1
|
Feigenbaum F, Parks SE, Martin MP, Ross TD, Kupanoff KM. Surgical Intervention is Associated with Improvement in Health-Related Quality of Life Outcomes in Patients with Symptomatic Sacral Tarlov Cysts: Results from a Prospective Longitudinal Cohort Study. World Neurosurg 2024; 187:e189-e198. [PMID: 38636633 DOI: 10.1016/j.wneu.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The treatment of symptomatic Tarlov cysts remains a controversial topic within neurosurgery. We describe our experience with patients who underwent surgical intervention for sacral Tarlov cysts at a single institution. General and disease-specific outcome measures were used to assess health-related quality of life. METHODS Patients who underwent surgical treatment for one or more sacral Tarlov cysts between 2018 and 2021 were included. The Tarlov Cyst Quality of Life (TCQoL), a validated disease-specific measure, was the primary outcome of the study. Secondary outcomes included general outcome measures: 36-Item Short Form Survey, the Oswestry Disability Index, and Visual Analog Scale. Patients were followed at 3, 6, and 12 months postoperatively. Repeated measures analyses were used to assess change from preoperative to 12 months postoperative. RESULTS Data were obtained from 144 patients who underwent surgery for sacral Tarlov cysts, average age 52.3 ± 11.3 years, 90.3% female. Patients reported significant mean improvement on the TCQoL over time (preoperative 3.2 ± 0.1; 3-month postoperative 2.1 ± 0.1; 6-month 1.9 ± 0.1; 12-month 1.9 ± 0.1; P < 0.001). Patient age and duration of symptoms were not associated with outcome. A total of 82.3% of patients reported improvement on TCQoL. There was not a significant difference in the proportion of patients reporting improvement on TCQoL by cyst size (small 90.9% vs. large 77.9%; P = 0.066). CONCLUSIONS Our longitudinal series demonstrated patient-reported improvement following surgery for symptomatic sacral Tarlov cysts using a validated disease-specific health-related quality of life scale through 12 months after surgery. Patient age and preoperative duration of symptoms were not correlated with outcome.
Collapse
Affiliation(s)
| | | | | | | | - Kristina M Kupanoff
- Department of Surgery, University of Arizona School of Medicine - Phoenix, Phoenix, Arizona, USA
| |
Collapse
|
2
|
Tracz J, Judy BF, Jiang KJ, Caraway CA, Yang W, De Macena Sobreira NL, Khan M, Witham TF. Interventional approaches to symptomatic Tarlov cysts: a 15-year institutional experience. J Neurointerv Surg 2024; 16:737-741. [PMID: 37402574 DOI: 10.1136/jnis-2023-020564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Tarlov cysts are perineural collections of cerebrospinal fluid most often affecting sacral nerve roots, which may cause back pain, extremity paresthesias and weakness, bladder/bowel dysfunction, and/or sexual dysfunction. The most effective treatment of symptomatic Tarlov cysts, with options including non-surgical management, cyst aspiration and injection of fibrin glue, cyst fenestration, and nerve root imbrication, is debated. METHODS Retrospective chart review was conducted for 220 patients with Tarlov cysts seen at our institution between 2006 and 2021. Logistic regression analysis was conducted to determine the association between treatment modality, patient characteristics, and clinical outcome. RESULTS Seventy-two (43.1%) patients with symptomatic Tarlov cysts were managed non-surgically. Of the 95 patients managed interventionally, 71 (74.7%) underwent CT-guided aspiration of the cyst with injection of fibrin glue; 17 (17.9%) underwent cyst aspiration alone; 5 (5.3%) underwent blood patching; and 2 (2.1%) underwent more than one of the aforementioned procedures. Sixty-six percent of treated patients saw improvement in one or more symptoms, with the most improvement in patients after aspiration of cyst with injection of fibrin glue; however, this association was not statistically significant on logistic regression analysis. CONCLUSION Although the subtype of percutaneous treatment was not significantly associated with optimal or suboptimal patient outcomes, cyst aspiration both with and without injection of fibrin glue may serve as a useful diagnostic tool to (1) determine symptom etiology and (2) identify patients who might have achieved temporary improvement between the time of cyst aspiration and refill with cerebrospinal fluid as potential candidates for neurosurgical intervention of cyst fenestration and nerve root imbrication.
Collapse
Affiliation(s)
- Jovanna Tracz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly J Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chad A Caraway
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Majid Khan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
3
|
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] [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.
Collapse
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
| |
Collapse
|
4
|
Lu Y, Bao L, Wang N, Chen S, Qian Y, Gu J, Kang R, Xie L. A bibliometric and visualization study of global research trends in sacral Tarlov cyst from 2000 to 2022. Front Surg 2024; 10:1301739. [PMID: 38234453 PMCID: PMC10791765 DOI: 10.3389/fsurg.2023.1301739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024] Open
Abstract
Background Symptomatic sacral Tarlov cyst (STC) exerts a significant negative impact on the patient's quality of life, highlighting the significance of the increasing number of studies on STC. However, bibliometric analyses in this research field are scarce. Thus, this study aims to provide a comprehensive knowledge structure and identify the research trends of STC through bibliometrics. Methods Articles related to STC from 2000 to 2022 were sourced from the Web of Science Core Collection database. VOSviewer 1.6.16, CiteSpace 6.1.6, GraphPad Prism 8.2.1 and R-package "bibliometrix" were used to analyse the data and generate knowledge maps. Results A total of 930 studies on STC from 2000 to 2022 were included. The findings revealed a consistent yet upward trend in the number of annual publications in this field. The United States, China and Turkey were the most prolific and influential countries contributing to this field, with the University of Illinois, the University of Maryland and the National Institute of Standards & Technology being the most notable research institutions. Key journals include World Neurosurgery [Impact Factor (IF) = 2.210], Journal of Vascular Surgery (IF = 4.860) and Journal of Neurosurgery-Spine (IF = 3.467). Additionally, Tarlov Mj, Tarlov E and Zachariah Mr exhibit the highest number of publications, making them the leading authors in this field. A twenty-year retrospection of research trends using keyword analysis reveals four principal directions, namely "definition", "pathogenesis", "diagnosis" and "treatment". Currently, therapeutic surgical intervention is the key treatment for this disease, with future treatments primarily hinging on minimally invasive methodologies rooted in microendoscopic and endoscopic techniques. Conclusion This pioneering, comprehensive scientific bibliometric study provides a holistic summary of STC research trends and hot spots spanning the past 22 years. The results identify existing research frontiers and chart maps for future studies, serving as a valuable reference for scholars vested in this field.
