Surgical Treatment of Sacral Perineural Cyst -Case Report-

Abstract

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.

Multiple Large Perineural (Tarlov) Cysts in the Sacrum of a Cadaver: A Case Report and Review

“…Symptoms are aggravated by standing, walking, or climbing stairs and are only relieved by recumbence [5-6]. …”

“…Symptoms of Tarlov cysts include sacral and ischial pain, urogenital and bowel incontinence, sciatica, coccydynia, and cauda equina syndrome [ 3 , 5 , 7 ]. Symptoms are aggravated by standing, walking, or climbing stairs and are only relieved by recumbence [ 5 - 6 ].…”

“…Most cases of Tarlov cysts are asymptomatic and do not freely communicate with the subarachnoid space [ 4 ]. Although many clinical studies have examined the surgical treatments, the pathogenesis and best treatment has yet to be determined and is controversial [ 2 , 5 - 6 ]. To our knowledge, there have been no cadaveric studies of the perineural sacral cyst.…”

Clinical Experience of Symptomatic Sacral Perineural Cyst

“…However, even when surgical treatment is performed, there is no improvement in approximately 28% of patients, and there are reports that it instead causes complications such as CSF leakage, urinary dysfunction, and cerebral hemorrhage [12]. Therefore, there should be caution when selecting surgical treatment and it may be more beneficial for patients when conservative treatments such as epidural block are considered first.…”

Symptomatic Tarlov cyst in cervical spine

“…Joshi et al had to go for surgical excision in their case of a large Tarlov cyst mimicking a cervical spinal tumour 7. The surgery per se has its own technical difficulties and challenges as repair of such small lesions may be associated with complications of nerve root injury, postoperative CSF leak and subsequent persistent neuropathic pain 8…”