risks. When data were lacking, authorial expertise and case reports informed details of the specific interventional and surgical techniques, as well as medical, physical, and psychological management. Cyst-wrapping surgery appeared to offer the best long-term outcomes by permanently reducing cyst size and reconstructing the nerve root sleeves. This curtails ongoing injury to the axons and neuronal death, and may also promote axonal regeneration to improve somatic and autonomic sacral nerve function.
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Affiliation(s)
| | - Frank Feigenbaum
- 2Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas
| | - Julie G Pilitsis
- 3Department of Neurosurgery, Florida Atlantic University, Boca Raton, Florida
| | - Rudolph J Schrot
- 4Department of Neurosurgery, Sutter Medical Center Sacramento, Sacramento, California
| | - Anne Louise Oaklander
- 5Departments of Neurology and Pathology (Neuropathology), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Elise J B De
- 6Department of Urology, Albany Medical College, Albany, New York
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3
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Kameda-Smith MM, Fathalla Z, Ibrahim N, Astaneh B, Farrokhyar F. A systematic review of the efficacy of surgical intervention in the management of symptomatic Tarlov cysts: a meta-analysis. Br J Neurosurg 2024; 38:49-60. [PMID: 33754918 DOI: 10.1080/02688697.2021.1874294] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/07/2021] [Indexed: 10/21/2022]
Abstract
Introduction: Tarlov cysts (TC) are sacral perineural cysts that are often found incidentally during spinal imaging. In a small fraction, symptomatic TC can cause pain, bowel, bladder and/or sexual dysfunction, as well as motor and sensory deficits. While many surgeons regard TCs as a non-operative entity, there have been suggestions that operative intervention in carefully selected symptomatic patients may be beneficial. The aim of this meta-analysis is to identify whether surgical treatment for symptomatic TCs is beneficial with an acceptable complication profile.Materials and methods: The authors conducted a systematic outcome analysis of symptomatic TCs treated either with surgery or conservatively managed.Results: Sixteen studies (N = 238) met the inclusion criteria for final meta-analysis. The literature search was performed using PubMed, Ovid MEDLINE, CINAHL, and EMBASE databases up to September 2017 and with an updated search in April 2019. The post-operative complication rate in patients undergoing surgical intervention was 16.9 (11.8 to 22.7) and cyst recurrence was 8.5 (3.5 to 15.4). When a complication occurred, the most frequent complication of surgical intervention was the development of a surgical site infection and/or CSF leak. Of the 15 studies reporting long-term follow-up, 81.0 (74.0-88.0) of patients remained symptom-free for more than 1 year (Mean: 27.5 months, SD = 11.5).Conclusion: We rigorously analyse the efficacy of open surgical decompression and repair of symptomatic TCs and corroborate the findings of sustained long-term resolution of symptoms.
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Affiliation(s)
- Michelle M Kameda-Smith
- McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Forough Farrokhyar
- McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Dada A, Macki M, Tawil M, Chryssikos T, Tan LA. Surgical Untethering of S1 Nerve Root Herniation Into L4 Perineural Cyst: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:103. [PMID: 37707423 DOI: 10.1227/ons.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/06/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Abraham Dada
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco , California , USA
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Feigenbaum F, Parks SE, Martin MP, Chapple KM. Surgical Intervention is Associated with Improved Outcomes in Patients with Symptomatic Cervical Spine Tarlov Cysts: Results from a Prospective Cohort Study. World Neurosurg 2024; 181:e405-e410. [PMID: 37866779 DOI: 10.1016/j.wneu.2023.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Tarlov cysts are known contributors to radiculopathy but are often misdiagnosed and mismanaged due to a paucity of information. This is particularly true of cervical spine Tarlov cysts because most attention has been focused on sacral cysts. In this study, we describe our longitudinal experience with patients who underwent surgery for cervical spine Tarlov cysts. We hypothesized that patients undergoing surgical treatment for cervical spine Tarlov cysts would report improvement following surgery. METHODS We conducted a prospective study of patients who underwent surgical treatment for cervical Tarlov cysts between 2010 and 2021. The Short-Form 36-item survey (SF-36) was administered at the preoperative and follow-up visits. Repeated measures analyses were used to assess changes from preoperatively to postoperatively. RESULTS A total of 37 patients with cervical spine cysts were included in the study. Follow-up data were available for 27 patients with a median follow-up of 1 year. Of the cohort, 97.3% were women, with an average age of 47.5 ± 10.3 years. Patients reported statistically significant improvement in 2 of the 4 SF-36 physical health domains (physical function, P< 0.001; and bodily pain, P < 0.001) and 2 of the 4 mental health domains (vitality/energy, P < 0.003; and social functioning, P = 0.007). Patients also reported less interference in work, education, and retirement activities at follow-up (P = 0.017). CONCLUSIONS Our longitudinal series consisted of patients with symptomatic cervical spine Tarlov cysts, which, to the best of our knowledge, is the largest series described. Significant improvements in the SF-36 domains were documented, indicating these patients can be successfully treated surgically.
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Affiliation(s)
- Frank Feigenbaum
- Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas, USA.
| | - Susan E Parks
- Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas, USA
| | - Madelene P Martin
- Department of Neurosurgery, Feigenbaum Neurosurgery, Dallas, Texas, USA
| | - Kristina M Chapple
- Department of Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
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Fabiano AS, Youssef C, Morrill K, Al Tamimi M, Bagley CA, Aoun SG. Excision of Giant Perineural Cyst Over the T1 Nerve Root With Neural Reconstruction: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e372. [PMID: 37668996 DOI: 10.1227/ons.0000000000000874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/14/2023] [Indexed: 09/06/2023] Open
Affiliation(s)
- Alexander S Fabiano
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Hagihara S, Ohta H, Tanaka J, Shiokawa T, Matsumoto Y, Kida Y, Iguchi Y, Tatsumi M, Tahara K, Shibata T, Kyoichi Sanada, Kida H, Takemitsu Y, Yamamoto T. Perineural cyst with intracystic cerebrospinal fluid leakage by traction of nerve root -a case report. J Orthop Sci 2023; 28:1561-1565. [PMID: 34801339 DOI: 10.1016/j.jos.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shusuke Hagihara
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Hideki Ohta
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Jun Tanaka
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan.
