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Surgical excision of symptomatic sacral perineurial Tarlov cyst: case series and review of the literature

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Abstract

Object

Symptomatic sacral perineural cysts are extremely rare. The aim of this retrospective study is to investigate the outcome of 15 consecutive patients treated by microsurgical resection of the cyst and to review the literature.

Methods

The authors retrospectively reviewed their clinical data archive from 2002 to 2014. Fifteen patients who were operated on due to symptomatic sacral perineural cysts were enrolled in the study. Patients’ symptoms, radiographs, intra-operative findings, and clinical results were evaluated. All 15 patients underwent microsurgical excision of the cyst. The literature on this topic available in PubMed was also reviewed.

Results

There were 5 men and 10 women included in the study, with a mean age of 31 years (range 7–60 years). Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3–160 months). All the patients experienced complete or substantial resolution of the preoperative local and radicular pain after surgery.

Conclusions

Cyst excision is an effective and safe technique for symptomatic sacral perineural (Tarlov) cysts. Careful patient selection is vital to the management and treatment of this difficult and controversial pathology.

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Abbreviations

MRI:

Magnetic resonance imaging

VAS:

Visual analog scale

MRC:

Medical research council

CT:

Computerized tomography

CSF:

Cerebrospinal fluid

References

  1. Acosta FL Jr, Quinones-Hinojosa A, Schmidt MH, Weinstein PR (2003) Diagnosis and management of sacral Tarlov cysts Case report and review of the literature. Neurosurg Focus 15:E15

    Article  PubMed  Google Scholar 

  2. Cantore G, Bistazzoni S, Esposito V, Tola S, Lenzi J, Passacantilli E, Innocenzi G (2013) Sacral Tarlov cyst: surgical treatment by clipping. World Neurosurg 79(2):381–389

    Article  PubMed  Google Scholar 

  3. Caspar W, Papavero L, Nabhan A, Loew C, Ahlhelm F (2003) Microsurgical excision of symptomatic sacral perineural cysts: a study of 15 cases. Surg Neurol 59:101–106

    Article  PubMed  Google Scholar 

  4. Fortuna A, La Torre E, Ciappetta P (1977) Arachnoid diverticula: a unitary approach to spinal cysts communicating with the subarachnoid space. ActaNeurochir (Wien) 39:259–268

    Article  CAS  Google Scholar 

  5. Guo D, Shu K, Chen R, Ke C, Zhu Y, Lei T (2007) Microsurgical treatment of symptomatic sacral perineural cysts. Neurosurgery 60:1059–1066

    Article  PubMed  Google Scholar 

  6. Kurz LT, Centeno RS, Alksne JF et al (1989) Perineural cysts of the sacral nerve roots. Neuro-Orthop 7:24–31

    Google Scholar 

  7. Lee JY, Impekoven P, Stenzel W, Lohr M, ErnestusRI Klug N (2004) CT-guided percutaneous aspiration of Tarlov cyst as a useful diagnostic procedure prior tooperative intervention. Acta Neurochirur (Wien) 146:667–670

    Article  Google Scholar 

  8. Langdown AJ, Grundy JR, Birch NC (2005) The clinical relevance of Tarlov cysts. J Spinal Disord Tech 18:29–33

    Article  PubMed  Google Scholar 

  9. McGrum G, Williams B (1982) Spinal extradural pouches. J Neurosurg 57:849–852

    Article  Google Scholar 

  10. Murphy K, Wyse G, Gailloud P, Woodworth GF, Sciubba DM, Oka M, Sasson D, Long D (2008) Two-needle technique for the treatment of symptomatic Tarlov cysts. J Vasc Interv Radiol 19:771–773

    Article  PubMed  Google Scholar 

  11. Mummaneni PV, Pitts LH, McCormack BM, Corroo JM, Weinstein PR PR (2000) Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery 47:74–79

    CAS  PubMed  Google Scholar 

  12. Neulen A, Kantelhardt SR, Pilgram-Pastor SM, Metz I, Rohde V, Giese A (2011) Microsurgical fenestration ofPerineural cysts to the thecal sac at the level of thedistaldural sleeve. Acta Neurochir 153:1427–1434

