What is a Tarlov Cyst?

Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that appear near the nerve roots in the spine. They contain cerebrospinal fluid (CSF), which surrounds the brain and spinal cord. It is mostly seen in the lower levels of the spine (especially in the sacral/tail region). A person may have multiple cysts of varying sizes. They usually do not cause any symptoms and are detected incidentally in MRI (MR) films. Cyst-related complaints vary according to its size and location. In general, the larger it is, the greater the risk of causing a complaint. Pain, decrease in muscle strength, sensory disturbances, deterioration in bladder and bowel functions can be seen in the areas where the affected nerve roots are responsible.

Cystic lesion 3.3×1.7 cm in size at S2-S3 level. Image source: Dr G Balachandran, Radiopaedia.org . id: 17343

Why Does It Happen?

Their incidence in the community is estimated to be 5-9%. It is more common in women than men. It is thought that only 1% of all perineural cysts cause complaints.

It originates from the sheath of the posterior root ganglia of the spinal cord. It is not known exactly why they occur. Shock, trauma (fall, etc.), excessively demanding physical activities may cause existing cysts to grow and become symptomatic. Lifting weights can increase CSF pressure, leading to enlargement of the cyst.

Tarlov Cyst Symptoms

They are usually asymptomatic, that is, they do not give any symptoms.

If the cyst enlarges and presses on the nearby nerve root, a sharp, burning pain (sciatic pain) may be felt along the places where this nerve root goes, for example, down the back of the hip and thigh. If the nerve pressure is advanced, loss of muscle strength, thinning of the leg muscles, impaired sensation, and gait disturbance may occur.

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Tarlov cysts can sometimes become large enough to erode the surrounding bone. It can cause back pain . Urinary disorders (incontinence, inability to feel, etc.), constipation, sexual dysfunction can be seen due to the nerves going to the bladder, genitals and intestines. If the pressure of the cerebrospinal fluid changes, it can cause headache.

Diagnosis

Tarlov cysts are diagnosed by being seen on lumbar vertebra (lumbar spine) MRI. CT-myelography can be performed if the cyst is desired to be better visualized. Whether there is nerve damage and its degree can be determined by EMG examination. Urodynamics may be performed to evaluate bladder function in a person with urinary complaints.

What Diseases Can It Be Confused With?

Lumbar hernia , arachnoiditis, spinal synovial cyst, dural ectasia, meningocele, nerve sheath tumor (schwannoma, neurofibroma), spinal metastasis, gynecological problems in women may cause similar signs or symptoms.

Treatment

In most cases, no treatment is required. Cysts causing complaints can be drained (drained) with a needle under CT guidance; thus reducing the pressure and pain it causes. Fibrin glue can be injected into the cyst. However, the improvement may be temporary and the cyst may fill up again. Corticosteroid injections are another treatment option.

Removal of the cyst with microsurgical methods can be applied to people whose neurological symptoms progress, whose pain continues and who do not benefit from other treatments. Different techniques such as decompressive laminectomy, microsurgical cyst fenestration may also be preferred according to the characteristics of the case.

Surgery may have undesirable consequences such as CSF leakage, infection (meningitis), and non-recovery of symptoms. The decision for surgery is made by weighing the possible benefits and risks.

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