Reinforced radiculoplasty for the treatment of symptomatic sacral Tarlov cysts: A clinical analysis of 71 cases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the safety and efficacy of reinforced radiculoplasty in the treatment of symptomatic sacral Tarlov cysts (TCs).@*METHODS@#A retrospective analysis was performed on the clinical data and follow-up data of 71 patients with symptomatic sacral TCs who underwent reinforced radiculoplasty in the Neurosurgery Department of Peking University Third Hospital from June 2018 to March 2021. All the operations were performed under neuroelectrophysiological monitoring. Intraoperative cyst exploration, partial resection of the cyst wall, narrowing of the leak, nerve root sleeve radiculoplasty and artificial dural reinforcement were performed. The incidence of postoperative complications and new neurological dysfunction was analyzed. Visual analogue scale (VAS) was used to assess the changes of pain before and after surgery. The Japanese Orthopedics Association (JOA) low back pain score was used to evaluate the changes in nerve function before and after surgery.@*RESULTS@#In the study, 71 patients had 101 TCs, 19 (18.8%) TCs originated from the left S1 nerve, 26 (25.7%) originated from the left S2 nerve, 3 (3.0%) originated from the left S3 nerve, 14 (13.9%) originated from the right S1 nerve, 33 (32.7%) originated from the right S2 nerve, 6 (5.9%) originated from the right S3 nerve, all the TCs underwent reinforced radiculoplasty. Deep infection (1 case), subcutaneous effusion (1 case), fat li-quefaction (1 case) and urinary tract infection (4 cases) were recorded postoperatively. The patients were followed up for 12-43 months (median, 26 months). Two cases had new urinary retention after operation, and the catheter was removed at the end of the first and second months respectively. One case had new fecal weakness, which improved after 3 months. Compared with preoperation, VAS decreased significantly at the last follow-up [median, 6 (4-9) vs. 1 (0-5), Z=-7.272, P < 0.001], JOA score increased significantly [median, 20 (16-25) vs. 27 (18-29), Z=-7.265, P < 0.001]. There were 18 cured cases (25.4%), 41 excellent cases (57.7%), 8 effective cases (11.3%), and 4 invalid cases (5.6%). The total efficiency was 94.4% (67/71). Two (1.98%) cysts recurred.@*CONCLUSION@#For patients with symptomatic sacral TCs, reinforced radiculoplasty can significantly improve the pain and nerve function, which is safe and reliable.

A Rare Cause of Thoracic Spinal Cord Compression by Multiple Large Tarlov Cysts / 대한신경손상학회지

Spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Bifocal location of thoracic and sacral SEACs is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral Tarlov cysts (TC). The surgical management and postoperative outcome of the patient are discussed. A 34-year-old woman was referred to the hospital for acute thoracic pain with a history of chronic long-standing back pain. She complained of walking difficulties. Neurological examination demonstrated incomplete spastic paraplegia with sensory level in T9. Magnetic resonance imaging revealed a large cystic formation from T7-11 and at the level of the sacrum. We performed laminectomies at the level of interest from T7-11. The cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Subsequently, a duraplasty was performed with autologous grafts from the lumbar fascia. The condition of the patient improved after surgery and he was recovering well at follow-up. Although the surgical treatment of TC is controversial, especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.

Quiste de Tarlov bilateral, presentación de un caso / Tarlov cyst bilateral, case report

Los quistes de Tarlov, son crecimientos quísticos benignos sub diagnosticados y no reportándose ningún caso en Bolivia. Son clasificados como quistes meníngeos tipo II, infrecuentes (incidencia estimada de 4,6% - 9%), de características benignas, en su mayoría localizados en región sacra. Asintomáticos, en su gran mayoría diagnosticados de manera incidental. Se presenta el caso de una paciente con dolor crónico de tipo radicular en fosa iliaca izquierda sin mejoría ni explicación del mismo. Se le realizó tomografía computarizada y resonancia magnética por las cuales se llegó al diagnóstico. Posteriormente se da tratamiento conservador sintomatológico con mejoría evidente de las misma. No requiriendo tratamiento quirúrgico.

