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Kameda-Smith MM, Fathalla Z, Ibrahim N, Astaneh B, Farrokhyar F. A systematic review of the efficacy of surgical intervention in the management of symptomatic Tarlov cysts: a meta-analysis. Br J Neurosurg 2024; 38:49-60. [PMID: 33754918 DOI: 10.1080/02688697.2021.1874294] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/07/2021] [Indexed: 10/21/2022]
Abstract
Introduction: Tarlov cysts (TC) are sacral perineural cysts that are often found incidentally during spinal imaging. In a small fraction, symptomatic TC can cause pain, bowel, bladder and/or sexual dysfunction, as well as motor and sensory deficits. While many surgeons regard TCs as a non-operative entity, there have been suggestions that operative intervention in carefully selected symptomatic patients may be beneficial. The aim of this meta-analysis is to identify whether surgical treatment for symptomatic TCs is beneficial with an acceptable complication profile.Materials and methods: The authors conducted a systematic outcome analysis of symptomatic TCs treated either with surgery or conservatively managed.Results: Sixteen studies (N = 238) met the inclusion criteria for final meta-analysis. The literature search was performed using PubMed, Ovid MEDLINE, CINAHL, and EMBASE databases up to September 2017 and with an updated search in April 2019. The post-operative complication rate in patients undergoing surgical intervention was 16.9 (11.8 to 22.7) and cyst recurrence was 8.5 (3.5 to 15.4). When a complication occurred, the most frequent complication of surgical intervention was the development of a surgical site infection and/or CSF leak. Of the 15 studies reporting long-term follow-up, 81.0 (74.0-88.0) of patients remained symptom-free for more than 1 year (Mean: 27.5 months, SD = 11.5).Conclusion: We rigorously analyse the efficacy of open surgical decompression and repair of symptomatic TCs and corroborate the findings of sustained long-term resolution of symptoms.
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Affiliation(s)
- Michelle M Kameda-Smith
- McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Forough Farrokhyar
- McMaster University, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Hao S, Li H, Liu S, Guo Y, Chen H, Zhang Z, Dong S. Case Report: Microscope-assisted surgery of C7 nerve root cyst with neurological symptoms. Front Surg 2022; 9:977637. [PMID: 35990095 PMCID: PMC9386117 DOI: 10.3389/fsurg.2022.977637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cervical nerve root cysts are rare and easily missed or misdiagnosed in clinical practice. Although conventional surgery is effective for cervical nerve root cysts, it is limited by the small surgical field of view and operating range, relatively difficult procedure, and incomplete cyst resection. Microscope-assisted magnification of the surgical field of vision reduces the difficulty and ensures complete cyst resection. Case presentation A 58-year-old male patient was diagnosed with a cervical nerve root sleeve cyst on the right C7 vertebra with neurological symptoms. Microscope-assisted surgery was used as treatment. The cyst was completely removed by the microscope-assisted surgery, with satisfactory patient recovery. The surgery did not produce complications, such as spinal cord neurovascular injury, and the patient's symptoms disappeared quickly after surgery. During the 2-year follow-up, there was no complication and no recurrence. Conclusion Microscope-assisted surgery in treatment of the C7 nerve root cyst could achieve a complete resection.