Collapse
Affiliation(s)
- Yang Lu
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Luyao Bao
- Department of Traditional Chinese Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Nan Wang
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuang Chen
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuzhang Qian
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jun Gu
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ran Kang
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lin Xie
- Department of Orthopaedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
5
|
Murphy K, Nasralla M, Pron G, Almohaimede K, Schievink W. Management of Tarlov cysts: an uncommon but potentially serious spinal column disease-review of the literature and experience with over 1000 referrals. Neuroradiology 2024; 66:1-30. [PMID: 37828278 PMCID: PMC10761484 DOI: 10.1007/s00234-023-03226-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Tarlov cysts were thought to be anatomic variants of uncertain etiology and clinical significance when initially described over 80 years ago. They are often detected in routine lumbosacral imaging and generally not reported in a differential diagnosis. There is increasing evidence that at least some Tarlov cysts are symptomatic and can have a significant adverse impact on patients' health and well-being. Women are disproportionately affected with this condition, often presenting with long-standing pain and neurological dysfunctions. Significant gender bias has been a concern in the management of these patients. Unfortunately, there is no consensus on patient selection or management approaches for symptomatic Tarlov cysts. This review article updates information on the prevalence, diagnosis, clinical significance, and treatments of these cysts. Based on these findings and experience with over 1000 patient referrals, a treatment decision algorithm for symptomatic Tarlov cysts was constructed to provide guidance for appropriate management of patients with these complex cysts.
Collapse
Affiliation(s)
- Kieran Murphy
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
| | - Mehran Nasralla
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Gaylene Pron
- Dalla Lana School of Public Health, Institute Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Khaled Almohaimede
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Wouter Schievink
- Department of Neurosurgery, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, 6Th Floor, Los Angeles, CA, 90048, USA
| |
Collapse
|
6
|
Abdi D, Huttunen J, Leinonen V, Savolainen S, Danner N. Operative Treatment of Tarlov Cysts - Outcomes and Predictors of Improvement after Surgery: A Series of 97 Consecutive Patients and a Systematic Review of Literature. Global Spine J 2023:21925682231221538. [PMID: 38069780 DOI: 10.1177/21925682231221538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
STUDY DESIGN A register-based retrospective series and a systematic review of literature. OBJECTIVES Tarlov cysts are meningeal cysts typically found in the sacral region. They have a dualistic nature ranging from an incidental finding to a symptomatic pathology. There are no established treatment protocols and predictors of operative outcome. Therefore, we aimed to study the outcome of surgical treatment for Tarlov cysts and to characterize patient-, and treatment-related factors predicting outcomes. METHODS A systematic review of previous literature was performed and a retrospective cohort of all patients operated on for Tarlov cysts at BLINDED between 1995 and 2020 was collected. Patient records were evaluated along with radiological images. RESULTS Ninety-seven consecutive patients were identified with follow-up data available for 96. Improvement of symptoms after surgery was observed in 76.0% of patients (excellent or good patient-reported outcome) and the complication rate was 17.5%. Sacral or lower back pain as a preoperative symptom was associated with improvement after surgery (P = .007), whereas previous lower back surgery was more common in patients who did not benefit from surgery (P = .034). No independent predictors of outcome were identified in a regression analysis. CONCLUSIONS This is the second-largest study on the treatment of Tarlov cysts ever published. Operative treatment in a selected patient population will likely produce improvement in the symptoms when balanced with the complication rate and profile of surgery. Preoperative lower back or sacral pain is a potential indicator for improvement after surgery.
Collapse
Affiliation(s)
- Delshad Abdi
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Neurocenter, Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Ville Leinonen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurocenter, Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Sakari Savolainen
- Neurocenter, Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Nils Danner
- Neurocenter, Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
7
|
Lin G, Yang C, Yu T, Zhang J, Si Y, Wu C, Ma C, Liu B, Yang J, Xie J. Sacral terminal filar cyst: a distinct variant of spinal meningeal cyst and midterm clinical outcome following combination resection surgery. Front Surg 2023; 10:1272580. [PMID: 38026491 PMCID: PMC10654982 DOI: 10.3389/fsurg.2023.1272580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Spinal meningeal cysts (SMCs) are currently classified into three types: extradural cysts without nerve root fibers (Type I), extradural cysts with nerve root fibers (Type II), and intradural cysts (Type III). However, the sacral terminal filar cyst is a distinct subtype with the filum terminale rather than nerve roots within the cyst. This study aimed to investigate the clinicoradiological characteristics and surgical outcomes of sacral terminal filar cysts. Methods A total of 32 patients with sacral terminal filar cysts were enrolled. Clinical and radiological profiles were collected. All patients were surgically treated, and preoperative and follow-up neurological functions were evaluated. Results Chronic lumbosacral pain and sphincter dysfunctions were the most common symptoms. On MRI, the filum terminale could be identified within the cyst in all cases, and low-lying conus medullaris was found in 23 (71.9%) cases. The filum terminale was dissociated and cut off in all cases, and the cyst wall was completely resected in 23 (71.9%) cases. After a median follow-up period of 26.5 ± 15.5 months, the pain and sphincter dysfunctions were significantly improved (both P < 0.0001). The cyst recurrence was noted in only 1 (3.1%) case. Conclusions Sacral terminal filar cysts are rare, representing a distinct variant of SMCs. Typical MRI features, including filum terminale within the cyst and low-lying conus medullaris, may suggest the diagnosis. Although the optimal surgical strategy remains unclear, we recommend a combination of resection of the cyst wall and dissociation of the filum terminale. The clinical outcomes can be favorable.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jun Yang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| | - Jingcheng Xie
- Department of Neurosurgery, Peking University Third Hospital, Beijing, China
| |
Collapse
|
8
|
Yucesoy K, Yilmaz M, Kaptan H, Ikizoglu E, Arslan M, Erbayraktar SR. A novel surgical technique for treatment of symptomatic Tarlov cysts. Br J Neurosurg 2023; 37:188-192. [PMID: 34931571 DOI: 10.1080/02688697.2021.2016623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this retrospective study was to describe a novel, simple surgical technique for the treatment of symptomatic Tarlov cysts. METHODS A total of 40 patients with symptomatic Tarlov cysts, admitted to our tertiary center between 1998 and 2019 constituted the study group. All patients underwent microsurgical puckering of the cyst, the technique we described to prevent a recurrence. Patients' symptoms, radiological findings, intraoperative findings, and clinical results were evaluated. RESULTS Of the 40 patients (5 males, 35 females) whose charts were reviewed, the mean age was 28.4 (range, 17-61) years. The mean follow-up was 8 (range, 3 months to 21 years) years. Preoperatively, the most common symptoms were leg pain and numbness of the lower extremity. Postoperatively, no major complications were observed. Clinical progression was halted in all patients; 33 (82%) patients recovered completely and seven (17%) patients reported partial recovery. Cystic cavity persisted radiologically in five (12%) patients, decreased in size in 30 (75%) patients, and regressed completely in the remaining five (12%) patients. None of the patients had permanent neurological deficits. CONCLUSION Puckering of the cyst membrane is a safe and easy-to-perform surgical technique for symptomatic Tarlov cysts. This technique can be used almost in all cases instead of the commonly used microsurgical cyst excision or cyst fenestration.