Tarlov cyst is a benign cystic growth usually underdiagnosed. No case has been reported so far in Bolivia. Classified as a Type II meningeal cysts, rare (estimated incidence of 4,6% - 9%), of benign characteristics, most commonly located in the sacral region. Asymptomatic and diagnosed incidentally most of the times. The patient comes with a chief complaint of chronic radicular back pain in the left iliac fossa with no improvement or explanation thereof. The patient underwent CT and MRI leading us to the diagnosis. The patient is managed with conservative treatment targeting the symptoms, with notorious improvement not requiring surgical treatment.

Cervical Perineural Cyst Masquerading as a Cervical Spinal Tumor

Tarlov (perineural) cysts of the nerve roots are common and usually incidental findings during magnetic resonance imaging of the lumbosacral spine. There are only a few case reports where cervical symptomatic perineural cysts have been described in the literature. We report such a case where a high cervical perineural cyst was masquerading as a cervical spinal tumor.

Microsurgical Excision of Symptomatic Sacral Perineurial Cyst with Sacral Recapping Laminectomy : A Case Report in Technical Aspects

Perineurial cysts (Tarlov cysts) are lesions of the nerve root that are often observed in the sacral area. There is debate about whether symptomatic perineurial cysts should be treated surgically. We presented three patients with symptomatic perineurial cyst who were treated surgically, and introduced sacral recapping laminectomy. Patients complained of low back pain and hypesthesia on lower extremities. We performed operations with sacral recapping technique for all three. The outcome measure was baseline visual analogue score and post operative follow up magnetic resonance images. All patients were completely relieved of symptoms after operation. Although not sufficient to address controversies, this small case series introduces successful use of a particular surgical technique to treat sacral perineural cyst, with resolution of most symptoms and no sequelae.

Delayed Diagnosis of Cauda Eqina Syndrome with Perineural Cyst after Combined Spinal-Epidural Anesthesia in Hemodialysis Patient

Symptomatic Tarlov (perineural cysts) are uncommon. In the following hemodialysis case, cauda equina syndrome was not detected after combined spinal-epidural anesthesia untilthe patient reported a lack of sensation in the perianal area 14 days postoperatively. She had normal motor function of her extremities. A laminectomy and cyst irrigation was performed. After the operation, her sphincter disturbance subsided gradually and her symptoms had disappeared.

Lumbar Epidural Varix Mimicking Perineural Cyst

Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots.

Clinical Experience of Symptomatic Sacral Perineural Cyst

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 and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.

A symptomatic lumbosacral perineural cyst: A case report / 대한마취과학회지

Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms.

Rare Clinical Presentations of Perineural Cysts Besides Radicular Pain

No abstract available.

Multiple Bilateral Thoracic Perineural Cysts: A Case Report

STUDY DESIGN: Case report OBJECTIVES: We report a case of relatively rare multiple bilateral perineural cysts. SUMMARY OF LITERATURE REVIEW: Tarlov cysts, also known as perineural cysts are most often found in the sacral region, but there are a few cases reported in the thoracic region. In particular, there are very few cases of multiple bilateral thoracic perineural cysts. MATERIALS AND METHODS: A woman aged 65 years with perineural cysts in the bilateral T10-T11 and T11-12 neural foramens, underwent a T10-11-12 decompressive laminectomy and resection of the cyst. RESULTS: Satisfactory results were obtained for the patient after surgery. CONCLUSIONS: For more detailed and definitive treatment of thoracic perineural cysts, additional cases are required.

Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage.

Derivación lumboperitoneal como tratamiento de quistes de Tarlov sintomáticos / Lumboperitoneal shunt for treatment of symptomatic lumbar Tarlov cysts

La Lumbalgia es una causa frecuente de discapacidad y de limitación funcional en nuestra sociedad, con un costo financiero, social y laboral muy alto. Es un problema común que afecta a ambos sexos y la mayoría de las edades, para las que aproximadamente uno de cada cuatro adultos busca atención al cabo de seis meses. En los EE.UU., para las personas de 45 años o menos, el dolor lumbar es la causa más frecuente de limitación de actividad. Hay diferentes causas de lumbalgia siendo la enfermedad degenerativa lumbar la causa más común. Dentro de la causas menos frecuente de lumbalgia, se encuentra las asociadas quistes perineurales, llamados también quistes de Tarlov. La gran mayoría de los quistes de Tarlov son asintomáticos, su ubicación más frecuente es la región sacra. Algunos de ellos se tornan sintomáticos y requieren tratamiento. Se han descrito varias formas de manejo entre las cuales se encuentra la resección quirúrgica, la punción percutánea del quiste y las derivaciones quiste peritoneal o Lumboperitoneal. Hasta el momento, no hay consenso sobre cuál es la mejor forma de tratar éstas lesiones. En este artículo pretendemos mostrar una serie de 3 casos donde los pacientes fueron tratados con derivación lumboperitoneal con mejoría clínica completa. Se ha realizado una revisión de la literatura acerca del tratamiento de esta patología que es poco frecuente.

