Symptomatic Tarlov cysts are often overlooked: ten reasons why—a narrative review

Hulens, Mieke; Rasschaert, Ricky; Bruyninckx, Frans; Dankaerts, Wim; Stalmans, Ingeborg; Mulder, Peter De; Vansant, Greet

doi:10.1007/s00586-019-05996-1

Cited by 32 publications

(31 citation statements)

References 53 publications

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“…Patients with TCs often experience back and leg pain, as well as a burning pain in the perineum, numbness in the lower limbs, sensory disturbances, abnormal urination and defecation, and sexual dysfunction. The symptoms are varied and can lead to misdiagnosis [4,3,5,9]. In the present case, the patient's main symptom was spermatorrhea.…”

Section: Discussionmentioning

confidence: 68%

Neglected tarlov cysts: A case of a tarlov cyst with spermatorrhea.

Sun

et al. 2020

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Background: Tarlov cysts are a commonly misdiagnosed condition, which can present with many rare symptoms. We report a case of a tarlov cyst with spermatorrhea, and review the pertinent literature.Case presentation: A 42-year-old male patient had a history of spermatorrhea for >10 years, but was incorrectly diagnosed as the patient and the doctors consistently mistook the symptoms for a genitourinary disease. Magnetic resonance imaging showed that two cysts in the sacral canal. The diagnosis was tarlov cyst. We performed surgery to remove the cyst and the symptoms of spermatorrhea disappeared after operation.Conclusions: This case demonstrates that orthopedics and urologists should improve their understanding of tarlov cysts in order to avoid misdiagnosis and mistreatment.

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Section: Discussionmentioning

confidence: 68%

Neglected tarlov cysts: A case of a tarlov cyst with spermatorrhea.

Sun

et al. 2020

Preprint

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“…Perineural cysts, or Tarlov cysts, can occur more frequently in those with connective tissue disease but are also frequent incidental radiographic findings in the general population. These cysts can sequester CSF and cause intractable headache in a minority of patients 5–7 . Although our patient has no connective tissue disease, his multiple Tarlov cysts may suggest underlying dural weakness that predisposed him to SIH.…”

Section: Figurementioning

confidence: 75%

“…The associated headache may worsen during the day with straining and exertion, particularly during upright and sitting positions that decrease compliance of the dural sac and cause caudal shift of CSF. 7,13,14 Decreased hydrostatic pressure in recumbency may improve peripheral pain and perhaps headache. 13 It is therefore possible that this patient's headache may have initially occurred in the setting of increased intracranial pressure before eventual connective tissue weakness and nerve sheath dilation resulted in the spontaneous CSF leaks.…”

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confidence: 99%

Paradoxical headache in a case of chronic spontaneous intracranial hypotension and multiple perineural cysts

et al. 2021

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“…They are significantly more common in women, and women are also more likely to be symptomatic (4). MRI studies of patients with back pain have revealed that 70% of patients with TCs are women, and sex-related differences in the composition of the dura mater or spinal nerve roots have been postulated to be the underlying cause of this female predominance (7). The pathogenesis of these cysts is unclear, although various hypotheses have been proposed to explain the formation of the slit valve mechanism that allows CSF to pass into the cysts (10).…”

Section: Management Coursementioning

confidence: 99%

“…Electromyography (EMG) can be useful for assessing patients who show symptoms of neurologic changes (4). There is no consensus on the appropriate treatment of TCs; known treatments for symptomatic TCs include conservative management, percutaneous interventions, or surgical procedures such as laminectomy and fenestration (7). Although endopelvic extension of TCs is uncommon, these cysts may present as an incidental finding on routine gynecological ultrasound imaging (8).…”

Section: Introductionmentioning

confidence: 99%

Tarlov Cysts Misdiagnosed as Adnexal Masses in Pelvic Sonography: A Literature Review

et al. 2020

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Introduction: A Tarlov cyst (TC) is a perineural cyst filled with cerebrospinal fluid that originates from the dorsal ganglion or the spinal posterior nerve root. TCs are usually asymptomatic and incidentally found in the sacral region. Endopelvic extension of TCs is uncommon and can be misdiagnosed as an adnexal mass on gynecological ultrasound imaging.Methods: We performed a search for all clinical studies of TCs that mimicked adnexal masses that had been published through October 12, 2020. We placed no restrictions on language or year of publication in our search, and we performed searches with the following keywords: perineural cyst, Tarlov cyst, sclerotherapy, management, and prognosis. We included all misdiagnosed cases or cases considered as adnexal masses on pelvic sonography.Results: We identified 21 cases of TCs mimicking adnexal masses and conducted a comprehensive analysis of these 21 cases to assess the epidemiology, symptoms, initial diagnoses, provisional ultrasound diagnoses, confirmative modalities, sizes, locations, treatments, and outcomes. The 21 cases included 16 symptomatic cases (76%) and 5 cases with incidental findings (24%), and the average patient age was 41.3 years. The initial diagnosis was performed with ultrasonography in all cases. The most frequent misdiagnosis was unspecified adnexal mass. Confirmative diagnostic modalities were MRI only (67%), CT only (5%), and both MRI and CT (28%). Treatments were surgery (33%), conservative treatment (19%), percutaneous intervention (5%), and alcohol sclerotherapy (5%). In two symptomatic cases misdiagnosed as pelvic masses, cystectomy was performed and leakage of cerebrospinal fluid occurred, necessitating repair of the leak. In one of the asymptomatic patients, cauda equina syndrome occurred after alcohol sclerotherapy for misdiagnosed TC. However, the patient improved with no neurologic deficit after 18 months of conservative treatment.Conclusion: The possibility of large TCs should be considered when assessing adnexal masses in sonography. Since TCs can masquerade as pelvic masses, they should be considered if the mass appears tubular/cystic or multilocular/multiseptate, does not move with respiration, and originates from the sacrum in sonography with or without neurologic symptoms. Accurate diagnosis can prevent medical mismanagement and reduce patient discomfort.

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Symptomatic Tarlov cysts are often overlooked: ten reasons why—a narrative review

Cited by 32 publications

References 53 publications

Neglected tarlov cysts: A case of a tarlov cyst with spermatorrhea.

Neglected tarlov cysts: A case of a tarlov cyst with spermatorrhea.

Paradoxical headache in a case of chronic spontaneous intracranial hypotension and multiple perineural cysts

Tarlov Cysts Misdiagnosed as Adnexal Masses in Pelvic Sonography: A Literature Review

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