| | - Teruaki Shiokawa
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | | | - Yoshikuni Kida
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Yohei Iguchi
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Masato Tatsumi
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Kenichi Tahara
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Tatsuya Shibata
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Kyoichi Sanada
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Hirotaka Kida
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | | | - Takuaki Yamamoto
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
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Liu PC, Chang HK, Chang CC, Wu JC. Letter to the Editor. Presacral Tarlov cyst in Marfan syndrome: intervention with microsurgical sealing or conservative treatment? J Neurosurg Spine 2023; 40:123-124. [PMID: 37890177 DOI: 10.3171/2023.8.spine23861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
| | - Hsuan-Kan Chang
- Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chang Chang
- Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Gardocki RJ, Chandler PJ, Vaughan WE, Zuckerman SL, Abtahi AM, Stephens BF. Endoscopic transforaminal treatment of a thoracic perineural cyst: a case report. Eur Spine J 2023; 32:2679-2684. [PMID: 36813905 DOI: 10.1007/s00586-023-07582-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND IMPORTANCE To describe the first case of a thoracic perineural cyst successfully treated using a direct thoracic transforaminal endoscopic approach. METHODS Case report. CLINICAL PRESENTATION A 66-year-old male presented with right-sided radicular pain in a T4 distribution. MRI of the thoracic spine revealed a right T4 perineural cyst caudally displacing the root in the T4-5 foramen. He had failed attempts at nonoperative management. The patient underwent an all endoscopic transforaminal perineural cyst decompression and resection as a same-day surgical procedure. Postoperatively, the patient noted near complete resolution of the preoperative radicular pain. A thoracic MRI with and without contrast was performed 3 months after surgery and showed no evidence of the preoperative perineural cyst and no symptom recurrence was noted by the patient. CONCLUSION This case report presents the first safe and successful report of an all endoscopic transforaminal decompression and resection of a perineural cyst in the thoracic spine.
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Affiliation(s)
- Raymond J Gardocki
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Philip J Chandler
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.
| | - Wilson E Vaughan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Abstract
Perineural (Tarlov) cysts are a common benign pathology in the lumbosacral area but are rarely symptomatic, even when compressing the spinal root. Despite the rarity of Tarlov cyst formation in the foramen of the spine, this type is more symptomatic than those in other sites due to the narrow space. We introduce a biportal endoscopic fenestration for symptomatic foraminal Tarlov cysts. We present the case of a 40-year-old woman experiencing radiating pain in her right lower leg for 4 years. On seeking treatment, her great toe and ankle plantar flexion power had decreased. Magnetic resonance imaging revealed a cystic mass located in the L5-S1 intervertebral foramen that compressed the lumbar nerve root. Partial laminotomy was performed using a percutaneous biportal endoscopic system with a far lateral approach. An oval cystic mass of 2.6×1.1 cm was identified on high-definition images. Partial bone and foraminal ligament removal and cystic membrane fenestration were performed for nerve decompression. After decompression, the patient's motor weakness and radiating pain improved. Due to high-definition images and the minimally invasive laminotomy procedures associated with percutaneous biportal endoscopic fenestration, a foraminal Tarlov cyst was fenestrated safely, and weakness arising from radiculopathy was resolved in the current case. [Orthopedics. 2023;46(2):e125-e128.].
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Huang Q, Li J, Zhou Q, Li H, Yang X, Peng L, Chen L, Qi S, Lu Y. Management of Symptomatic Sacral Perineural Cysts: A New Surgical Method. World Neurosurg 2022; 167:e978-e989. [PMID: 36058485 DOI: 10.1016/j.wneu.2022.08.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Microsurgical techniques are increasingly being recommended for the treatment of symptomatic Tarlov cysts (TCs) due to improved long-term outcomes compared to those of other strategies. However, these techniques are associated with a high risk of cyst recurrence and cerebrospinal fluid (CSF) leakage, resulting in the surgical strategy of TCs remaining controversial. We hypothesize that incomplete closure of the ostium between the cyst and the subarachnoid space is the probable cause of surgical failure. Accordingly, we present a novel method of cyst separation and ostium closure that aims to block the ostium more firmly and reliably. METHODS Thirty-five consecutive patients (21 females) underwent the modified ostium obstruction surgery due to symptomatic TCs. We collected and compared their outcomes at the final follow-up to evaluate the surgical effect. RESULTS Thirty-five patients had 74 TCs (S2 level, 48.7%; mean diameter, 2.0 ± 1.0 cm); ostia nerve root fibers were found in all TCs. The mean follow-up duration was 37.8 (range, 13.5-76.8) months. At the final follow-up, 33 patients experienced complete or substantial resolution of the preoperative symptoms. The symptom with the highest improvement rate was radicular pain. Both the modified evaluation criteria for the efficacy of lumbar function criterion and Japanese Orthopedic Association score 29 showed an overall improvement rate of 94.3%. Two patients experienced surgery-related neurological dysfunction. No cyst recurrence or CSF leakage was observed. Magnetic resonance imaging showed that all cysts disappeared or significantly reduced postoperatively. CONCLUSIONS The microscopic fenestration of cysts and modified ostium obstruction described herein is a safe and effective strategy for management of patients with symptomatic TCs and is associated with a low incidence of cyst recurrence and CSF leakage since it achieves complete closure of cyst ostium.
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Affiliation(s)
- Qinguo Huang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Neurosurgery, The Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Junjie Li
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qiang Zhou
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Li
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyu Yang
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lin Peng
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lei Chen
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Glioma Center, Guangzhou, China
| | - Yuntao Lu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Neurology Research Institution, Nanfang Hospital, Southern Medical University, Guangzhou, China; Nanfang Glioma Center, Guangzhou, China.
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Ma Q, Xie J, Yang C, Wu C, Zhang J, Yin X, Si Y, Liu Y, Yang J, Sun J. Multiple dimensions of radiographic reconstruction for the optimal operative strategy of sacral meningeal cysts. Eur Spine J 2022; 31:3146-3158. [PMID: 35947195 DOI: 10.1007/s00586-022-07337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/04/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND PURPOSE The contents and subtypes of sacral cysts are sophisticated in many cases. We applied multiple dimensional magnetic resonance imaging (MRI) reconstruction to preoperatively clarify the specific subtype of sacral meningeal cysts. MATERIALS AND METHODS We preoperatively used multimodal neural reconstruction MRI sequences to evaluate 76 patients with sacral cysts. The linear nerve roots were precisely traced based on sagittal or coronal images processed at various angles and levels which was conducive to the design of the operation strategy. RESULTS Cysts with nerve passage were detected in 47 cases (62%, 47/76), whereas cysts without nerve roots were detected in 24 cases (32%, 24/76). Five patients had mixed cysts with or without nerve roots. Intraoperative exploration results proved the high accuracy of image reconstruction; only one cyst without a nerve root was misdiagnosed prior to surgery. CONCLUSION MRI reconstruction based on the three-dimensional fast imaging employing steady-state acquisition T2 sequence precisely tracked the nerve roots of sacral cysts and guided the optimal strategy during surgery.
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Affiliation(s)
- Qianquan Ma
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Chenlong Yang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Chao Wu
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Jia Zhang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Xiaoliang Yin
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Yu Si
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Ying Liu
- Department of Radiology, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China
| | - Jianjun Sun
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, 100191, China.
