Minimally Invasive Treatment for a Sacral Tarlov Cyst Through Tubular Retractors.

BACKGROUND: Tarlov cysts (TC) are focal dilations of arachnoid and dura mater of the spinal posterior nerve root sheath that appear as cystic lesions of the nerve roots typically in the lower spine, especially in the sacrum, which can cause radicular symptoms when they increase in size and compress the nerve roots. Different open procedures have been described to treat TCs, but no minimally invasive procedures have been described to effectively address this pathology. CASE DESCRIPTION: A 29-year-old woman presented with right lower extremity pain and weakness. A magnetic resonance imaging scan demonstrated a lumbosacral TC that protruded through the right L5-S1 foramina. Through a small laminotomy, cyst drainage followed by neck ligation using a Scanlan modified technique through tubular retractors was performed. The patient recovered full motor function within the first days postoperatively and showed no signs of relapse at 6-month follow-up. CONCLUSIONS: Minimally invasive spine surgery through tubular retractors can be safely performed for successful excision and ligation of TC using a Scanlan modified technique.

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.

Tarlov cysts: endoscope-assisted obliteration of the communication with the spinal subarachnoid space.

BACKGROUND AND OBJECTIVE: The physiopathology of Tarlov or perineural cyst (PC) symptoms is unknown, but probably its filling and distention with spinal cerebrospinal fluid makes them symptomatic. The objective of this study is to describe the endoscope-assisted obliteration of the communication between PCs and the spinal subarachnoid space (SSS). PATIENTS AND METHODS: From 2007 to 2011, four male and two female patients (median age: 45 years) with PCs were treated. They complained of lumbar, sciatic, and/or perineal pain. Physical examination was normal. The diagnosis was made by magnetic resonance imaging (MRI). All the cysts were located in the midline between S1 and S3. An endoscope-assisted obliteration between PC and SSS was performed. The outcome was evaluated clinically with the Odom scale and radiologically with an MRI. RESULTS: After a median follow-up of 25.83 months, the outcome was excellent (four cases), good (one case), and poor (one case). There were no complications. The postoperative MRI showed size and signal intensity changes in all PCs reflecting their exclusion from the SSS. CONCLUSIONS: The endoscope-assisted obliteration of the communication between PCs and the SSS is a simple technique that rendered excellent to good results in 83% of the cases.

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.

[Tarlov's cyst: definition, etiopathogenesis, propaedeutic and treatment]. / Cisto de Tarlov: definição, etiopatogenia, propedêutica e linhas de tratamento.

Tarlov's cyst or perineurial cyst is disease on portion of the posterior nerve root in lumbo-sacral region. The lack of knowledge of physicians around the world about Tarlov's cyst as to their nature, significance and treatment also with differential diagnostics to radiculopathy in legs. With review of literature discuss about definition, etiopathogenesis, diagnostic investigation and treatment clinic and/or surgery. The pathogenesis Tarlov's cyst remains unclear; several cases have history of the trauma, old hemorrhage, congenital and iatrogenic. Cysts provoke low back pain, sacral radiculopathy, dyspareunia, urinary incontence. The magnetic resonance imaging is now the gold standard to diagnose cysts. The treatment is clinic or surgery depending neurologics finding and neuroimage.

[Tarlov cysts: report of four cases]. / Cistos de Tarlov: relato de quatro casos.

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.

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.