P Kümpers, E Wiesemann, H Becker, B Haubitz, R Dengler, D-H Zermann

Abteilung Nephrologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover.

PMID: 17004183 DOI: 10.1055/s-2005-91915

Abstract

Introduction: Asymptomatic cysts of the sacral nerve roots display a prevalence of 5 % and are occasionally demonstrated by MRI of the spine. Depending on their size and localization, arachnoid cysts may cause sacral or perineal pain, radicular sensomotory symptoms and neurogenic bladder and bowel dysfunction by compression of the nerve roots.

Case report: We report on a case of a recently developed neurogenic bladder dysfunction. MRI of the spine demonstrated two large, liquor-filled cysts of 2.5 and 3 cm diameter, bilaterally localized at the nerve roots S2/3. Neurological and urological examinations confirmed the diagnosis of symptomatic nerve root cysts at the level S2/3, resulting in detrusor areflexia. A microsurgical excision of the cysts ameliorated the patient’s pain symptoms. However, the detrusor areflexia did not improve.

Conclusions: Tarlov cysts are predominantly regarded an asymptomatic incidental feature of CT and MRI scans of the spine. The case of our patient, as well as the so far published reports indicate, however, that a Tarlov cyst may cause a variety of neurological and urological symptoms. Nerve root cysts should be seriously considered and not excluded at an early stage, especially when coincident with persistent neurological and urological symptoms.

https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-2005-919159

https://pubmed.ncbi.nlm.nih.gov/17004183/

Takatori, Mayumi MD; Hirose, Munetaka MD; Hosokawa, Toyoshi MD.

Kyoto Prefectural University of Medicine; Department of Anesthesiology; 465 Kajiicho, Kamigyo-ku; Kyoto 602-8566, Japan;

A 34-yr-old woman presented with a 6-yr history of left lower back pain and left lower extremity pain. Physical examination was unremarkable except for a positive straight leg-raising test on the left side.

Imaging revealed the presence of an extradural cyst located along the left L5 nerve root (Fig. 2). Cyst resection was performed successfully and histopathological examination confirmed the cyst as a perineural cyst.

https://journals.lww.com/anesthesia-analgesia/Fulltext/2008/03000/Perineural_Cyst_as_a_Rare_Cause_of_L5.64.aspx

K Yücesoy, S Naderi, H Ozer, M N Arda

Department of Neurosurgery, Dokuz Eylul University School of Medicine, Izmir, Turkey.

PMID: 10985157

Abstract

Most of the perineural cysts (Tarlov’s cysts) are asymptomatic. They are usually diagnosed incidentally, and a specific treatment is not necessary. They should be operated on, only if they produce progressive or disabling symptoms and/or sign clearly attributable to them. Several reports have been made regarding their sign and symptom, neurological and radiological features. This is a report emphasizing on their surgical indication and surgical treatment. We reported a 48 year-old woman who underwent surgery because of the symptomatic perineural cyst. It is concluded that the total excision of the perineural cyst is not necessary and a partial resection with a resultant reduction in the cyst size results in a favourable outcome.

https://pubmed.ncbi.nlm.nih.gov/10985157/

Mayur Sharma, Vernon Velho, Rahul Mally 1, Shadma W Khan

Department of Neurosurgery, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India.

PMID: 26396612 PMCID: PMC4553737 DOI: 10.4103/1793-5482.161177

Abstract

Lumbosacral perineural cysts (Tarlov’s cysts) are nerve root cysts, which are usually asymptomatic and are detected incidentally on imaging. These cysts are rare with an incidence of 4.6%. We report three cases of Lumbosacral Tarlov’s cysts, which presented with cauda equina syndrome and radicular pain syndrome. Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica. Complete excision of the cyst was achieved in two patients and marsupialization of the cyst was done in another patient due to its large size and dense adherence to the sacral nerve roots. All the patients were relieved of the radicular pain with no new neurological deficit following surgery. Symptomatic lumbosacral Tarlov’s cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica. Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms. Complete Surgical excision of these symptomatic cysts is the treatment of choice to achieve a cure.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553737/

https://pubmed.ncbi.nlm.nih.gov/26396612/

Wolfhard Caspar 1, Luca Papavero, Abdullah Nabhan, Cornelius Loew, Frank Ahlhelm

Department of Neurosurgery, Faculty of Medicine, Saarland University, Homburg-Saar, Germany.