Collapse
Affiliation(s)
- Kemal Yucesoy
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylul University, Izmir, Turkey
| | - Murat Yilmaz
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylul University, Izmir, Turkey
| | - Hulagu Kaptan
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylul University, Izmir, Turkey
| | - Ersin Ikizoglu
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylul University, Izmir, Turkey
| | - Mert Arslan
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylul University, Izmir, Turkey
| | - Serhat R Erbayraktar
- Faculty of Medicine, Department of Neurosurgery, Dokuz Eylul University, Izmir, Turkey
| |
Collapse
|
9
|
Kang SS, Kim SK, Nelliyan S, Lee SC. Percutaneous Biportal Endoscopic Fenestration for Symptomatic Foraminal Tarlov Cyst. Orthopedics 2023; 46:e125-e128. [PMID: 36067046 DOI: 10.3928/01477447-20220831-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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.].
Collapse
|
10
|
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] [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.
Collapse
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.
| |
Collapse
|
11
|
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. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 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] [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.
Collapse
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
| |
Collapse
|
12
|
Mahajan UV, Labak KB, Labak CM, Herring EZ, Lineberry K, Miller JP, Smith G. Pudendal tumor mimicking cauda equina syndrome and acute radiculopathy: case report. Spinal Cord Ser Cases 2022; 8:71. [PMID: 35918325 PMCID: PMC9345956 DOI: 10.1038/s41394-022-00537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Cauda equina syndrome (CES) is most caused by lumbar disc herniation, and the associated treatment involves prompt surgical decompression. Rarer causes of CES include perineural (Tarlov) cysts. CLINICAL PRESENTATION A 62-year-old female with history of rheumatoid arthritis, hip and knee replacements, and chronic low back pain presented with worsening back pain, left leg weakness and pain for 6 weeks, and bowel/bladder incontinence with diminished sensation in the perianal region for 24 h prior to presentation. MRI demonstrated severe spinal stenosis at L4-S1, central disc herniation at L5-S1, and compression of the cauda equina, consistent with CES. A lumbar decompression was performed. Patient did well at 2-week follow up, but presented 5 weeks post-discharge with increased left leg pain/weakness and genitalia anesthesia. Imaging was unremarkable. Two months later, the patient presented with diminished sensation in the buttocks and bilateral lower extremities and bowel/bladder incontinence. Imaging demonstrated a large cystic presacral mass with involvement of the left sciatic foramen and S3 neural foramen. A team of plastic, orthopedic, and neurological surgeons performed an S3 sacral laminectomy, foraminotomy, partial sacrectomy, and S3 rhizotomy, and excision of the large left hemorrhagic pudendal mass. Final pathology demonstrated a perineural cyst with organizing hemorrhage. On follow-up, the patient's pain and weakness improved. CONCLUSION CES-like symptoms were initially attributed to a herniated disk. However, lumbar decompression did not resolve symptoms, prompting further radiographic evaluation at two separate presentations. This represents the first reported case of a pudendal tumor causing symptoms initially attributed to a herniated disc.
Collapse
|
13
|
Farshad-Amacker NA, Sutter R. The Great Mimickers of Spinal Pathology. Semin Musculoskelet Radiol 2022; 26:439-452. [PMID: 36103886 DOI: 10.1055/s-0042-1748914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Back pain is one of the leading causes of health costs worldwide, particularly because of the further increased aging population. After clinical examination, spinal imaging is of utmost importance in many patients to reach the correct diagnosis. There are many imaging pitfalls and mimickers of spinal pathology on radiographs, magnetic resonance imaging, and computed tomography. These mimickers may lead to a misdiagnosis or a further imaging work-up if they are not recognized and thus lead to unnecessary examinations and increased health care costs. In this review we present the common mimickers of spinal pathology and describe normal variations when reading imaging studies of the spine.
Collapse
Affiliation(s)
- Nadja A Farshad-Amacker
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
14
|
Shimauchi-Ohtaki H, Honda F, Nakamura S, Yoshimoto Y. Severe constipation due to sacral perineural cysts in a pediatrics patient: A case report. Surg Neurol Int 2022; 13:317. [PMID: 35928307 PMCID: PMC9345110 DOI: 10.25259/sni_1152_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 07/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Symptomatic perineural cysts are rare in pediatric patients. Severe bowel dysfunction caused by the perineural cysts at the sacral level is particularly rare in children. Moreover, the long-term outcome of surgery for the perineural cysts in pediatric patients is uncertain. Here, we describe a rare case of perineural cysts originating in the S3 roots in a pediatric patient that manifested as severe constipation. Case Description: The case was a 13-year-old girl who presented with intractable vomiting and constipation. She also had low back and buttock pain, urinary incontinence, and periproctal sensory disturbance. Radiological studies revealed bilateral perineural cysts originating from the S3 nerve roots, which were considered to be the cause of her symptoms. Microsurgical decompression of the cysts relieved her intractable bowel dysfunction. There has been no recurrence in the 5 years since surgery. Conclusion: This case suggests that microsurgery for severe bowel dysfunction due to symptomatic perineural cysts could have a satisfactory long-term outcome in pediatric patients.