Lumbar pain is one of the causes of incapacity and limitation in our society. There are different causes of lumbar pain, having the degenerative cause being the most frequently found. Perineural cysts are a rare cause of incapacitating lumbar pain and the majority of these cysts are asymptomatic. There is a little information about the treatment of symptomatic perineural cysts. There has been described different treatment options which varies from surgical excision, cyst drainage and lumbar o cyst shunt to the peritoneal cavity. Till this moment there is no consensus on the optimal treatment of these lesions. In this article we want to show a small case series of 3 cases where these patients were treated with lumbo-peritoneal Shunt. This entire patient showed clinical improvement after the treatment. We will also review the literature regarding these rare lesions.

Sacral Perineural Cyst Accompanying Disc Herniation

Although most of sacral perineural cysts are asymptomatic, some may produce symptoms. Specific radicular pain may be due to distortion, compression, or stretching of nerve root by a space occupying cyst. We report a rare case of S1 radiculopathy caused by sacral perineural cyst accompanying disc herniation. The patient underwent a microscopic discectomy at L5-S1 level. However, the patient's symptoms did not improved. The hypesthesia persisted, as did the right leg pain. Cyst-subarachnoid shunt was set to decompress nerve root and to equalize the cerebrospinal fluid pressure between the cephalad thecal sac and cyst. Immediately after surgery, the patient had no leg pain. After 6 months, the patient still remained free of leg pain.

Perineural Cyst in Upper Lumbar Spine: A Case Report / 대한척추외과학회지

Spinal perineural cyst rarely appears in the upper lumbar spinal region as compared it occurrence at other spinal region. These cysts seldom cause radiating pain and neurologic symptoms because the majority of these cysts involve the sacral portion of the spine. Spinal perineural cyst can be recognized incidentally on magnetic resonance imaging while differentiating other diseases that cause back pain. The differential diagnosis of symptoms is needed to rule out whether or not the intraspinal cystic mass is the actual cause of radiculopathy. We report here on a case of perineural cyst at a left neural foramen of L2-3 and the patient displayed neurologic manifestations. The patient had progressively aggravated low back pain and sciatica of two years duration. MRI well demonstrated neural compression of the left 2nd lumbar neural root. Relief of symptoms were achieved by performing posterior decompression (hemilaminectomy, fascectomy & decompression of the ligamentum flavum), excision of the cyst and posterolateral fusion of L2-3.

Two Cases of Symptomatic Perineural Cysts (Tarlov Cysts) in One Family: A Case Report

Symptomatic sacral perineural cysts are uncommon. Several hypotheses have been proposed to explain the etiologies of perineural cysts, but the accurate etiologies remain unclear. We experienced two cases of symptomatic sacral perineural cysts (Tarlov cysts) in one family, who presented with perianal paresthesia. Both of them were operated and postoperatively their symptoms were disappeared immediately. We experienced the excellent treatment outcome with the surgical management of symptomatic perineural cysts in the sacral region. We assume that the theory of congenital origin including a familial tendency is the most plausible of the hypotheses that have been proposed.

Arthroscopic Treatment of Secondary Piriformis Syndrome by Perineural Cyst on the Sciatic Nerve: A Case Report

Secondary piriformis syndrome may develop under several conditions. We report on the method and usefulness of arthroscopic treatment of the piriformis muscle and benign perineural cyst of the sciatic nerve. Arthroscopic assessment was performed to a perineural cyst on the sciatic nerve seen through EMG and hip MRI. Through the posterior and posteroinferior portal, the lesion below the piriformis muscle was confirmed following release of the tendon. The incision and drainage of the perineural cyst was done so as to achieve decompression. The excision of the lesion was not carried out so as to avoid injury to the sciatic nerve. Symptoms did not recur during 10 months of follow up appointments.