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Incidental 99mTc-DTPA Uptake in Tarlov Cysts on Radionuclide SPECT/CT Cisternography. Clin Nucl Med 2017; 42:287-288. [DOI: 10.1097/rlu.0000000000001572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gunduz OH, Sencan S, Kokar S. A Rare Cause of Lumbar Radiculopathy: Perineural Cyst. PAIN MEDICINE 2015; 16:199-200. [DOI: 10.1111/pme.12560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sun JJ, Wang ZY, Liu B, Li ZD, Wu HB, Yen RY, Zheng M, Teo M, Liu IY. Neck transfixion for sacral extradural spinal meningeal cysts without spinal nerve root fibers. 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 2014; 25:1945-52. [DOI: 10.1007/s00586-014-3471-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 05/05/2014] [Accepted: 07/14/2014] [Indexed: 02/08/2023]
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Sun JJ, Wang ZY, Teo M, Li ZD, Wu HB, Yen RY, Zheng M, Chang Q, Yisha Liu I. Comparative outcomes of the two types of sacral extradural spinal meningeal cysts using different operation methods: a prospective clinical study. PLoS One 2013; 8:e83964. [PMID: 24386317 PMCID: PMC3873468 DOI: 10.1371/journal.pone.0083964] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 11/10/2013] [Indexed: 12/25/2022] Open
Abstract
This prospective study compares different clinical characteristics and outcomes of patients with two types of sacral extradural spinal meningeal cysts (SESMC) undergoing different means of surgical excision. Using the relationship between the cysts and spinal nerve roots fibers (SNRF) as seen under microscope, SESMCs were divided into two types: cysts with SNRF known as Tarlov cysts and cysts without. The surgical methods were tailored to the different types of SESMCs. The improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological function of the patients. Preoperative IJOA scores were 18.5±1.73, and postoperative IJOA scores were 19.6±0.78. The difference between preoperative and postoperative IJOA scores was statistically significant (t = -4.52, p = 0.0001), with a significant improvement in neurological function after surgery. Among the improvements in neurological functions, the most significant was sensation (z=-2.74, p=0.006), followed by bowel/bladder function (z=-2.50, p=0.01). There was a statistically significant association between the types of SESMC and the number (F=12.57, p=0.001) and maximum diameter (F=8.08, p=0.006) of the cysts. SESMC with SNRF are often multiple and small, while cysts without SNRF tend to be solitary and large. We advocate early surgical intervention for symptomatic SESMCs in view of significant clinical improvement postoperatively.
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Affiliation(s)
- Jian-jun Sun
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- * E-mail: (JS); (ZW)
| | - Zhen-yu Wang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
- * E-mail: (JS); (ZW)
| | - Mario Teo
- Department of Neurosurgery, Institute of Neurological Science, Glasgow, United Kingdom
| | - Zhen-dong Li
- Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Hai-bo Wu
- Department of Neuroradiology, Peking University Third Hospital, Peking University, Beijing, China
| | - Ru-yu Yen
- Department of General Surgery, Peking University Third Hospital, Peking University, Beijing, China
| | - Mei Zheng
- Department of Neurology, Peking University Third Hospital, Peking University, Beijing, China
| | - Qing Chang
- Department of Pathology, Peking University Third Hospital, Peking University, Beijing, China
| | - Isabelle Yisha Liu
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California, United States of America
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Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers. SCIENCE CHINA-LIFE SCIENCES 2013; 56:1007-13. [DOI: 10.1007/s11427-013-4536-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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Abstract
The spinal canal is frequently a source of difficulties, traps and diagnostic errors. Pitfalls related to artifacts are resolved by using appropriate sequences. Good knowledge of the appearance of certain particular anatomical structures (the cauda equina roots, the radicular veins of the lumbar spine and conus medullaris, the dorsal root ganglion) and of frequent variants (fibrolipoma of the filum terminale, common root sheaths, root cysts) will avoid a good many errors. Dilatation of epidural veins in intracranial hypotension can simulate the contrast enhancement of a tumour. An increase in epidural fat can induce pathogenic stenosis of the dural sheath.
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Lucantoni C, Than KD, Wang AC, Valdivia-Valdivia JM, Maher CO, La Marca F, Park P. Tarlov cysts: a controversial lesion of the sacral spine. Neurosurg Focus 2012; 31:E14. [PMID: 22133181 DOI: 10.3171/2011.9.focus11221] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The primary aim of our study was to provide a comprehensive review of the clinical, imaging, and histopathological features of Tarlov cysts (TCs) and to report operative and nonoperative management strategies in patients with sacral TCs. A literature review was performed to identify articles that reported surgical and nonsurgical management of TCs over the last 10 years. Tarlov cysts are often incidental lesions found in the spine and do not require surgical intervention in the great majority of cases. When TCs are symptomatic, the typical clinical presentation includes back pain, coccyx pain, low radicular pain, bowel/bladder dysfunction, leg weakness, and sexual dysfunction. Tarlov cysts may be revealed by MR and CT imaging of the lumbosacral spine and must be meticulously differentiated from other overlapping spinal pathological entities. They are typically benign, asymptomatic lesions that can simply be monitored. To date, no consensus exists about the best surgical strategy to use when indicated. The authors report and discuss various surgical strategies including posterior decompression, cyst wall resection, CT-guided needle aspiration with intralesional fibrin injection, and shunting. In operative patients, the rates of short-term and long-term improvement in clinical symptoms are not clear. Although neurological deficit frequently improves after surgical treatment of TC, pain is less likely to do so.
