Hiding in Plain Sight: A Case of Tarlov Perineural Cysts

Hiers, Reta Honey; Long, Donlin M.; North, Richard B.; Oaklander, Anne Louise

doi:10.1016/j.jpain.2010.07.007

Cited by 20 publications

(25 citation statements)

References 14 publications

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“…Conservative approaches including analgesic/anti-inflammatory medication and physical therapy have achieved varying degrees of success in reducing cyst-associated symptoms. 19 Surgical methods, meanwhile, include lumbar-peritoneal and cysto-subarachnoidal drainage and shunting, 20;21 bipolar cautery to shrink cysts, 22 decompressive laminectomy, 23–25 and laminectomy with either total cyst resection, 1;10;26;27 partial cyst wall resection, 28 or duroplasty/plication of cyst walls. 29 Despite standard limitations such as malfunction and infection after shunting, persistence of pain after laminectomy, and radicular deficits after ablative procedures, a prior review found that 88.6% of patients in the studies evaluated were satisfactorily relieved by surgery according to each report’s outcome criteria.…”

Section: Introductionmentioning

confidence: 99%

Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant

Murphy

Oaklander

Elias

et al. 2015

AJNR Am J Neuroradiol

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Purpose The purpose of this study was to analyze the safety and efficacy of intervention in patients with symptomatic Tarlov cysts by percutaneous, CT-guided two-needle cyst aspiration and fibrin sealant injection. Materials and Methods This study was designed to assess outcomes in patients who underwent CT-guided aspiration and injection of one or more sacral Tarlov cysts at Johns Hopkins Hospital between the years of 2003 and 2013. In all, 289 cysts were treated in 213 consecutive patients. All of these patients were followed for at least six months; 90% were followed for one year and 83% were followed for three to six years. The aspiration-injection procedure employed two needles and was carried out with local anesthesia and intravenous analgesia. In the fibrin injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH; Baxter Healthcare, Westlake Village, California). Results One year post-procedure, excellent results had been obtained in 104 patients (54.2% of patients followed) and good or satisfactory results had been obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At three to six years post-procedure, 74.0% of patients followed were satisfied with treatment. There were no significant complications. Conclusions The aspiration-injection technique described herein constitutes a safe and efficacious treatment option that holds promise for relieving cyst-related symptoms in many patients with very small risk.

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Section: Introductionmentioning

confidence: 99%

Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant

Murphy

Oaklander

Elias

et al. 2015

AJNR Am J Neuroradiol

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“…Additional evidence of increased intraspinal pressure indicates a higher risk of experiencing a dural leak while performing surgery for STCs [6,11,19,25,31,32]. This is because of the fragility of the tissues and the elevated pressure in the spinal canal [10].…”

Section: Pathogenesismentioning

confidence: 99%

“…This is because of the fragility of the tissues and the elevated pressure in the spinal canal [10]. Finally, a high frequency of headaches might also reflect increased pressure in the cerebrospinal canal [1,2,8,11,18,33].…”

Section: Pathogenesismentioning

confidence: 99%

“…It has been suggested that female patients are unlikely to discuss their perineal symptoms with their physician, and this omission may contribute to the impression that TCs are clinically insignificant [5,11,53].…”

Section: Perineal Pain and Numbnessmentioning

confidence: 99%

“…Depression is a common comorbidity in STC patients [2,11,55]. Longstanding, unexplained, and debilitating neuropathic pain is often misunderstood not only by a patient's family, friends, and peers but also by their physicians.…”

Section: Depressionmentioning

confidence: 99%

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Electromyography and A Review of the Literature Provide Insights into the Role of Sacral Perineural Cysts in Unexplained Chronic Pelvic, Perineal and Leg Pain Syndromes

Hulens¹,

Frans²,

Alix³

et al. 2017

Int J Phys Med Rehabil

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Management of Tarlov cysts: an uncommon but potentially serious spinal column disease—review of the literature and experience with over 1000 referrals

Murphy,

Nasralla,

Pron

et al. 2023

Neuroradiology

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Tarlov cysts were thought to be anatomic variants of uncertain etiology and clinical significance when initially described over 80 years ago. They are often detected in routine lumbosacral imaging and generally not reported in a differential diagnosis. There is increasing evidence that at least some Tarlov cysts are symptomatic and can have a significant adverse impact on patients’ health and well-being. Women are disproportionately affected with this condition, often presenting with long-standing pain and neurological dysfunctions. Significant gender bias has been a concern in the management of these patients. Unfortunately, there is no consensus on patient selection or management approaches for symptomatic Tarlov cysts. This review article updates information on the prevalence, diagnosis, clinical significance, and treatments of these cysts. Based on these findings and experience with over 1000 patient referrals, a treatment decision algorithm for symptomatic Tarlov cysts was constructed to provide guidance for appropriate management of patients with these complex cysts.

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Hiding in Plain Sight: A Case of Tarlov Perineural Cysts

Cited by 20 publications

References 14 publications

Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant

Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant

Electromyography and A Review of the Literature Provide Insights into the Role of Sacral Perineural Cysts in Unexplained Chronic Pelvic, Perineal and Leg Pain Syndromes

Management of Tarlov cysts: an uncommon but potentially serious spinal column disease—review of the literature and experience with over 1000 referrals

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