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López Segura M, Toledo Muñoz LM, García Martínez MR, García Rojo B, Bastida Chacón A. Anaesthetic considerations for elective cesarean section in a patient with a giant Tarlov cyst. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:493-496. [PMID: 36088269 DOI: 10.1016/j.redare.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/13/2021] [Indexed: 06/15/2023]
Abstract
Tarlov cysts are a pathological dilatation of the meninges. Their incidence is more frequent in women between 30 and 50 years of age. The imaging test of choice for diagnosis is MRI. Of unknown etiology, most cases are asymptomatic, but symptoms of radicular irritation, among others, may occur. The therapeutic possibilities are multiple, reserving surgical excision as the last option. We report a case of successful spinal anaesthesia for elective cesarean section in a patient with a giant Tarlov cyst but with potential airway compromise, in whom the risks of general anaesthesia would be increased. Anaesthetic management presents a challenge for the anesthesiologist, especially in situations where the patient presents an increased anaesthetic risk for general anaesthesia, as is the case in the obstetric patient.
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Affiliation(s)
- M López Segura
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain.
| | - L M Toledo Muñoz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - M R García Martínez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - B García Rojo
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - A Bastida Chacón
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
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14
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Porche K, Hoh DJ. Editorial. Microsurgical treatment of sacral Tarlov cysts. J Neurosurg Spine 2022; 37:902-903. [PMID: 35901713 DOI: 10.3171/2022.4.spine22293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
RATIONALE Tarlov or perineurial cysts are nerve root lesions often found in the sacral region. Most perineural cysts (PCs) remain asymptomatic throughout a patient's life. While their pathogenesis is still unclear, trauma resulting in hemorrhaging into subarachnoid space has been put forward as a possible cause of these cysts. Recently, we worked with a patient experiencing symptomatic PCs after spontaneous subarachnoid hemorrhage. PATIENT CONCERNS A 45-year-old man had a coil embolization procedure performed after being diagnosed with a subarachnoid hemorrhage from a ruptured anterior communicating artery. His symptoms were relieved after the procedure, but 7 days later he reported worsening pain in the left perineal area. The pain was intermittent at its onset and exacerbated by sitting, walking, and coughing. DIAGNOSES Two weeks after the embolization procedure, a lumbar spine MRI revealed 2 PCs at the S1 and S2 level affecting the left S2 root with high signal intensity in T2 and T1 images, suggestive of bleeding within the cyst. INTERVENTIONS We operated using a posterior approach. Cyst fenestration was done after S1 laminectomy. We aspirated approximately 1 cc of old blood. OUTCOMES His pain was relieved immediately after cyst removal and no neurologic deterioration occurred during the postoperative period. LESSONS Subarachnoid hemorrhage can be the source of the development of pain from asymptomatic PCs, making them symptomatic. Surgical extirpation is 1 treatment option for these symptomatic PCs.
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Jeong S, Nahm FS, Lee JS, Han WK, Choi E, Lee PB, Lee HJ. Epiduroscopic decompression of a symptomatic perineural cyst: A case report. Medicine (Baltimore) 2019; 98:e17564. [PMID: 31689762 PMCID: PMC6946280 DOI: 10.1097/md.0000000000017564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Perineural cysts in the spinal canal are usually asymptomatic. However, symptoms can occur when the cyst becomes large enough to compress a nerve root. There are still no established treatment options for this disease. In this report, we describe a case of successful decompression of the large symptomatic perineural cyst using epiduroscope. PATIENT CONCERNS A 42-year-old male patient visited our pain center complaining of discomfort and pain in his right posterior thigh. Magnetic resonance imaging of the patient showed a large perineural cyst (53 × 31 × 21 mm) compressing the right S1 nerve. No other abnormalities that would explain the patient's symptoms were identified. DIAGNOSIS Perineural cyst at the right S1 nerve. INTERVENTIONS We performed an epiduroscopic decompression of the perineural cyst. After advancing the epiduroscope and locating the cyst, we used the laser to make a hole in the cyst wall. Then, the epiduroscope was advanced into the cyst, and the cystic fluid was aspirated. OUTCOMES The symptoms of the patient were relieved after the procedure, without any complications. There was no recurrence of symptoms until 6 months after the procedure. LESSONS The epiduroscope is a minimally invasive method which can be used safely for decompression of symptomatic perineural cysts in the spinal canal.
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Affiliation(s)
- Sangmin Jeong
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Francis Sahngun Nahm
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University
| | - Jae-Sung Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Woong Ki Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Pyung-Bok Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam
- Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
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Fletcher-Sandersjöö A, Mirza S, Burström G, Pedersen K, Kuntze Söderqvist Å, Grane P, Fagerlund M, Edström E, Elmi-Terander A. Management of perineural (Tarlov) cysts: a population-based cohort study and algorithm for the selection of surgical candidates. Acta Neurochir (Wien) 2019; 161:1909-1915. [PMID: 31270612 PMCID: PMC6704091 DOI: 10.1007/s00701-019-04000-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/25/2019] [Indexed: 11/27/2022]
Abstract
Objective Perineural cysts, also known as Tarlov cysts, are cerebrospinal fluid-filled growths that develop at the intersection of a dorsal root ganglion and posterior nerve root. They are typically an asymptomatic and incidental finding during routine spine imaging. For symptomatic perineural cysts, there is little evidence on which treatment is most effective or when it is indicated. The aim of this study was to review our experience from a population-based cohort of patients with symptomatic perineural cysts and to propose an algorithm that could be used in the selection of surgical candidates. Methods A retrospective review was conducted of all adult (≥ 15 years) patients with symptomatic perineural cysts who were referred to Karolinska University Hospital between 2002 and 2018. Results Thirty-nine patients were included. The most common symptom was sciatica (n = 22). Cyst aspiration was performed in 28 patients, 24 of whom showed clinical improvement and were offered surgery. Microsurgical cyst fenestration was performed in 17 patients, 16 of whom showed clinical improvement at long-term follow-up. There were no surgical complications. Ten of the patients who were offered surgery chose to be treated conservatively instead, four of whom showed progression of symptoms at long-term follow-up. Conclusions Microsurgical cyst fenestration seems to be a safe and effective option for symptomatic relief in patients with perineural cysts. Based on the results from our series and those of others, we propose an algorithm for the selection of surgical candidates. Electronic supplementary material The online version of this article (10.1007/s00701-019-04000-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Sadia Mirza
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Burström
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kyrre Pedersen
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Per Grane
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Fagerlund
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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18
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Mijalcic MR, Djurovic B, Cvrkota I, Jokovic M, Bascarevic V, Micovic M. Tarlov cyst-a rare lesion in children: case report. Childs Nerv Syst 2019; 35:701-705. [PMID: 30810854 DOI: 10.1007/s00381-019-04105-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/22/2019] [Indexed: 11/26/2022]
Abstract
Perineural cysts, also known as Tarlov cysts, are benign lesions increasingly found in patients undergoing neuroimaging studies. These cysts can very rarely be identified in children and even then, they are not so likely to be responsible for some neurological deficit. It seems to be of scientific and clinical importance to present a pediatric case with Tarlov cyst. We report a case of a patient, a 7-year-old boy, previously treated for nocturnal enuresis (bedwetting), who later developed signs and symptoms of classic urinary incontinence. Magnetic resonance imaging (MRI) showed a relatively large extradural cyst at the level of S2. The cyst was approached by laminectomy of L5 to S2, excised, and completely removed from the belonging nerve root. The patient has established normal sphincter control without even a single episode of involuntary discharge of urine. A surgery is a powerful, safe, and efficacious option for treatment in pediatric patients with sacral Tarlov cysts.