Collapse
|
15
|
Zhu D, Fan Z, Cheng F, Li Y, Huo X, Cui J. The Efficacy of an Ultrasound-Guided Improved Puncture Path Technique of Nerve Block/Pulsed Radiofrequency for Pudendal Neuralgia: A Retrospective Study. Brain Sci 2022; 12:brainsci12040510. [PMID: 35448041 PMCID: PMC9031648 DOI: 10.3390/brainsci12040510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 02/01/2023] Open
Abstract
Objectives: To investigate the efficacy and safety of an improved ultrasound-guided pulsed radiofrequency (PRF) and nerve block (NB) for patients with pudendal neuralgia (PN). Methods: This retrospective analysis included 88 adults with PN treated in the Pain Department of Southwest Hospital from November 2011 to June 2021, with treatment including NB (n = 40) and PRF (n = 48). The primary outcome variable was pain severity, measured by a standardized visual analog scale (VAS). VAS values were collected at 1, 3, 7, and 14 days and 1 and 3 months after patients were treated with NB or PRF. Results: Compared with patients treated with NB (n = 40) and those treated with PRF (n = 48), no significant difference in pain reduction was observed in the short term (p = 0.739 and 0.981, at 1 and 3 days, respectively); however, in the medium and long term (1 to 3 months), there were statistically significant improvements in the PRF group over the NB group (p < 0.001). Moreover, it was noted that the average pain severity of primary PN and PN due to sacral perineurial cyst was significantly reduced with PRF therapy in the medium and long term when compared to other secondary PNs, including surgery, trauma, and diabetes. Discussion: The ultrasound-guided, improved, and innovative PRF/NB puncture path technique allows for gentler stimulation and faster identification of the pudendal nerve. The PRF technique may provide better treatments for primary PN and sacral perineurial cyst causing secondary PN in the medium and long term.
Collapse
Affiliation(s)
- Dan Zhu
- Department of Pain Medicine, Southwest Hospital, Army Medical University, Chongqing 400038, China; (D.Z.); (Z.F.); (F.C.); (Y.L.)
| | - Zhenzhen Fan
- Department of Pain Medicine, Southwest Hospital, Army Medical University, Chongqing 400038, China; (D.Z.); (Z.F.); (F.C.); (Y.L.)
| | - Fujun Cheng
- Department of Pain Medicine, Southwest Hospital, Army Medical University, Chongqing 400038, China; (D.Z.); (Z.F.); (F.C.); (Y.L.)
| | - Yuping Li
- Department of Pain Medicine, Southwest Hospital, Army Medical University, Chongqing 400038, China; (D.Z.); (Z.F.); (F.C.); (Y.L.)
| | - Xingyue Huo
- Department of Population Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence: (X.H.); (J.C.); Tel.: +1-470-4953699 (X.H.); +86-13883788139 (J.C.)
| | - Jian Cui
- Department of Pain Medicine, Southwest Hospital, Army Medical University, Chongqing 400038, China; (D.Z.); (Z.F.); (F.C.); (Y.L.)
- Correspondence: (X.H.); (J.C.); Tel.: +1-470-4953699 (X.H.); +86-13883788139 (J.C.)
| |
Collapse
|
16
|
Ma Q, Wu C, Zhang J, Yin X, Yang C, Si Y, Wu H, Zhao Q, Liu Y, Yuan H, Chang Q, Xie J, Yang J, Sun J. Arachnoidal Diverticula of Sacral Extradural Meningeal Cyst: A Novel Definition and Case Series. World Neurosurg 2022; 163:e106-e112. [DOI: 10.1016/j.wneu.2022.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
|
17
|
Berlin E, Khan S, Sullivan W, Schneider B, Walker J. Giant Tarlov Cyst and the Importance of Advanced Imaging Before Interventional Spine Injections. Am J Phys Med Rehabil 2022; 101:e46-e47. [PMID: 35175965 DOI: 10.1097/phm.0000000000001849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Evan Berlin
- From the Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee (EB, SK, WS, BS); and Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee (JW)
| | | | | | | | | |
Collapse
|
18
|
Shoyab M. Tarlov cysts in back pain patients: prevalence, measurement method and reporting points. Br J Radiol 2021; 94:20210505. [PMID: 34538080 DOI: 10.1259/bjr.20210505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Determining the prevalence of Tarlov cysts in low back pain patients. METHODS AND MATERIALS The picture archiving & communication system (PACS) & hospital information system (HIS) of a corporate hospital were retrospectively analyzed to determine the percentage of Tarlov cysts among patients undergoing spinal MRI for back pain over 3 years (January 2017 to December 2019). RESULTS 384 patients had undergone spinal MRI for back pain over the study period, and 25 of them (6.51%) had Tarlov cysts. Vast majority (15 cases) showed cysts located at S2/S3 level, and few were found at S1/S2 and other levels. Single cysts were found in most (=18) of the cases, while 7 cases of multiple / bilateral cysts were found. Cyst dimensions were higher in craniocaudal than anteroposterior or transverse directions. In case of multiple cysts, one or two cysts were noted as dominant, having higher dimensions than the others. The study data revealed no gender or age predilection. CONCLUSIONS We conclude that including the entire sacrum with a T2 sagittal sequence in all MRI for low back pain can increase detection of Tarlov cysts, and thereby provide more data for further analysis. ADVANCES IN KNOWLEDGE We propose the concept of one "dominant" cyst when there are multiple Tarlov cysts. We recommend that diameter or size of Tarlov cysts be specified to their craniocaudal dimension. We also suggest reporting points for contextual structured reporting, viz. presence or absence of bony scalloping, neural foraminal narrowing, nerve root compression or extraforaminal extension.
Collapse
|
19
|
Sun P, Xu W, Ye Y, Zhong F, Wan X, Li Y. Neglected Tarlov cysts: a case of a Tarlov cyst with spermatorrhea. Eur J Med Res 2021; 26:44. [PMID: 33964972 PMCID: PMC8106831 DOI: 10.1186/s40001-021-00514-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background Tarlov cysts are a commonly misdiagnosed condition, which can present with many rare symptoms. We report a case of a Tarlov cyst with spermatorrhea and review the pertinent literature. Case presentation A 42-year-old male patient had a history of spermatorrhea for > 10 years, but was incorrectly diagnosed as the patient and the doctors consistently mistook the symptoms for a genitourinary disease. Magnetic resonance imaging showed that two cysts in the sacral canal. The diagnosis was Tarlov cyst. We performed surgery to remove the cyst and the symptoms of spermatorrhea disappeared after the operation. Conclusions This case demonstrates that orthopedics and urologists should improve their understanding of Tarlov cysts to avoid misdiagnosis and mistreatment.
