Sacral Perineural Cyst Accompanying Disc Herniation

Ju, Chang Il; Shin, Ho Seong; Kim, Seok Won; Kim, Hyeun Sung

doi:10.3340/jkns.2009.45.3.185

Cited by 19 publications

(27 citation statements)

References 13 publications

(15 reference statements)

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“…These phenomena can be explained by the ball-valve mechanism. 3,5,11,12) In our case, although the pain was neither exacerbated by movements which increase the CSF pressure nor relieved by recumbence, we diagnosed S-2 and S-3 nerve root radiculopathy caused by a sacral perineural cyst, because MR imaging had revealed the perineural cyst at the S2 level affecting the right S-2 and S-3 nerve roots without lumbar or sacral lesions.…”

Section: Discussionmentioning

confidence: 89%

“…Several surgical procedures for perineural cysts have been reported, [1][2][3][4][5][6][7][10][11][12][13][14][15][16]18,19) but no consensus exists of the most appropriate. The procedures are of three types: procedures to lower CSF hydrostatic and pulsatile pressures, such as external CSF drainage 1) or lumbar peritoneal shunt 1) ; procedures to decompress cysts, such as simple decompressive laminectomy, 15) CT-guided percutaneous aspiration, 7,13) or cyst-subarachnoid shunt 5,10) ; and direct surgical procedures such as bipolar cautery to shrink cysts, 14) total cyst removal, 2,12) partial cyst removal with neck ligation, 4,18) or cyst wall imbrication.…”

Section: Discussionmentioning

confidence: 99%

“…The procedures are of three types: procedures to lower CSF hydrostatic and pulsatile pressures, such as external CSF drainage 1) or lumbar peritoneal shunt 1) ; procedures to decompress cysts, such as simple decompressive laminectomy, 15) CT-guided percutaneous aspiration, 7,13) or cyst-subarachnoid shunt 5,10) ; and direct surgical procedures such as bipolar cautery to shrink cysts, 14) total cyst removal, 2,12) partial cyst removal with neck ligation, 4,18) or cyst wall imbrication. 3,6,11,16,19) These surgical options are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…6,13) Depending on the location, size, and relationship to the nerve roots, perineural cysts may cause local or radicular pain, sensory disturbance, motor deficits, neurogenic claudication, bowel and bladder dysfunction, or sexual impotence. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Specific radicular pain may be the result of distortion, compression, or stretching of the nerve root by the space-occupying features of cysts. Symptoms can be exacerbated by changes in posture, coughing, Valsalva maneuvers, standing, lifting, and climbing stairs, all of which increase CSF pressure.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Sacral Perineural Cyst -Case Report-

Matsumoto

Miki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 67-year-old man presented with persistent penis and scrotum pain due to S-2 and S-3 radiculopathy caused by a sacral perineural cyst. The cyst was treated with microsurgical partial cyst removal and cyst wall imbrication, together with closure of the point through which cerebrospinal fluid (CSF) flowed from the subarachnoid space into the cyst cavity. His pain resolved without recurrence of the cyst or complications. Symptomatic perineural cysts are quite rare. Surgical closure of the point through which CSF flows from the subarachnoid space into the cyst cavity is the most important intervention for symptomatic perineural cysts. If the source of CSF leakage cannot be detected, placement of a cystsubarachnoid shunt should be considered in addition to partial cyst removal and cyst wall imbrication.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Sacral Perineural Cyst -Case Report-

Matsumoto

Miki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…The largest cyst found during our study was 4 cm in diameter. The common symptoms associated with Tarlov cysts are local low back pain, perineal or sciatic pain, vaginal or penile paraesthesia or sensory changes over the buttocks, perineal area and lower extremity, neurogenic claudication and genitourinary/bowel dysfunction 7,8,10,12,13,[17][18][19][20]22,23,25,32,33,[36][37][38][39][40][41] . Most of our patients presented with multiple complaints.…”

Section: Asian Journal Of Medical Sciences 4(2013) 35-42mentioning

confidence: 99%

Symptomatic Tarlov Cysts: an MRI evaluation of case series and literature review

et al. 2013

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Aim:To analyze the characteristics of symptomatic Tarlov cysts by MRI. Materials and Methods:Neuroimaging and clinical outcome data were reviewed of 48 consecutive patients treated for symptomatic Tarlov cysts. All patients were scanned under Philips Gyroscan Intera 1.5T scanner with spinal surface coils. Two widely used surgical procedures were performed, 1) incision and drainage of the cyst with imbrication of the redundant nerve root sheath, and 2) exposure of the cyst, drainage of cyst contents, identification of nerve roots, and cyst wall resection combined with duraplasty. The post-operation follow-up was obtained from return visits to the neurosurgery and orthopaedic out-patient department or by telephone questionnaires.Results: All cystic lesions showed hypointense signal intensity on T1WI and hyperintense signal intensity on T2WI, but the nerve root showed iso-intensity on T1WI and low signal intensity on T2WI. They were linear in shape on sagittal view, and hypo intense dotted spots within the cysts on traverse view. Surrounding structures of the larger cysts were compressed and had bone erosions in some cases; the spinal canal and the intervertebral foramen on the affected side were enlarged. The lesions/cyst wall showed no enhancement after gadolinium administration.Conclusion: MRI will give a definite diagnosis of Tarlov cysts if nerve root presents within the cyst cavity or in the cyst wall; eliminating the need for histological confirmation. A correct analysis of the characteristics of symptomatic Tarlov cysts by MRI, will document its usefulness in noninvasive diagnosis and aid in exploration of the simplest treatment method.

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Uncommon cause of radiculopathy: A case of symptomatic Tarlov cyst in an elderly female and literature review

Devkota,

Adhikari,

Lamichhane

et al. 2024

Clinical Case Reports

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Key Clinical MessageTarlov cysts are uncommon causes of sacral radiculopathy, with particular predilection to second and third sacral roots, requiring timely diagnosis with lumbosacral MRI, and surgical management if symptomatic.AbstractTarlov cysts or Type II meningeal cysts, are CSF‐filled sacs located in the extradural space of the sacral spinal canal, commonly originating at the dorsal root ganglion. While they were first documented by Tarlov in 1938, their etiology remains uncertain, with theories suggesting trauma‐induced bleeding or congenital abnormalities. These cysts, estimated to affect between 1% and 9% of the adult population, typically manifest as incidental findings but may lead to symptoms such as radiculopathies, sacral pain, and weakness in related sacral muscles. We present a case of a 63‐year‐old female presenting with recurrent left buttock pain and radiating leg discomfort. Physical examination revealed tenderness in the left buttock region, positive straight leg raise test, and minimal sensory deficits in the S1‐S2 dermatomes. A provisional diagnosis of radiculopathy was made, prompting further evaluation with MRI, revealing a Tarlov cyst and absence of lumbar spinal canal stenosis or neural foraminal compromise. The patient declined intervention and was managed conservatively. This case highlights the diagnostic challenges and therapeutic considerations in managing symptomatic Tarlov cysts, emphasizing the importance of tailored treatment strategies.

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Sacral Perineural Cyst Accompanying Disc Herniation

Cited by 19 publications

References 13 publications

Surgical Treatment of Sacral Perineural Cyst -Case Report-

Surgical Treatment of Sacral Perineural Cyst -Case Report-

Symptomatic Tarlov Cysts: an MRI evaluation of case series and literature review

Uncommon cause of radiculopathy: A case of symptomatic Tarlov cyst in an elderly female and literature review

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