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Affiliation(s)
- M R Mijalcic
- Department of Pediatric Neurosurgery, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia.
| | - B Djurovic
- Department of Pediatric Neurosurgery, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia
| | - I Cvrkota
- Department of Pediatric Neurosurgery, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia
| | - M Jokovic
- Department of Pediatric Neurosurgery, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia
| | - V Bascarevic
- Department of Pediatric Neurosurgery, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia
| | - M Micovic
- Department of Pediatric Neurosurgery, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia
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19
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Paterakis K, Brotis A, Bakopoulou M, Rountas C, Dardiotis E, Hadjigeorgiou GM, Fountas KN, Karantanas A. A Giant Tarlov Cyst Presenting with Hydronephrosis in a Patient with Marfan Syndrome: A Case Report and Review of the Literature. World Neurosurg 2019; 126:581-587. [PMID: 30880195 DOI: 10.1016/j.wneu.2019.02.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Giant Tarlov cysts are always symptomatic and mimic many serious pathologic entities. We present the largest, to our knowledge, reported Tarlov cyst. CASE DESCRIPTION A 33-year-old woman with Marfan syndrome suffered from right kidney hydronephrosis because of ureter obstruction, for which she was treated with nephrostomy. Her neurologic examination was unremarkable. The role of magnetic resonance imaging in the management of this case is described. Absence of intractranial hypotension symptoms after cerebrospinal fluid (CSF) overdrainage suggested the presence of a valve-like mechanism. The patient was planned for surgical cyst remodeling by the application of titanium clips. The cyst's neck was exposed through an L5-S2 laminectomy. L5 and S1 laminae were severely eroded. CSF leaked out of the underlying, bulging, and thinned dura at each attempt for clip application. Intraoperatively, multiple responses from the S1, S2, and S3 roots were simultaneously recorded at each stimulation. Therefore, we decided to abandon this technique and performed a nonwatertight duroplasty followed by a layered wound closure instead. A week later, the patient received a lumbar-peritoneal shunt. The patient remained neurologically intact, the cyst shrunk, and the nephrostomy was removed. CONCLUSIONS Indirect evidence was helpful to assess for the presence of a valve-like mechanism. Intraoperatively, the surgeon must keep on high alert for sacral erosion to avoid inadvertent dural tear and rootlet injury. Finally, lumboperitoneal diversion remains a valid alternative in the management of our giant Tarlov cyst because it reduced the intracystic pressure that resulted in cyst regression.
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Affiliation(s)
- Konstantinos Paterakis
- Medical School, University of Thessaly, Thessaly, Greece; Department of Neurosurgery, University Hospital of Larissa, Thessaly, Greece.
| | - Alexandros Brotis
- Department of Neurosurgery, University Hospital of Larissa, Thessaly, Greece
| | - Maria Bakopoulou
- Animus-Kyanous Stavros Private Clinic, Larissa, Thessaly, Greece
| | - Christos Rountas
- Department of Radiology, University Hospital of Larissa, Medical School, University of Thessaly, Thessaly, Greece
| | - Efthymios Dardiotis
- Department of Neurology University Hospital of Larissa, Medical School, University of Thessaly, Thessaly, Greece
| | - Georgios M Hadjigeorgiou
- Department of Neurology University Hospital of Larissa, Medical School, University of Thessaly, Thessaly, Greece
| | - Kostas N Fountas
- Medical School, University of Thessaly, Thessaly, Greece; Department of Neurosurgery, University Hospital of Larissa, Thessaly, Greece
| | - Apostolos Karantanas
- Department of Diagnostic Radiology, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
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Huang Y, Zhu T, Lin H, Li J, Zeng T, Lin J. Symptomatic Tarlov Cysts: Surgical Treatment by Subcutaneous Infusion Port. World Neurosurg 2018; 113:e722-e726. [PMID: 29510285 DOI: 10.1016/j.wneu.2018.02.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment of Tarlov cysts is challenging and difficult. The objective of our study was to describe the security and efficacy of the subcutaneous infusion port for drainage of symptomatic Tarlov cysts. METHODS The authors executed a retrospective review of data from 5 symptomatic Tarlov cysts patients who were treated using a subcutaneous infusion port from June 2014 to July 2017. Numerical Rating Scale scores and the Japanese Orthopedic Association scores of back pain were analyzed. Complications and adverse effects on postoperative days 1, 7, 14, and 28 were also analyzed. The mean follow-up was 12.6 months. RESULTS Five adults (3 females and 2 males) who had been symptomatic received a subcutaneous infusion port. After treatment, all patients experienced pain relief and pain alleviation lasted from 1 day to 3 years without complications and adverse effects. CONCLUSIONS A subcutaneous infusion port is a useful treatment option for symptomatic Tarlov cysts. When the patients' symptoms returned and the cysts repressurized, we quickly and simply drained the cysts by using the infusion port.
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Affiliation(s)
- Ying Huang
- Department of Pain, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tong Zhu
- Department of Pain, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Hongyi Lin
- Department of Pain, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jing Li
- Department of Pain, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tao Zeng
- Department of Pain, Huaqiao Hospital, Kunshan, Jiangsu, China
| | - Jian Lin
- Department of Pain, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
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21
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Jiang W, Hu Z, Hao J. Management of Symptomatic Tarlov Cysts: A Retrospective Observational Study. Pain Physician 2017; 20:E653-E660. [PMID: 28727710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Symptomatic Tarlov cysts are a common cause of chronic pain. Many methods have been reported to treat this disease, with variable results. Most previous reports concerning the treatment methods of symptomatic Tarlov cysts were either sporadic case reports or series of limited cases. OBJECTIVE This study aimed to further optimize the management for patients with symptomatic Tarlov cysts (TCs) by analyzing the results of 82 patients who were treated with different strategies. STUDY DESIGN Three different strategies were applied to 82 patients with symptomatic TCs and their clinical effects were evaluated in 13 months to 12 years follow-up. SETTING A pain management practice, a medical center, major metropolitan city, China. METHODS From June 2003 to August 2015, a total number of 82 patients with symptomatic TCs were treated with 3 different methods (microsurgical cyst fenestration and imbrication, C-arm fluoroscopy guided percutaneous fibrin gel injection, and conservative management) in the first affiliated hospital of Chongqing Medical University. The pain severity was assessed according to visual analog scale (VAS), and imaging changes were evaluated by magnetic resonance imaging (MRI). Patient improvements in pain and neurologic function were evaluated during a follow-up the period of 13 months to 12 years. RESULTS All the patients who underwent microsurgical cyst fenestration and imbrication had either complete (7 patients, 50%) or substantial (7 patients, 50%) resolution of their preoperative symptoms and neurological deficits. However, 3 patients (21%) had cerebrospinal fluid (CSF) leakage and 3 patients (21%) suffered from recurrent symptoms. In C-arm fluoroscopy guided percutaneous fibrin gel injection group, 34 patients (61%) had complete resolution and 22 patients had (39%) substantial resolution, and no CSF leakage or recurrence occurred. Only 3 patients (25%) got substantial resolution in the conservative management group, but 9 patients (75%) had aggravation. LIMITATIONS An observational study with a relatively small sample size. CONCLUSIONS C-arm fluoroscopy guided percutaneous fibrin gel injection therapy could be recommend as a better consideration for symptomatic TCs. KEY WORDS Tarlov cysts, C-arm fluoroscopy guided, fibrin gel, microsurgical cyst fenestration, conservative management.