Collapse
Affiliation(s)
- Pan Sun
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, People's Republic of China
| | - Wangbing Xu
- Spinal Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, 445, Bayi Avenue, Donghu, Nanchang, 330004, Jiangxi, People's Republic of China
| | - Yongxiang Ye
- Spinal Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, 445, Bayi Avenue, Donghu, Nanchang, 330004, Jiangxi, People's Republic of China
| | - Faming Zhong
- Spinal Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, 445, Bayi Avenue, Donghu, Nanchang, 330004, Jiangxi, People's Republic of China
| | - Xuan Wan
- Spinal Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, 445, Bayi Avenue, Donghu, Nanchang, 330004, Jiangxi, People's Republic of China
| | - Yong Li
- Spinal Department of Orthopedics, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, 445, Bayi Avenue, Donghu, Nanchang, 330004, Jiangxi, People's Republic of China.
| |
Collapse
|
20
|
Kozłowski P, Kalinowski P, Kozłowska M, Jankiewicz M, Budny A, Starosławska E, Burdan F. Spinal Perineural Cysts among European Patients. J Neurol Surg A Cent Eur Neurosurg 2021; 82:463-467. [PMID: 33822351 DOI: 10.1055/s-0040-1722194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A perineural (Tarlov) cyst is a fluid-filled lesion occurring between the perineurium and the endoneurium of spinal nerve roots. The aim of the study was to evaluate the prevalence and morphology of perineural cysts, detected incidentally in patients with symptomatic degenerative disk disease. MATERIALS/METHODS The study was based on the retrospective data gathered during magnetic resonance imaging (MRI) examinations. RESULTS AND CONCLUSIONS Out of 3,128 spinal MRI examinations, perineural cysts were detected in 286 patients (9%). The cysts were most commonly observed in the sacral region, followed by thoracic, cervical, and lumbar regions. Cysts were more common in women than in men and the average age of patients was 54.8 years. In the majority, a single cyst was found. The average longest dimension of the lesion was 11.72 mm.
Collapse
Affiliation(s)
- Piotr Kozłowski
- Radiation Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Paweł Kalinowski
- Independent Epidemiology Unit, Medical University of Lublin, Lublin, Lubelskie, Poland
| | - Magdalena Kozłowska
- Oncology Department, Medical University of Lublin, Lublin, Lubelskie, Poland
| | - Małgorzata Jankiewicz
- Radiation Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Agnieszka Budny
- Radiation Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Elżbieta Starosławska
- Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Franciszek Burdan
- Radiology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland.,Humana Anatomy Department, Medical University of Lublin, Lublin, Lubelskie, Poland
| |
Collapse
|
21
|
Kim S, Lee HJ, Park JH, Kim T, Nam K. Tarlov Cysts Misdiagnosed as Adnexal Masses in Pelvic Sonography: A Literature Review. Front Med (Lausanne) 2020; 7:577301. [PMID: 33425933 PMCID: PMC7793900 DOI: 10.3389/fmed.2020.577301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: A Tarlov cyst (TC) is a perineural cyst filled with cerebrospinal fluid that originates from the dorsal ganglion or the spinal posterior nerve root. TCs are usually asymptomatic and incidentally found in the sacral region. Endopelvic extension of TCs is uncommon and can be misdiagnosed as an adnexal mass on gynecological ultrasound imaging. Methods: We performed a search for all clinical studies of TCs that mimicked adnexal masses that had been published through October 12, 2020. We placed no restrictions on language or year of publication in our search, and we performed searches with the following keywords: perineural cyst, Tarlov cyst, sclerotherapy, management, and prognosis. We included all misdiagnosed cases or cases considered as adnexal masses on pelvic sonography. Results: We identified 21 cases of TCs mimicking adnexal masses and conducted a comprehensive analysis of these 21 cases to assess the epidemiology, symptoms, initial diagnoses, provisional ultrasound diagnoses, confirmative modalities, sizes, locations, treatments, and outcomes. The 21 cases included 16 symptomatic cases (76%) and 5 cases with incidental findings (24%), and the average patient age was 41.3 years. The initial diagnosis was performed with ultrasonography in all cases. The most frequent misdiagnosis was unspecified adnexal mass. Confirmative diagnostic modalities were MRI only (67%), CT only (5%), and both MRI and CT (28%). Treatments were surgery (33%), conservative treatment (19%), percutaneous intervention (5%), and alcohol sclerotherapy (5%). In two symptomatic cases misdiagnosed as pelvic masses, cystectomy was performed and leakage of cerebrospinal fluid occurred, necessitating repair of the leak. In one of the asymptomatic patients, cauda equina syndrome occurred after alcohol sclerotherapy for misdiagnosed TC. However, the patient improved with no neurologic deficit after 18 months of conservative treatment. Conclusion: The possibility of large TCs should be considered when assessing adnexal masses in sonography. Since TCs can masquerade as pelvic masses, they should be considered if the mass appears tubular/cystic or multilocular/multiseptate, does not move with respiration, and originates from the sacrum in sonography with or without neurologic symptoms. Accurate diagnosis can prevent medical mismanagement and reduce patient discomfort.
