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Tarlov cyst

Tarlov or perineurial cysts are pathological formations located in the space between the peri-and endoneurium of the spinal posterior nerve root sheath. These lesions have been estimated to affect less than 9% of the adult population. Although originally believed by Tarlov to be asymptomatic lesions, these cysts, when present in the sacral neural canal and foramina, have since been found to cause a variety of symptoms, including radicular pain, paresthesias, and urinary or bowel dysfunction. The development of CT myelography has led to an improvement in our ability to diagnose "Tarlov cysts" as a cause of sacral radiculopathy. Although the term Tarlov cyst has often been erroneously applied to other cystic spinal lesions, the distinctive feature of the Tarlov perineurial cyst is the presence of spinal nerve root fibers within the cyst wall, or the cyst cavity itself.

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39 yo with back pain

Tarlov or perineurial cysts are pathological formations located in the space between the peri-and endoneurium of the spinal posterior nerve root sheath. These lesions have been estimated to affect less than 9% of the adult population. Although originally believed by Tarlov to be asymptomatic lesions, these cysts, when present in the sacral neural canal and foramina, have since been found to cause a variety of symptoms, including radicular pain, paresthesias, and urinary or bowel dysfunction. The development of CT myelography has led to an improvement in our ability to diagnose "Tarlov cysts" as a cause of sacral radiculopathy. Although the term Tarlov cyst has often been erroneously applied to other cystic spinal lesions, the distinctive feature of the Tarlov perineurial cyst is the presence of spinal nerve root fibers within the cyst wall, or the cyst cavity itself.
Despite advancements in diagnosis, there remains a great deal of controversy regarding the optimal treatment of symptomatic Tarlov cysts. Nonsurgical therapies include lumbar CSF drainage and CT scanning guided cyst aspiration, neither of which prevents symptomatic cyst recurrence. Neurosurgical techniques for symptomatic perineurial cysts include simple decompressive laminectomy, cyst and/or nerve root excision, and microsurgical cyst fenestration and imbrication. Although no consensus exists on the definitive treatment of symptomatic Tarlov cysts, probably surgical methods have yielded the best long-term results to date.

Suggested reading:

1. Acosta FL JR, Alfredo Quinones-Hinojosa AQ, Schmidt MH, and Weinstein PR. Diagnosis and management of sacral Tarlov cysts. Case report and review of the literature. Neurosurg. Focus / Volume 15 / August, 2003. 1-7.

2. Paulsen RD, Call GA and Murtagh FR. Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). American Journal of Neuroradiology, Vol 15, Issue 2 293-297,

3. Khosla A, Wippold II FJ. Pictorial Essay. CT Myelography and MR Imaging of Extramedullary Cysts of the Spinal Canal in Adult and Pediatric Patients. AJR:178, January 2002
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