Symptomatic Tarlov cyst: report and review.

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.

Sacral Perineural Cyst: A Case Report / 대한정형외과학회잡지

A sacral perineural cyst is composed of an arachnoid membrane of the nerve root at the sacral region. We performed a wide posterior decompression and cystectomy in a patient who suffered from back pain with pain radiating in both lower extremities, and whose MRI findings coincided with those of a sacral perineural cyst. Clinical improvement was observed during the follow-up review. We report the surgical treatment with a review of the relevant literature.

Gabapentina no tratamento da dor decorrente de cistos perineurais sacrais: relato de caso / Gabapentin to treat sacral perineural cyst-induced pain: case report

JUSTIFICATIVA E OBJETIVOS: Os cistos perineurais podem gerar dor com características neuropáticas de difícil controle. Os anticonvulsivantes são medicações utilizados para tratamento de dores com essas características. O objetivo deste relato é mostrar um caso com total remissão da dor com uso de gabapentina após o insucesso no tratamento com todas as outras alternativas terapêuticas utilizadas. RELATO DE CASO: Paciente de 67 anos, diabética, com queixa de dor lombossacra há dois meses, com as seguintes características: diária, em pontada e queimação, de intensidade leve a moderada e com irradiação para região posterior da coxa. Piorava com o movimento e com a posição ortostática. Há seis meses havia tido um episódio semelhante de dor, que melhorou com o uso de corticoesteróides. A ressonância nuclear magnética da coluna lombossacra mostrava lesões císticas perineurais sacrais em S1, S2 e S3 com diâmetro de 2,5 a 4 cm, comprimindo o saco dural associado à erosão óssea. Foi introduzida a gabapentina em doses progressivas até 900 mg/dia, com alívio completo do quadro álgico. CONCLUSÕES: A dor neuropática provocada pelo cisto de Tarlov pode ser controlada de maneira adequada com gabapentina.

BACKGROUND AND OBJECTIVES: Perineural cysts may induce difficult to control neuropathic pain. Anticonvulsivants are used to treat such pain. This report aimed at presenting a case of total pain remission with gabapentin after failure of all other therapeutic alternatives used. CASE REPORT: Female, diabetic patient, 67 years old, complaining of lumbosacral pain for two months, with the following characteristics: daily, sharp and burning pain of mild to moderate intensity irradiating to posterior thigh. Pain would worsen with movement and in the standing position. Six months before she had had a similar pain episode which improved with steroids. Lumbosacral spine MRI showed 2.5 cm sacral perineural cyst injuries at S1, S2 and S3, compressing the dural sac and associated to bone erosion. Gabapentin was introduced in progressive doses until 900 mg/day, with complete pain relief. CONCLUSIONS: Tarlov's cyst neuropathic pain may be adequately controlled with gabapentin.

JUSTIFICATIVA Y OBJETIVOS: Los quistes perineurales pueden generar dolor con características neuropáticas de difícil control. Los anticonvulsivantes son medicaciones utilizadas para tratamiento de dolores con esas características. El objetivo de este relato es mostrar un caso con total remisión del dolor con el uso de gabapentina después del mal suceso en el tratamiento con todas las otras alternativas terapéuticas utilizadas. RELATO DE CASO: Paciente de 67 anos, diabética, con queja de dolor lombosacra hace dos meses, con las siguientes características: diaria, en puntada y quemazón, de intensidad leve a moderada y con irradiación para región posterior del muslo. Peoraba con el movimiento y con la posición ortostática. Hace seis meses tuvo un episodio semejante de dolor, que mejoró con el uso de corticoesteróides. La resonancia nuclear magnética de la columna lombosacra mostraba lesiones císticas perineurales sacrales en S1, S2 y S3 con diámetro de 2,5 a 4 cm, comprimiendo el saco dural asociado a la erosión ósea. Fue introducida la gabapentina en dosis progresivas hasta 900 mg/día, con alivio completo del cuadro álgico. CONCLUSIONES: El dolor neuropático provocado por el quiste de Tarlov puede ser controlada de manera adecuada con gabapentina.