Collapse
Affiliation(s)
- Shengshu Kim
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-si, South Korea
| | - Ho Jun Lee
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-si, South Korea
| | - Joong Hyun Park
- Department of Neurology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul-si, South Korea
| | - Taeyeon Kim
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-si, South Korea
| | - Kiyeun Nam
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-si, South Korea
| |
Collapse
|
22
|
Zhu H, Shen L, Chen Z, Yang M, Zheng X. Giant Tarlov Cysts with Rare Pelvic Extension: Report of 3 Cases and Literature Review. World Neurosurg 2020; 139:505-511. [PMID: 32344135 DOI: 10.1016/j.wneu.2020.04.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Giant presacral Tarlov cysts (TCs) with pelvic extension are extremely rare and have many special features that differ from normal TCs in examination, diagnosis, symptoms, and treatment. We report 3 rare cases of giant presacral TCs with pelvic extension and review the pertinent literature. CASE DESCRIPTION We report 3 cases of giant presacral TCs with rare pelvic extension and analyzed the symptoms, diagnoses, and surgical procedures. Operations with the key point of blocking the inlet of the fistula from inside the dural sac were performed in all 3 cases. All 3 patients revealed alleviation of previous symptoms with no serious complications. Postoperative magnetic resonance imaging showed all the cysts were well blocked with no cyst recurrence. CONCLUSIONS Giant TC with pelvic extension is extremely rare and often is discovered on gynecological ultrasound, where it might be misdiagnosed as adnexal mass. Different from patients with normal TCs, these patients also may present with abdominal symptoms like hydronephrosis, abdominal, or pelvic pain due to the cyst's ventral mass effect. Thus, patients with abdominal and back symptoms at the same time should be paid particular attention for lumbosacral magnetic resonance imaging examination to avoid misdiagnosis. Surgical procedures are recommended for symptomatic cases. However, cyst resection by laparotomy is doomed to postoperative recurrence because the fistula still exists. We describe a simple procedure with the key point of blocking the inlet of cyst fistula, which is more applicable and minimizes the probability of cyst recurrence.
Collapse
Affiliation(s)
- Hanshuo Zhu
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Lin Shen
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zheng Chen
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Min Yang
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xuesheng Zheng
- Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| |
Collapse
|
23
|
Kikuchi M, Takai K, Isoo A, Taniguchi M. Myelographic CT, A Check-Valve Mechanism, and Microsurgical Treatment of Sacral Perineural Tarlov Cysts. World Neurosurg 2020; 136:e322-e327. [PMID: 31931233 DOI: 10.1016/j.wneu.2019.12.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There is currently no consensus regarding surgical indications for symptomatic sacral perineural cysts. METHODS Nine patients with symptomatic sacral perineural cysts underwent microsurgery. All patients fulfilled the following criteria: (1) cyst sizes larger than 15 mm; (2) cysts show the "delayed inflow" and/or "delayed outflow" of contrast on myelographic computed tomography (CT), and (3) neurological symptoms correlate with the primary cyst. RESULTS On myelographic CT, all primary cysts showed the "delayed inflow" of contrast; the average cyst/thecal sac Hounsfield units (HU) ratio was 0.17. In 7 patients, the primary cyst showed "delayed outflow"; the average cyst/thecal sac HU ratio increased to 3.12 on images obtained 24 hours after contrast injection. Regarding the modified Rankin Scale, 67% of patients reported that their overall symptoms improved to normal activities after surgery. The most improved symptom was coccydynia (75% improvement, P = 0.017), followed by leg radiation pain (67% improvement, P = 0.027) and buttock pain (50% improvement, P = 0.068). Bowel/bladder dysfunction improved in 100% of patients, but newly developed in 1 patient (P = 0.32). Perineal pain only decreased in 33% (P = 0.41). CONCLUSIONS To the best of our knowledge, this is the first study to have performed a quantitative analysis of the dynamics of cerebrospinal fluid in sacral perineural cysts using myelographic CT. Sixty-seven percent of patients benefited from surgery; however, our criteria may not be a necessary and sufficient condition for patient selection because 33% did not respond to surgery despite the successful elimination of the check-valve.
Collapse
Affiliation(s)
- Miyu Kikuchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Keisuke Takai
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.
| | - Ayako Isoo
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Makoto Taniguchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| |
Collapse
|
24
|
Yang K, Tao H, Feng C, Xu J, Duan C, Yang W, Su W, Li H, Li H. Surgical management of sacral meningeal cysts by obstructing the communicating holes with muscle graft. BMC Musculoskelet Disord 2019; 20:635. [PMID: 31888578 PMCID: PMC6937820 DOI: 10.1186/s12891-019-2998-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The surgical indication and treatment of sacral meningeal cyst have not been well established and current methods are usually accompanied by complications and recurrence. The aim of this study is to discuss the treatment of symptomatic sacral meningeal cyst, by investigating the surgical results of our surgically treated patients, and minimize the complications and recurrence. METHODS We retrospectively reviewed all patients with symptomatic sacral meningeal cysts who were surgically treated by a single surgeon in the same institution from 2002 to 2017. All patients underwent the same operation by incising the cyst wall and obstructing the communicating hole with muscle graft, while the cyst wall was left untreated instead of resected or imbricated. The obstruction was verified by doing a Valsalva-like maneuver. The preoperative symptoms and signs, and the outcomes at most recent follow-up were rated and compared by Neurological Scoring System. RESULTS A total of 18 patients (7 male patients and 11 female patients, average age 42.3 years) were followed up for an average of 51.7 months. All patients had communicating holes linking the cysts and the dural sacs. The average preoperative neurological score was 19.7 ± 2.2, and it was improved to 23.2 ± 2.8 at the most recent follow-up (p < 0.01). CONCLUSIONS The sacral meningeal cyst originated from the communication with the dural sac. Surgical treatment of symptomatic sacral meningeal cysts can yield a long-term resolution of the appropriately selected patient's symptoms. Obstructing the communicating hole with muscle graft is an effective and simple method to obliterate the cyst. The incised cyst wall can be left untreated instead of resected or imbricated.
Collapse
Affiliation(s)
- Kai Yang
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Huiren Tao
- Department of Orthopaedics, Shenzhen University General Hospital, 1098th Xueyuan Road of Xili University Town, Shenzhen, 518055, Guangdong Province, China.
| | - Chaoshuai Feng
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Jiawei Xu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Chunguang Duan
- Department of Orthopaedics, Shenzhen University General Hospital, 1098th Xueyuan Road of Xili University Town, Shenzhen, 518055, Guangdong Province, China
| | - Weizhou Yang
- Department of Orthopaedics, First Affiliated Hospital of Xi'an Jiaotong University, 277th Yanta West Road, Xi'an, 710061, Shaanxi Province, China
| | - Wei Su
- Department of Orthopaedics, First Affiliated Hospital of Xi'an Jiaotong University, 277th Yanta West Road, Xi'an, 710061, Shaanxi Province, China
| | - Huan Li
- Department of Cardiology, Xijing Hospital, Military Medical University of PLA Airforce (Former Fourth Military Medical University), 127th Changle West Road, Xi'an, 710032, Shaanxi Province, China
| | - Haopeng Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, 157th West Fifth Road, Xi'an, 710004, Shaanxi Province, China.