PMID: 12648906 DOI: 10.1016/s0090-3019(02)00981-3

Abstract

Background: The widespread use of magnetic resonance imaging (MRI), now the first line investigation for back and leg pain, reveals cystic sacral lesions more often than myelography did in the past. There is agreement that symptomatic perineurial sacral cysts should be treated surgically. However, it is still debated whether the preference should be given to the curative option, consisting of excision of the cyst with duraplasty, or to drainage of the cyst to relieve symptoms. In this retrospective study the efficacy of microsurgical cyst resection with duraplasty is evaluated.

Methods: In 15 patients presenting with pain and neurologic deficits, myelography and/or MRI detected sacral cysts. The clinical features suggested that the space-occupying lesions caused the disturbances. Microsurgical excision of the cyst along with duraplasty or plication of the cyst wall was performed in all the cases. Postoperative care included bed rest and CSF drainage for several days.

Results: In 13 out of 15 patients the preoperative radicular pain disappeared after surgery. The 2 patients with motor deficits and the 6 patients with bladder dysfunction recovered completely. In all except 1 of the 10 patients complaining of sensory disturbances a significant improvement was achieved. No complications were observed.

Conclusion: Microsurgical excision of the cyst combined with duraplasty or plication of the cyst wall is an effective and safe treatment of symptomatic sacral cysts and, in the view of the authors, the method of choice.

https://www.sciencedirect.com/science/article/abs/pii/S0090301902009813?via%3Dihub

https://pubmed.ncbi.nlm.nih.gov/12648906/

Michelle M Kameda-Smith, Zina Fathalla, Nadeem Ibrahim, Behrooz Astaneh, 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.

PMID: 33754918 DOI: 10.1080/02688697.2021.1874294

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.

https://www.tandfonline.com/doi/abs/10.1080/02688697.2021.1874294?journalCode=ibjn20

https://pubmed.ncbi.nlm.nih.gov/33754918/

Hiroaki Matsumoto, Shigeo Matsumoto, Takanori Miki, Yuki Miyaji, Hiroaki Minami, Atsushi Masuda, Shogo Tominaga, Yasuhisa Yoshida, Ikuya Yamaura, Shigeatsu Natsume, Kozo Yoshida

Department of Neurosurgery, Eisyokai Yoshida Hospital, Kobe, Hyogo, Japan.

PMID: 22198114 DOI: 10.2176/nmc.51.867

Abstract

A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. His pain resolved without recurrence of the cyst or complications. Symptomatic perineural cysts are quite rare. Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cyst-subarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.

https://www.jstage.jst.go.jp/article/nmc/51/12/51_12_867/_article

https://pubmed.ncbi.nlm.nih.gov/22198114/

Ramesh Kumar Sen, Tarun Goyal, Sujit Kumar Tripathy, Soumya Chakraborty

Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

PMID: 22535818 DOI: 10.1177/230949901202000117

Abstract

Perineural cysts are common and usually detected incidentally during magnetic resonance imaging of the lumbosacral spine. Treatment is indicated only when the cyst is symptomatic. We report one such patients presented with cauda equina syndrome and another with low back pain with claudication. They underwent excision and duraplasty; both motor and sensory fibres were carefully separated from the cyst wall using a nerve root retractor and penfield. There was no nerve root damage or neural deficit. Symptoms were relieved postoperatively.

https://journals.sagepub.com/doi/10.1177/230949901202000117?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&

https://pubmed.ncbi.nlm.nih.gov/22535818/

Masato Tanaka, Shinnosuke Nakahara, Yasuo Ito, Kazuo Nakanishi, Yoshihisa Sugimoto, Hisanori Ikuma, Toshifumi Ozaki

Department of Orthopaedic Surgery, Okayama University Hospital, Okayama 700-8558, Japan.

PMID: 16508691 DOI: 10.18926/AMO/30758

Abstract

The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83%) of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17%) of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.

https://www.lib.okayama-u.ac.jp/www/acta/pdf/60_1_65.pdf

https://pubmed.ncbi.nlm.nih.gov/16508691/