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Affiliation(s)
- Wei Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing 400016, China
| | - Zhenming Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing 400016, China
| | - Jie Hao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Chongqing 400016, China
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Panagiotopoulos V, Papathanasopoulos P, Bonanos G, Messinis L, Fotakopoulos G, Klironomos G, Geropoulou E, Partheni M, Konstantinou D. Ataxic gait due to posterior thoracic spinal cord compression by a Tarlov cyst. J Neurosurg Sci 2016; 60:408-410. [PMID: 27402409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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23
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Schizas C. [Back surgery patient, still in pain]. Rev Med Suisse 2014; 10:238. [PMID: 24624669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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24
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Sun JJ, Wang ZY, Teo M, Li ZD, Wu HB, Yen RY, Zheng M, Chang Q, Yisha Liu I. Comparative outcomes of the two types of sacral extradural spinal meningeal cysts using different operation methods: a prospective clinical study. PLoS One 2013; 8:e83964. [PMID: 24386317 PMCID: PMC3873468 DOI: 10.1371/journal.pone.0083964] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 11/10/2013] [Indexed: 12/25/2022] Open
Abstract
This prospective study compares different clinical characteristics and outcomes of patients with two types of sacral extradural spinal meningeal cysts (SESMC) undergoing different means of surgical excision. Using the relationship between the cysts and spinal nerve roots fibers (SNRF) as seen under microscope, SESMCs were divided into two types: cysts with SNRF known as Tarlov cysts and cysts without. The surgical methods were tailored to the different types of SESMCs. The improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological function of the patients. Preoperative IJOA scores were 18.5±1.73, and postoperative IJOA scores were 19.6±0.78. The difference between preoperative and postoperative IJOA scores was statistically significant (t = -4.52, p = 0.0001), with a significant improvement in neurological function after surgery. Among the improvements in neurological functions, the most significant was sensation (z=-2.74, p=0.006), followed by bowel/bladder function (z=-2.50, p=0.01). There was a statistically significant association between the types of SESMC and the number (F=12.57, p=0.001) and maximum diameter (F=8.08, p=0.006) of the cysts. SESMC with SNRF are often multiple and small, while cysts without SNRF tend to be solitary and large. We advocate early surgical intervention for symptomatic SESMCs in view of significant clinical improvement postoperatively.
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Affiliation(s)
- Jian-jun Sun
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- * E-mail: (JS); (ZW)
| | - Zhen-yu Wang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- * E-mail: (JS); (ZW)
| | - Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Zhen-dong Li
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Hai-bo Wu
- Department of Neuroradiology, Peking University Third Hospital, Peking University, Beijing, China
| | - Ru-yu Yen
- Department of General Surgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Mei Zheng
- Department of Neurology, Peking University Third Hospital, Peking University, Beijing, China
| | - Qing Chang
- Department of Pathology, Peking University Third Hospital, Peking University, Beijing, China
| | - Isabelle Yisha Liu
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States of America
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Abstract
BACKGROUND There has been no consensus on the optimal treatment of symptomatic sacral perineural cysts. Most previous reports concerning the management methods were either sporadic case reports or a series of limited cases. This study is to further optimize the management for patients with symptomatic sacral perineural cysts by analyzing the outcomes of a cohort of patients who were treated with different strategies. METHODS AND FINDINGS We reviewed the outcomes of 15 patients with symptomatic sacral perineural cysts who were managed by three different modalities from 1998 through 2010. Six patients underwent microsurgical cyst fenestration and cyst wall imbrication. Seven patients underwent a modified surgical procedure, during which the cerebrospinal fluid leak aperture was located and repaired. Two patients were treated with medication and physical therapy. Outcomes of the patients were assessed by following up (13 months to 10 years). All of the six patients treated with microsurgical cyst fenestration and cyst wall imbrication experienced complete or substantial relief of their preoperative symptoms. However, the symptoms of one patient reappeared eight months after the operation. Another patient experienced a postoperative cerebrospinal fluid leakage. Six of the seven patients treated with the modified surgical operation experienced complete or substantial resolution of their preoperative symptoms, with only one patient who experienced temporary worsening of his preoperative urine incontinence, which disappeared gradually one month later. No new postoperative neurological deficits, no cerebrospinal fluid leaks and no recurrence were observed in the seven patients. The symptoms of the two patients treated with conservative measures aggravated with time. CONCLUSIONS Microsurgical operation should be a treatment consideration in patients with symptomatic sacral perineural cysts. Furthermore, the surgical procedure with partial cyst removal and aperture repair for prevention of cerebrospinal fluid leakage seemed to be more simple and effective.
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Affiliation(s)
- Jianqiang Xu
- Department of Neurosurgery, General Hospital of Fengfeng Group, Handan, China
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Abstract
Perineural cysts are common and usually detected incidentally during magnetic resonance imaging of the lumbosacral spine. Treatment is indicated only when the cyst is symptomatic. We report one such patients presented with cauda equina syndrome and another with low back pain with claudication. They underwent excision and duraplasty; both motor and sensory fibres were carefully separated from the cyst wall using a nerve root retractor and penfield. There was no nerve root damage or neural deficit. Symptoms were relieved postoperatively.