| |
Collapse
|
25
|
Sharma M, SirDeshpande P, Ugiliweneza B, Dietz N, Boakye M. A systematic comparative outcome analysis of surgical versus percutaneous techniques in the management of symptomatic sacral perineural (Tarlov) cysts: a meta-analysis. J Neurosurg Spine 2019; 30:623-634. [PMID: 30738394 DOI: 10.3171/2018.10.spine18952] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/11/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Symptomatic perineural or Tarlov cysts (TCs) are a rare cause of chronic low-back pain. Given the rarity of the disease, there is no literature consensus regarding the optimal management of these cysts. METHODS The authors conducted a systematic comparative outcome analysis of symptomatic TCs treated with surgery (group A, 32 studies, n = 333) or percutaneous interventions (group B, 6 studies, n = 417) analyzing the demographic characteristics, baseline characteristics of the cysts, clinical presentations, types of interventions, complication rates, and the recurrence rate in both treatment groups. The literature search was performed using the PubMed, MEDLINE, Cochrane, and Ovid databases up to 2018. The MeSH search terms used were "Tarlov cyst," "sacral perineural cyst," "sacral nerve root cyst," "meningeal cyst of the sacral spine," "extra meningeal cyst with spinal nerve root fibers," "spinal extradural arachnoid pouch," and "cyst of the sacral nerve root sheath." The authors used statistical tests for two proportions using the "N-1" chi-square test with the free version of MedCalc for Windows for comparison among the groups. RESULTS Overall symptomatic improvement was reported in 83.5% of patients in both groups; however, exacerbation of preprocedural symptoms was significantly higher in group B than group A (10.1% vs 3.3%, p = 0.0003). The overall complication rates in the surgical and nonsurgical groups were 21% and 12.47%, respectively. Transient sciatica was the most common complication in both groups (17% vs 8%, respectively; p = 0.017). The incidence of cyst recurrence was much lower in group A than group B (8% vs 20%, p = 0.0018). The mean follow-up duration for the surgical group was 38 ± 29 months (25 studies, n = 279), while that for the nonsurgical group was 15 ± 12 months (4 studies, n = 290) (p < 0.0001). CONCLUSIONS The authors noted that although the surgical interventions were associated with higher postprocedural complication rates, long-term efficacy and success in terms of cyst resolution were superior following surgery compared to percutaneous procedures in the management of symptomatic TCs. There was no difference in symptom recurrence with either of the techniques.
Collapse
|
26
|
Abstract
RATIONALE Most perineural cysts are asymptomatic and discovered incidentally at the time of imaging. Although enlargement of the perineural cyst (PC) through a ball-valve mechanism and resultant compression of the adjacent neural or bony structures are known to be a source of pain in PCs, the reason why asymptomatic PCs become symptomatic is unclear. The authors report a case of PC, which was presumed to become symptomatic after subarachnoid hemorrhage without enlargement of the pre-existing PC. PATIENT CONCERNS A 47-year-old woman complained of lumbosacral pain after neck clipping for a ruptured cerebral aneurysm. DIAGNOSES Magnetic resonance imaging (MRI) revealed a PC with intracystic hemorrhage at the S2 level. In comparison with the size of the PC on computed tomography performed 3 years ago, there was no change in the size. Electrodiagnostic studies performed 6 weeks after the onset of the pain showed subacute right S2 radiculopathy. INTERVENTIONS With conservative treatment, her pain gradually diminished. OUTCOMES When the lumbosacral pain improved, follow-up MRI showed that a fluid-fluid level within the PC disappeared. LESSONS Hemorrhage from the subarachnoid space, such as spontaneous aneurysmal SAH, into the pre-existing PC can cause an asymptomatic PC to become symptomatic without getting enlarged. Stretching of the nerve root due to hemorrhage or irritation of the nerve root due to an inflammatory reaction to blood products can make asymptomatic PCs symptomatic without enlargement of PCs.
Collapse
Affiliation(s)
| | - Kiyeun Nam
- Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Goyang, Korea and Dongguk University, Seoul, Korea
| |
Collapse
|
27
|
Dayyani M, Zabihyan S. Giant Tarlov Cyst of Infancy. World Neurosurg 2018; 123:348-350. [PMID: 30576828 DOI: 10.1016/j.wneu.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
We report an 8-month-old female infant with complaints of irritability and recent inability to sit in a stable position. On physical examination, a palpable mass in the left upper quadrant of her abdomen was evident. Sonography and magnetic resonance imaging showed a giant cyst, consisting of 2 communicating compartments: dorsal and ventrolateral. The dorsal part compressed the conus medullaris, and the ventrolateral part compressed the left kidney. Partial cyst wall resection and imbrication for the dorsal pouch were done, and diagnosis of Tarlov cyst was confirmed via the visualization of the endocystic nerve root during surgery. Familiarizing physicians with this unusual presentation of Tarlov cyst may help them in early recognition of this lesion, and subsequent surgery might be considered to prevent clinical sequela. To our knowledge, a lumbar Tarlov cyst presenting as a giant abdominal cyst in an infant has not been reported in the English-language literature.
Collapse
Affiliation(s)
- Mojtaba Dayyani
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zabihyan
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
28
|
Abstract
OF BACKGROUND DATA In the general population, it has been estimated that 1.5% of people have ≥1 Tarlov cysts, with about 13% of those being symptomatic. Despite a range of options for treatment, there is debate about when, and how to optimally treat individuals with Tarlov cysts among clinicians, and among policy decision makers. OBJECTIVE To summarize the current evidence on surgical treatment of Tarlov cysts. STUDY DESIGN A systematic review was completed. METHODS Nine databases were searched. Abstracts and full-texts were assessed by 2 reviewers. To be included, studies had to assess safety, efficacy, or effectiveness of treating Tarlov cysts, had to be written in English or French, and had to be a randomized, quasi-randomized, observational cohort, case control, or case series design including ≥2 participants. Logistic regression analysis was undertaken on the patient-level data collected to assess the association of patient and cyst characteristics on treatment success. RESULTS In total, 31 studies were included in this systematic review; all were case series. Among the 646 participants included in these 31 studies, 210 experienced complete resolution of symptoms (32%), 327 had partial resolution (50%), 106 did not have any improvement or worsening of symptoms (16%), and 3 had their symptoms worsen after surgery (0.4%). A number of adverse events were reported after surgery; however, all were temporary. The analysis of 49 patients with data on cyst size resulted in the odds of complete resolution of symptoms being lower for patients with larger cysts (odds ratio=0.53, P-value=0.107) although this finding is not statistically significant. For those with a cyst >1.5 cm the odds of complete resolution were (odds ratio=0.36, P-value=0.190) compared with those with a cyst <1.5 cm. CONCLUSIONS The evidence suggests that surgery for symptomatic Tarlov cysts may be an effective option for partially or completely relieving symptoms. Contrary to previous findings larger cysts were not associated with completely relieving symptoms.
