CT-Guided Aspiration of a Hemorrhagic Tarlov Cyst for the Treatment of a Post-Partum Sciatica: A Case Report and a Review of the Literature

Abstract

BackgroundTarlov or perineural cysts are dilations of nerve roots resulting from a pathologically increased cerebrospinal fluid pressure. Although it is very common in the general population, most of these cysts remain asymptomatic. In some cases, they can evolve and exert pressure on neural elements, independently from their initial size.Case reportIn this paper, we describe the case of a 33-year-old female known to have asymptomatic multiple and large radicular and pelvic Tarlov cysts. One cyst located in the right pelvic space progressed acutely after delivery, inducing a painful sciatica without neurological deficit. The intracystic bleeding can be a direct consequence of the delivery, leading to an acute and mechanical local compression of the right S1 root. A CT-guided puncture and aspiration allowed a complete recovery. This case report was completed by a review of the literature of these rare intracystic Tarlov bleedings.ConclusionsIntracystic hemorrhage is a rare complication of Tarlov cysts. Delivery-induced cyst bleeding was not described before. Patients known to have large and multiple Tarlov cysts should be monitored in post-partum, as their presence is considered a risk factor. Percutaneous cyst aspiration seems to be an effective and safe treatment to relieve symptoms.

A bibliometric and visualization study of global research trends in sacral Tarlov cyst from 2000 to 2022

“…Clinical symptoms, such as pain, affecting normal life, bowel and urinary dysfunction, and the absence of conditions like lumbar disc herniation and spinal tumours should warrant surgical intervention. For complications of Tarlov cysts (STC), such as intracystic hemorrhage, surgery is considered an effective treatment method ( 39 ). Additionally, for cysts with a diameter exceeding 1.5 centimeters, surgical intervention is also recommended.…”

Giant Tarlov Cyst presenting as pelvic mass: Often doing less is better

“…[ 4 , 5 , 10 ] Rare presentation of Tarlov cyst being mistaken for hydrosalpinx had also been reported. [ 1 , 29 ] Non-surgical management with lumbar CSF drainage and CT-guided cyst aspiration is scarcely reported to provide months of symptom-free periods before recurrence. [ 20 ] Neurosurgical interventions include laminectomy, cyst and/or nerve root excision, and fenestration of cyst and imbrication.…”

“…Yamagami, [38] 2019 Nishimura et al, [23] Tokgöz et al, [34] Serratrice et al, [29] 2022 L5-S3 cyst with epidermoid in a 42-year-old woman was reported in year 2020. e case becomes more interesting when it is revealed that the epidermoid is Iatrogenic and acquired.…”