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Affiliation(s)
- Ramesh Kumar Sen
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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27
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Neulen A, Kantelhardt SR, Pilgram-Pastor SM, Metz I, Rohde V, Giese A. Microsurgical fenestration of perineural cysts to the thecal sac at the level of the distal dural sleeve. Acta Neurochir (Wien) 2011; 153:1427-34; discussion 1434. [PMID: 21562735 PMCID: PMC3111602 DOI: 10.1007/s00701-011-1043-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/26/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgery for symptomatic sacral perineural cysts remains an issue of discussion. Assuming micro-communications between the cyst and thecal sac resulting in a valve mechanism and trapping of CSF as a pathomechanism, microsurgical fenestration from the cyst to the thecal sac was performed to achieve free CSF communication. METHODS In 13 consecutive patients (10 female, 3 male), MRI revealed sacral perineural cysts and excluded other pathologies. Micro-communication between the thecal sac and the cysts was shown by delayed contrast filling of the cysts on postmyelographic CT. Surgical fenestration achieved free CSF communication between the thecal sac and cysts in all patients. The patient histories, follow-up examinations and self-assessment scales were analyzed. Symptoms at initial presentation included lumbosacral pain, pseudoradicular symptoms, genital pain and urinary dysfunction. Mean follow-up was 10.7 ± 6.6 months. FINDINGS Besides one CSF fistula, no surgical complications were observed. Five patients did not improve after surgery; in four of these cases multiple cysts were found, but small and promptly filling cysts remained untreated. Seven patients reported lasting benefit following surgery; three of these had single cysts, and all had cysts >1 cm. One patient initially benefited from cyst fenestration but experienced recurrent pain within 2 months postoperatively. Re-myelography revealed delayed contrast filling of the recurrent cyst; however, surgical revision did not lead to an improvement despite successful fenestration and collapse of the cyst revealed by postoperative imaging. CONCLUSIONS Microsurgical fenestration of sacral perineural cysts to the thecal sac is a surgical approach that has shown success in the treatment of lumbosacral pain, pseudoradicular symptoms, genital pain and urinary dysfunction associated with sacral perineural cysts. Our analysis, however, shows that mainly patients with singular large cysts benefit from this treatment.
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Affiliation(s)
- Axel Neulen
- Department of Neurosurgery, Center of Neurological Medicine, University of Göttingen, Göttingen, Germany.
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Hristova R, Hadjidekov G. [Diagnostic and clinical behaviour with Tarlov cyst in gynaecology practice]. Akush Ginekol (Sofiia) 2011; 50 Suppl 2:49-51. [PMID: 22524142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The following presents cases from the gynaecological practice which resulted in a surgical intervention due to the detection of cystic formations of origin out of the reproductive system. Although rare, Tarlov cyst has its place in the differential diagnostic plan of ovarian formations. MRI scan remains an alternative to the ultrasound imagery and is the main diagnostic method for obtaining the right diagnosis. This further aids the set of actions appropriate with patients suffering from Tarlov cyst. Thus, unnecessary abdominal surgical interventions are not to be undertaken.
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Hwang DS, Kang C, Lee JB, Cha SM, Yeon KW. Arthroscopic treatment of piriformis syndrome by perineural cyst on the sciatic nerve: a case report. Knee Surg Sports Traumatol Arthrosc 2010; 18:681-4. [PMID: 20062971 DOI: 10.1007/s00167-009-1013-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 11/27/2009] [Indexed: 12/18/2022]
Abstract
This is a case report of an arthroscopic treatment performed on a patient with piriformis syndrome due to perineural cyst on piriformis muscle and sciatic nerve. Confirmation, incision, and drainage of benign cystic lesion on the sciatic nerve below the piriformis muscle were performed following the release of the piriformis tendon through the posterior and posteroinferior arthroscopic portal. Recurrence of the symptoms has not been observed since postoperative period of 20 months. Nor did the MRI taken after the procedure reveal any such recurrence.
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Affiliation(s)
- Deuk-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, 33 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea.
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Sajko T, Kovać D, Kudelić N, Kovac L. Symptomatic sacral perineurial (Tarlov) cysts. Coll Antropol 2009; 33:1401-1403. [PMID: 20102100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (> or = 1.5 cm) and symptomatic perineurial cyst, as in three patients reported in this article, microsurgical treatment was successful. Although rare, perineurial (Tarlov) cysts must be taken into consideration when approaching to patient with low back and radicular pain. Authors review the medical literature, pathological and pathophysiological features and treatment options of sacral perineurial cysts.
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Affiliation(s)
- Tomislav Sajko
- Department of Neurosurgery, University Hospital Sestre milosrdnice, Zagreb, Croatia.
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Ruibal Moldes M, Sánchez Rodríguez-Losada J, López García D, Casas Agudo V, Janeiro País JM, González Martín M. [Tarlov cyst and symptomatic bladder disfuction]. Actas Urol Esp 2009; 32:1035-6. [PMID: 19143297 DOI: 10.1016/s0210-4806(08)73984-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain aetiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53-year-old woman witha symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery.
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Abstract
✓ Perineural cysts have become a common incidental finding during lumbosacral magnetic resonance (MR) imaging. Only some of the symptomatic cysts warrant treatment. The authors describe the successful operative treatment of a patient with, to the best of their knowledge, the largest perineural cyst reported to date.
A 29-year-old woman had been suffering from long-standing constipation and low-back pain. During an obstetric investigation for infertility, the clinician discovered a huge presacral cystic mass. Computed tomography myelography showed the lesion to be a huge Tarlov cyst arising from the left S-3 nerve root and compressing the ipsilateral S-2 nerve. The cyst was successfully treated by ligation of the cyst neck together with sectioning of the S-3 nerve root. Postoperative improvement in her symptoms and MR imaging findings were noted.
Identification of the nerve root involved by the cyst wall, operative indication, operative procedure, and treatment of multiple cysts are important preoperative considerations.
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Affiliation(s)
- Kazuhiko Ishii
- Department of Neurosurgery, Kameda Medical Center, Chiba, Japan.
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Abstract
Abstract
OBJECTIVE
The aim of this study was to investigate the microsurgical results of symptomatic sacral perineurial cysts of 11 patients and to discuss the treatment options of the past 10 years.
METHODS
We retrospectively reviewed the records of 11 patients with symptomatic sacral perineurial cysts who underwent microsurgical treatment at Tongji Hospital, Huazhong University of Science and Technology from 1993 through 2006. The philosophy was to perform total or partial cyst wall removal, to imbricate the remaining nerve sheath if possible, and to repair local defect with muscle, Gelfoam (Pharmacia & Upjohn, Kalamazoo, MI), and fibrin glue. Patient outcomes were assessed by comparing the preoperative and postoperative examination results. The average follow-up time obtained from return visits to the neurosurgery clinic or by telephone questionnaires ranged from 2 months to 13 years. A literature search and analysis of current treatment options were performed.
RESULTS
Nine of the 11 patients (82%) experienced complete or substantial relief of their preoperative symptoms. One patient (Patient 4) experienced worsening of bladder dysfunction after surgery and recovered slowly to subnormal function during the subsequent 2 months. The symptoms of Patient 9 did not resolve, and magnetic resonance imaging showed that the cyst had reoccurred. The patient underwent reoperation 3 months later without any improvement. One patient (Patient 11) experience a cerebrospinal fluid leakage complication. Neither new postoperative neurological defects nor infection were observed in our series. In the literature, there are six different treatment options under debate and controversially discussed.
CONCLUSION
Microsurgical treatment yielded the best long-term resolution of patient symptoms to date and should be recommended to appropriately selected patients.