Collapse
|
29
|
Boukobza M, Roussel A, Fernandez-Rodriguez P, Laissy JP. Giant multiple and bilateral presacral Tarlov cysts mimicking adnexal mass - imaging features. Int Med Case Rep J 2018; 11:181-184. [PMID: 30174464 PMCID: PMC6110282 DOI: 10.2147/imcrj.s147791] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Perineural or Tarlov cysts (TCs) are nerve root cysts. They are usually incidental findings on MRI and are most frequently observed in the sacral spine. A 49-year-old woman presented with lower abdominal discomfort for several months. Physical examination demonstrated a cyst-like mass. An ultrasonographic examination revealed a cystic mass near the right ovary. MRI (3-Tesla unit) showed multiple, bilateral, and almost symmetric giant TCs with presacral space and endopelvic extension and minime scalloping. TCs originated from the right and left L5, S1, S2, and S3 nerve root sleeves entered the presacral space and extended into the pelvis.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France,
| | - Alexandre Roussel
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France,
| | | | - Jean-Pierrre Laissy
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France, .,INseRM U1148, Paris, France.,University Paris 7, Bichat Hospital, Paris, France
| |
Collapse
|
30
|
Percutaneous Endoscopic Treatment for a Symptomatic Sacral Tarlov Cyst. World Neurosurg 2018; 116:390-393. [DOI: 10.1016/j.wneu.2018.05.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/17/2022]
|
31
|
Pfund N, Oh A, Cyna A. Successful spinal anaesthesia in a patient with a Tarlov cyst. Int J Obstet Anesth 2018; 34:96-98. [DOI: 10.1016/j.ijoa.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 10/22/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
|
32
|
An Uncommon Cause of Upper Limb Pain: Cervical Perineural (Tarlov) Cyst Chain. Am J Phys Med Rehabil 2018; 97:e98-e99. [PMID: 29509549 DOI: 10.1097/phm.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
33
|
Wang B, Pu F, Wu Q, Zhang Z, Shao Z. Presacral Tarlov Cyst as an Unusual Cause of Abdominal Pain: New Case and Literature Review. World Neurosurg 2018; 110:79-84. [DOI: 10.1016/j.wneu.2017.10.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
|
34
|
Rustagi T, Kurra S, Lavelle W. Fifth Lumbar L5 Perineural Cyst with Unusual Radiculopathy: Traction Plexopathy. Cureus 2018; 10:e2052. [PMID: 32175195 PMCID: PMC7053797 DOI: 10.7759/cureus.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/11/2018] [Indexed: 11/05/2022] Open
Abstract
Perineural cysts are cystic dilations and are frequently seen in relation to the lumbosacral spine. We describe a case of a fifth lumbar (L5) perineural cyst with unusual radicular symptoms and discuss the possible role of traction plexopathy caused by the cyst. A 38-year-old male presented with a longstanding history of back pain and right side thigh pain. This pain radiated from the buttocks to the lateral and anterior aspect of the thigh. He described the pain as pins and needles/burning with no significant relief with medications or rest. Imaging of the lumbar spine revealed a cystic lesion on the right side involving the L5 nerve root in the foraminal region. He failed conservative treatment and elected to have the cyst removed even with a guarded prognosis. A wide L5 laminectomy was performed. Due to the size of the cyst which was causing traction on the exiting L5 nerve root, the L5 pedicle was excised in order to delineate the cyst and to prevent any iatrogenic injury to the root. The patient had the dramatic improvement in his radicular pain immediately after the surgery and continues to be pain-free at his latest three-year follow-up. This case highlights the unusual pain pattern distribution from a perineural cyst possibly secondary to traction effect of the tumor.
Collapse
Affiliation(s)
- Tarush Rustagi
- Department of Spine Surgery, Indian Spinal Injuries Center, New Delhi, IND
| | - Swamy Kurra
- Department of Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, USA
| | - William Lavelle
- Department of Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, USA
| |
Collapse
|
35
|
Maier C, Eitner L, Altenscheidt J, Nicolas V, Martinez R. [Unsuccessful pain treatment over 6 years of a thoracic radiculopathy caused by an unrecognized Tarlov cyst]. Schmerz 2017; 32:56-60. [PMID: 29270852 DOI: 10.1007/s00482-017-0262-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents a case of unsuccessful pharmaceutical and invasive pain treatment for 6 years without any adequate diagnostics in a female suffering from unilateral thoracic radiculopathy (Th8, right) leading to severe disability and unemployment. The origin was an undetected Tarlov cyst. After resection of the cyst the pain and other complaints disappeared (follow up: 8 months) without need for further pain medication. This case underlines the necessity of adequate diagnostics ahead of long-term pain treatment. Thoracic Tarlov cysts are very uncommon but should be included in the differential diagnosis because curative treatment may be possible.
Collapse
Affiliation(s)
- C Maier
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| | - L Eitner
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - J Altenscheidt
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - V Nicolas
- Institut für Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - R Martinez
- Abteilung für Neurochirurgie und Neurotraumatologie, , Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| |
Collapse
|
36
|
Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2016. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:11-19. [PMID: 28062915 DOI: 10.1007/s00586-016-4942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
|
37
|
Benoist M. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "medical" articles in the European Spine Journal, 2016. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:1-10. [PMID: 27900554 DOI: 10.1007/s00586-016-4886-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Michel Benoist
- Département de Rhumatologie, Service de Chirurgie Orthopédique, Hôpital Beaujon, 100 Boulevard Général Leclerc, 92118, Clichy, France.
| |
Collapse
|
38
|
Weigel R, Polemikos M, Uksul N, Krauss JK. Tarlov cysts: long-term follow-up after microsurgical inverted plication and sacroplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3403-3410. [DOI: 10.1007/s00586-016-4744-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/24/2016] [Accepted: 08/08/2016] [Indexed: 11/27/2022]
|