    Article  PubMed  PubMed Central  Google Scholar 

  13. Paulsen RD, Call GA, Murtagh FR (1994) Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR Am J Neuroradiol 15:293–299

    CAS  PubMed  Google Scholar 

  14. Park HJ, Kim IS, Lee SW, Son BC (2008) Two cases of symptomatic perineural cysts (Tarlov cysts) in one family—a case report. J Korean Neurosurg Soc 44:174–177

    Article  PubMed  PubMed Central  Google Scholar 

  15. Prolo DJ, Oklund SA, Butcher M (1986) Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions. Spine 11:601–606

    Article  CAS  PubMed  Google Scholar 

  16. Schreiber F, Haddad B (1951) Lumbar and sacral cysts causing pain. J Neurosurg 8:504–509

    Article  CAS  PubMed  Google Scholar 

  17. Sajko T, Kovač D, Kudelić N, Kovac L (2009) Symptomatic sacral perineural (Tarlov) cysts. Coll Antropol 33:1401–1403

    PubMed  Google Scholar 

  18. Smith ZA, Li Z, Raphael D, Khoo LT (2011) Sacral laminoplasty and cystic fenestration in the treatment of symptomatic sacral perineural (Tarlov) cysts: technical case report. Surg Neurol Int 2:129

    Article  PubMed  PubMed Central  Google Scholar 

  19. Stewart DH, Red DE (1971) Spinal arachnoid diverticula. J Neurosurg 35:65–70

    Article  PubMed  Google Scholar 

  20. Sato K, Nagata K, Sugita Y (2002) Spinal extradural meningeal cyst: correct radiological and histo-pathological diagnosis. Neurosurg Focus 13:ecp1

    Article  PubMed  Google Scholar 

  21. Tarlov IM (1970) Spinal perineural and meningeal cysts. J Neural Neurosurg Psychiatry 33:833–843

    Article  CAS  Google Scholar 

  22. Tanaka M, Nakahara S, Ito Y, Nakanishi K, Sugimoto Y, Ikuma H, Ozaki T (2006) Surgical results of sacral perineural (Tarlov) cysts. Acta Med Okayama 60:65–70

    PubMed  Google Scholar 

  23. Tarlov IM (1948) Cysts (perineurial) of the sacral roots: another cause (removable) of sciatic pain. JAMA 138:740–744

    Article  CAS  Google Scholar 

  24. Tarlov IM (1953) Sacral nerve-root cysts: another cause of the sciatic or cauda equina syndrome. Charles C. Thomas, Springfield, pp 56–116

    Google Scholar 

  25. Tarlov IM (1938) Perineurial cysts of the spinal nerve roots. Arch Neurol Psychiatry 40:1067–1074

    Article  Google Scholar 

  26. Voyadzis JM, Bhargava P, Henderson FC (2001) Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg 95:25–32

    CAS  PubMed  Google Scholar 

  27. Vincent C, Puech P, David M (1930) Sur le diagnostic, le traitementchirugical, le prognostique des arachnoiditesspinales. Rev Neurol 37:577–604

    Google Scholar 

  28. Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236

    Article  CAS  PubMed  Google Scholar 

  29. Youmans JR (1996) Neurological surgery: a comprehensive reference guide to the diagnosis and management of neurosurgical problems, 4th edn. Saunders, Philadelphia, pp 32–33

    Google Scholar 

  30. Zhang T, Li Z, Gong W, Sun B, Liu S, Zhang K, Yin D, Xu P, Jia T (2007) Percutaneous fibrin glue therapy for meningeal cysts of the sacral spine with or without aspiration of the cerebrospinal fluid. J Neurosurg Spine 7:145–150

    Article  PubMed  Google Scholar 

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Correspondence to Ahmed Elsawaf.

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Conflict of interest

The authors have no interest in the materials and methodology advanced in this manuscript. The study was done after consent was taken from all patients and full discussion with them about benefits and hazards of surgical approach.

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Elsawaf, A., Awad, T.E. & Fesal, S.S. Surgical excision of symptomatic sacral perineurial Tarlov cyst: case series and review of the literature. Eur Spine J 25, 3385–3392 (2016). https://doi.org/10.1007/s00586-016-4584-3

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  • DOI: https://doi.org/10.1007/s00586-016-4584-3

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