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Affiliation(s)
- Dongsheng Guo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Chaiyabud P, Suwanpratheep K. Symptomatic Tarlov cyst: report and review. J Med Assoc Thai 2006; 89:1047-50. [PMID: 16881441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion. The cysts are relatively rare and most of them are asymptomatic. Some Tarlov cysts can exert pressure on nerve elements resulting in pain, radiculopathy and even multiple radiculopathy of cauda equina. There is no consensus on the appropriate therapeutic options of Tarlov cysts. The authors present a case of two sacral cysts diagnosed with magnetic resonance imaging. The initial symptoms were low back pain and sciatica and progressed to cauda equina syndrome. Surgical treatment was performed by sacral laminectomy and wide cyst fenestration. The neurological deficits were recovered and had not recurred after a follow-up period of nine months. The literature was reviewed and discussed. This is the first reported case in Thailand.
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Affiliation(s)
- Pradit Chaiyabud
- Neurosurgery Unit, Department of Surgery, Ratchaburi Hospital, Tahiland
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Tanaka M, Nakahara S, Ito Y, Nakanishi K, Sugimoto Y, Ikuma H, Ozaki T. Surgical results of sacral perineural (Tarlov) cysts. Acta Med Okayama 2006; 60:65-70. [PMID: 16508691 DOI: 10.18926/amo/30758] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83%) of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17%) of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.
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Affiliation(s)
- Masato Tanaka
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan.
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Hefti M, Landolt H. Presacral mass consisting of a meningocele and a Tarlov cyst: successful surgical treatment based on pathogenic hypothesis. Acta Neurochir (Wien) 2006; 148:479-83. [PMID: 16322904 DOI: 10.1007/s00701-005-0684-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Accepted: 10/12/2005] [Indexed: 11/26/2022]
Abstract
This illustrative case shows a meningocele created by erosion of the sacrum by a perineurial cyst. It is the first report of a large presacral mass consisting of a perineurial cyst and a meningocele simultaneously. We describe a hypothesis for the pathogenesis of this particular constellation of circumstances and present a successful surgical option based on the assumed pathogenesis.
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Affiliation(s)
- M Hefti
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
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38
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Mojaza M, Albeck MJ. [Symptomatic perineural cysts]. Ugeskr Laeger 2005; 167:1865-6. [PMID: 15929337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Masoud Mojaza
- Arhus Universitetshospital, Arhus Sygehus, Neurokirurgisk Afdeling.
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Abstract
✓ The authors describe a technique for percutaneous endoscopic shunt placement to treat clinically symptomatic spinal cysts. Seven patients underwent the procedure—five with syringomyelia, one with a symptomatic perineurial cyst, and one with a large arachnoid cyst. In all patients the shunt was successfully placed, and clinical improvement occurred in six. In four patients the entire procedure was performed endoscopically, whereas in three conversion to an open surgical exposure was required for safe access of a syrinx cavity. Overall, however, the pleural or peritoneal catheter was successfully placed endoscopically in all seven patients. There were two cases of postoperative positional headaches of which one required valve revision. In one case the catheter migrated and required repositioning. Percutaneous endoscopic shunt placement appears feasible in appropriately selected patients.
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Affiliation(s)
- James D Guest
- Department of Neurological Surgery, University of Miami, Miami, Florida 33136, USA.
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Abstract
Because physical examination typically demonstrates normal findings in cases of low-back pain, diaglosis of the cause can be challenging. Frequent magnetic resonance imaging studies of the lumbosacral spine can typically lead to discovery of benign diseases and thus misinterpretation of these images. The authors report an unusual case in which a functional ovarian cyst was incidentally associated with a perineural cyst and mimicked a lateral sacral meningocele. In light of this, the authors recommend repeated examinations to avoid mistakes.
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Affiliation(s)
- Anne Heckly
- Departments of Obstetrics and Gynecology, Radiology, and Neurosurgery, CHRU Pontchaillou, Rennes, France
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Abstract
Four perineurial cysts cases (Tarlov's cysts) are reported. The purpose of this study is to describe and to compare them with data from a literature review. The evaluation was performed among 88 adult patients with symptoms of radiculopathy, sacral pain, low back pain. Four patients revealed Tarlov's cysts (4.5%). The diagnosis was made by magnetic resonance imaging. Four cases underwent sacral laminectomy. Following surgery, the claudication pain resolved with no motor or sensory deficits. Tarlov's cysts should be considered as a differential diagnosis of sacral radiculopathy, sacral or lumbar pain syndromes and mainly to the lumbar disc prolapse. The goal of the surgical treatment is to relieve the neural compression and stop bone erosion.
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Lee JY, Impekoven P, Stenzel W, Löhr M, Ernestus RI, Klug N. CT-guided percutaneous aspiration of Tarlov cyst as a useful diagnostic procedure prior to operative intervention. Acta Neurochir (Wien) 2004; 146:667-70. [PMID: 15197609 DOI: 10.1007/s00701-004-0274-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tarlov or perineural cysts are lesions of the nerve root most often found in the sacral region. Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection. In this article, we report three cases of a sacral perineural cyst, causing sciatic pain, and emphasize the usefulness of CT-guided percutaneous aspiration as an important diagnostic and prognostic procedure prior to definitive operative treatment.
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Affiliation(s)
- J-Y Lee
- Department of Neurosurgery, University of Cologne, Cologne, Germany.
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Abstract
Perineurial (Tarlov) cysts are meningeal dilations of the posterior spinal nerve root sheath that most often affect sacral roots and can cause a progressive painful radiculopathy. Tarlov cysts are most commonly diagnosed by lumbosacral magnetic resonance imaging and can often be demonstrated by computerized tomography myelography to communicate with the spinal subarachnoid space. The cyst can enlarge via a net inflow of cerebrospinal fluid, eventually causing symptoms by distorting, compressing, or stretching adjacent nerve roots. It is generally agreed that asymptomatic Tarlov cysts do not require treatment. When symptomatic, the potential surgery-related benefit and the specific surgical intervention remain controversial. The authors describe the clinical presentation, treatment, and results of surgical cyst fenestration, partial cyst wall resection, and myofascial flap repair and closure in a case of a symptomatic sacral Tarlov cyst. They review the medical literature, describe various theories on the origin and pathogenesis of Tarlov cysts, and assess alternative treatment strategies.
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Affiliation(s)
- Frank L Acosta
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143-0112, USA
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Miyakoshi N, Shimada Y, Murai H, Suzuki T, Hongo M, Itoi E. Combination of lumbar kyphosis, epidural lipomatosis, and perineural cyst as a cause of neurological deficit: a case report. J Orthop Sci 2003; 7:717-20. [PMID: 12486480 DOI: 10.1007/s007760200128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe the rare simultaneous occurrence of epidural lipomatosis and a perineural cyst at the same level, lumbar kyphosis, osteoporotic vertebral fractures, and neurological deficits. A 75-year-old corticosteroid-dependent female farmer presented with severe low back pain, progressive lumbar kyphosis, and inability to stand because of numbness and muscle weakness of both legs. Plain radiographs displayed markedly decreased bone density, significant lumbar kyphosis, and vertebral compression fractures of L2, L3, and L4. Magnetic resonance imaging of the lumbar spine revealed a perineural cyst at the L2-3 level, extensive epidural lipomatosis, and spinal canal stenosis. Laminectomy from L3 to L5 with resection of epidural fatty tissue restored her walking ability. We postulate that the osteoporotic fractures and epidural lipomatosis were induced by corticosteroid therapy. Preexisting degenerative lumbar kyphosis of the type commonly seen in elderly farmers could have promoted osteoporotic lumbar vertebral fractures at points where bending stress had been strongly exerted. The combination of a perineural cyst and epidural lipomatosis at the same level has not been reported previously.
