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

Abstract

Background: Tarlov cysts are sacral perineural cysts arising between the peri and endoneurium of the posterior spinal nerve root at the Dorsal Root Ganglion and have a global prevalence rate of 4.27%. These are primarily asymptomatic (only 1% with symptoms) and typically arise in females between the ages of 50–60. Patients’ symptoms include radicular pain, sensory dysesthesias, urinary and/or bowel symptoms, and sexual dysfunction. Non-surgical management with lumbar cerebrospinal fluid drainage and computerized tomography-guided cyst aspiration typically provide only months of improvement before recurring. Surgical treatment includes a laminectomy, cyst, and/or nerve root decompression with fenestration of the cyst and/ or imbrication. Early surgery for large cysts provides the longest symptom-free periods. Case Description: A 30-year-old male presented with a very large magnetic resonance-documented Tarlov cyst (Nabors Type 2) arising from bilateral S2 nerve root sheaths with marked pelvic extension. Although he was initially treated with a S1, S2 laminectomy, closure of the dural defect, and excision/marsupialization of the cyst, he later required placement of a thecoperitoneal shunt (TP shunt). Conclusion: A 30-year-old male with large Nabors Type 2 Tarlov cyst arising from both S2 nerve root sheaths required a S1-S2 laminectomy, dural closure/marsupialization, and imbrication of the cyst, eventually followed by placement of a TP shunt.

Advances in the Diagnosis and Treatment of Sacral Cysts

“…The nature of pain is mostly dull or aching pain, and in severe cases, severe pain or burning pain can occur. When the pressure in the spinal canal increases [8], such as prolonged standing, prolonged sitting, exertion, coughing, etc., the accumulation of cerebrospinal fluid in the sacral canal can lead to symptom aggravation, and patients may manifest a series of neurological dysfunctions, such as lower extremity muscle weakness, muscle atrophy, hypesthesia, ankle reflexes abnormalities, and so on. Among them, hypesthesia is the most common symptom, mostly appearing in the distal part of the lower limbs with a stocking-like distribution.…”