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Affiliation(s)
- Corrado Lucantoni
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy
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Choi BH, Kim SY, Kim JM. A symptomatic lumbosacral perineural cyst -A case report-. Korean J Anesthesiol 2012; 62:493-6. [PMID: 22679550 PMCID: PMC3366320 DOI: 10.4097/kjae.2012.62.5.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/16/2011] [Accepted: 05/22/2011] [Indexed: 12/01/2022] Open
Abstract
Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms.
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Affiliation(s)
- Byung Hee Choi
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
| | - Sae Young Kim
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
| | - Jin Mo Kim
- Department of Anesthesiology and Pain Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
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Abstract
STUDY DESIGN A case series and literature review are presented. OBJECTIVE To review relevant data for the management of perineural cysts, and present a case series of 2 patient with symptomatic perineural cysts treated by steroid therapy. SUMMARY OF BACKGROUND DATA Perineural cysts are usually an incidental finding, but rarely may cause mechanical nerve root compression. Surgical treatments for perineural cysts are complicated by postoperative pseudomeningocoele and intracranial hypotension, and reoccurrence of the cyst. There are no reported nonsurgical treatments for perineural cysts. METHODS We present a case series symptomatic perineural cysts. RESULTS Patients with lumbar and cervical perineural cysts were treated successfully with oral and epidural steroid therapy. CONCLUSION Steroid therapy may offer a nonsurgical alternative for the treatment of symptomatic perineural cysts.
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Shiau JSC, Raden M, Juliano JE. Sacral intraspinal meningocele in a patient presenting with abdominal pain. Case report. J Neurosurg 2007; 107:53-6. [PMID: 17644921 DOI: 10.3171/ped-07/07/053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sacral meningoceles are typically asymptomatic. When they are symptomatic, patients commonly present with signs and symptoms of nerve root compression and back pain. The authors report the case of a 10-year-old girl with an intraspinal sacral meningocele who presented initially only with severe right lower quadrant pain. The patient underwent successful surgical treatment of the meningocele and experienced subsequent resolution of the abdominal pain. This is the first reported case of an intraspinal sacral meningeal cyst in which the only presenting symptom was abdominal pain and which was successfully treated with surgery. It is postulated that the sacral meningocele caused severe abdominal pain secondary to compression of the sacral parasympathetic fibers that pass through the sacral plexus on each side of the cord corresponding to the S-2 and S-3 levels.
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Affiliation(s)
- John S C Shiau
- Division of Neurosurgery, Staten Island University Hospital, Staten Island, New York 10304, USA.
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Feigenbaum F, Henderson FC. Giant sacral meningeal diverticula: surgical implications of the “thecal tip” sign. J Neurosurg Spine 2006; 5:443-6. [PMID: 17120895 DOI: 10.3171/spi.2006.5.5.443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The surgical anatomy of giant sacral meningeal diverticula varies greatly depending on whether they develop ventral or dorsal to the thecal sac and spinal nerve roots. The ability to distinguish between the two lesion types preoperatively is therefore advantageous. The authors present a method of distinguishing ventral from dorsal meningeal diverticula on magnetic resonance imaging using the “thecal tip sign.” They also describe the differences in operative technique required for resection of each type of diverticular cyst.
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Affiliation(s)
- Frank Feigenbaum
- Midwest Neurosurgery Associates, Kansas City, Missouri 64132, USA.
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Feigenbaum F, Henderson F. Surgical Management of Meningeal Cysts, Including Perineural (Tarlov) Cysts and Meningeal Diverticula. ACTA ACUST UNITED AC 2006. [DOI: 10.1053/j.semss.2006.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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