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Affiliation(s)
- Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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Caspar W, Papavero L, Nabhan A, Loew C, Ahlhelm F. Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases. Surg Neurol 2003; 59:101-5; discussion 105-6. [PMID: 12648906 DOI: 10.1016/s0090-3019(02)00981-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The widespread use of magnetic resonance imaging (MRI), now the first line investigation for back and leg pain, reveals cystic sacral lesions more often than myelography did in the past. There is agreement that symptomatic perineurial sacral cysts should be treated surgically. However, it is still debated whether the preference should be given to the curative option, consisting of excision of the cyst with duraplasty, or to drainage of the cyst to relieve symptoms. In this retrospective study the efficacy of microsurgical cyst resection with duraplasty is evaluated. METHODS In 15 patients presenting with pain and neurologic deficits, myelography and/or MRI detected sacral cysts. The clinical features suggested that the space-occupying lesions caused the disturbances. Microsurgical excision of the cyst along with duraplasty or plication of the cyst wall was performed in all the cases. Postoperative care included bed rest and CSF drainage for several days. RESULTS In 13 out of 15 patients the preoperative radicular pain disappeared after surgery. The 2 patients with motor deficits and the 6 patients with bladder dysfunction recovered completely. In all except 1 of the 10 patients complaining of sensory disturbances a significant improvement was achieved. No complications were observed. CONCLUSION Microsurgical excision of the cyst combined with duraplasty or plication of the cyst wall is an effective and safe treatment of symptomatic sacral cysts and, in the view of the authors, the method of choice.
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Affiliation(s)
- Wolfhard Caspar
- Department of Neurosurgery, Faculty of Medicine, Saarland University, Homburg-Saar, Germany
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Abstract
In this study we present a case of Tarlov's cyst that is treated operatively. The operation involved partial excision and oversewing of the cyst wall with connection to the dural sac and methylmethacrylate filling of the sacral bone defect that is formed by the cyst to prevent cyst recurrence. In symptomatic cases Tarlov's cyst can be treated operatively with a favorable outcome.
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Affiliation(s)
- Kemal Yucesoy
- Department of Neurosurgery, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey.
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47
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Wilkinson HA. Tarlov cysts. J Neurosurg 2002; 97:271; author reply 271-2. [PMID: 12296694 DOI: 10.3171/spi.2002.97.2.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
OBJECT Tarlov or perineurial cysts are lesions of the nerve root most often found in the sacral region. Although there is agreement that asymptomatic Tarlov cysts should be followed, it is still debated whether patients with symptomatic Tarlov cysts should be treated surgically. The authors assessed the outcome and efficacy of cyst wall resection in 10 patients with symptomatic Tarlov cysts. The medical literature is reviewed, theories of origin are evaluated, and suggestions as to their cause and pathogenesis are offered. METHODS Ten consecutive patients harboring symptomatic Tarlov cysts were treated by the senior author between 1989 and 1999. All patients were assessed for neurological deficits and pain by neurological examination and visual analog scale, respectively. Computerized tomography myelography was performed in all patients to diagnose delayed filling of the cysts. A sacral laminectomy with resection of the sacral cyst or cysts was performed in all patients. Resected material from eight of 10 patients was submitted for histopathological evaluation. Seven (70%) of 10 patients obtained complete or substantial resolution of their symptoms, with an average follow up of 31.7 months. All of these patients had Tarlov cysts larger than 1.5 cm in diameter, producing radicular pain or bladder and bowel dysfunction. Three (30%) of 10 patients experienced no significant improvement. All three patients harbored Tarlov cysts smaller than 1.5 cm in diameter, producing nonradicular pain. Histopathological examination was performed on specimens from eight of 10 patients, which demonstrated nerve fibers in 75% of cases, ganglion cells in 25% of cases, and evidence of old hemorrhage in half. CONCLUSIONS Large cysts (> 1.5 cm) and the presence of associated radicular symptoms strongly correlate with excellent outcome. Tarlov cysts may result from increased hydrostatic pressure and trauma.
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Affiliation(s)
- J M Voyadzis
- Department of Neurosurgery and Pathology, Georgetown University Medical Center, Washington, DC, USA
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Nikolic B, Abbara S, Heindel W, Volz M, Terstegge K, Klug N, Lackner K. [The sacral perineural system--are there radiological criteria for an indication for surgery? First results and literature survey]. ROFO-FORTSCHR RONTG 2000; 172:1035-42. [PMID: 11199432 DOI: 10.1055/s-2000-11848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To establish recommendations for diagnostic imaging of cystic lesions of the sacral region and to evaluate for potential predictors of therapeutic outcome. METHODS Conventional imaging of the lumbar spine, conventional CT, myelography, post myelo-CT and MRI were performed in 7 symptomatic [corrected] patients. All patients underwent operative decompression and histological examination. The radiographic examinations were reevaluated retrospectively and correlated with the postoperative outcome. RESULTS In one patient the differential diagnosis of a neurinoma could not be excluded with CT and CT-myelography alone. In all 7 patients MRI provided a definite diagnosis and a precise presentation of the cyst extension. A complete postoperative remission of symptoms was noticed in 4, a partial remission in three cases. The correlation of cyst extension, cyst shape, and the communication with the subarachnoid space did not provide predictive information concerning operative outcome. CONCLUSION MR can be used as the sole imaging tool for demonstration of cystic lesions. Relevant disadvantages in comparison to myelography and myelo-CT were not evident. No imaging modality could predict the value of surgical intervention.
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Affiliation(s)
- B Nikolic
- Institut für Radiologie und Radiologische Diagnostik der Universität zu Köln.
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50
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Yücesoy K, Naderi S, Ozer H, Arda MN. Surgical treatment of sacral perineural cysts. A case report. Kobe J Med Sci 1999; 45:245-50. [PMID: 10985157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Most of the perineural cysts (Tarlov's cysts) are asymptomatic. They are usually diagnosed incidentally, and a specific treatment is not necessary. They should be operated on, only if they produce progressive or disabling symptoms and/or sign clearly attributable to them. Several reports have been made regarding their sign and symptom, neurological and radiological features. This is a report emphasizing on their surgical indication and surgical treatment. We reported a 48 year-old woman who underwent surgery because of the symptomatic perineural cyst. It is concluded that the total excision of the perineural cyst is not necessary and a partial resection with a resultant reduction in the cyst size results in a favourable outcome.
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Affiliation(s)
- K Yücesoy
- Department of Neurosurgery, Dokuz Eylul University School of Medicine, Izmir, Turkey
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