Tarlov cysts: clinical evaluation of an italian cohort of patients

Abstract

Tarlov cyst syndrome is a rare, often asymptomatic disorder, characterised by isolated or multiple nerve-root cysts, usually occurring in the sacral spine, near the dorsal root ganglion, between the perineurium and endoneurium. The cysts may cause lower back pain, sacral radiculopathy, dyspareunia and urinary incontinence. There is little data in the literature on the relationship between Tarlov cysts and symptoms. Here, we report further details on the clinical impact of Tarlov cysts and investigate their pathogenesis and role as a cause of lumbosacral symptoms. We examined 157 patients with MRI evidence of symptomatic Tarlov cysts. Patients underwent complete neurological examination and were scored by the Hamilton Depression Rating Scale and the Visual Analogue Scale. Complete lower limb electromyography was performed in 32 patients. Clinical picture was correlated with size and number of cysts detected by MRI. Family history was recorded for signs of genetic inheritance. Almost all patients suffered perineal or lower back pain; 34 complained of sphincter and 46 of sexual disorders. Hamilton scores were abnormal, and family history was positive in a few cases. The scanty literature on Tarlov cysts mainly regards therapy by a neurosurgical approach. Our results provide new data on clinical impact and possible pathogenetic mechanisms.

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

“…It has been reported that 61.2%-87% of patients who harbor TCs are women [5,6,30,48,50]. We found that this number was 74.8% in case reports and 90% in our EMG study.…”

“…Feigenbaum performed TC surgeries in 8 women with PGAD, resulting in a significant improvement in symptoms [56]. In a cohort of 157 STC patients, Marino reported that sexual issues were identified in 29% of the patients [30]. Of the 23 sexually active female patients in our study, 16 reported dyspareunia.…”

“…Onset may occur when there is a history of trauma or heavy straining [30]. In our study, 16.7% of the patients reported that trauma was the trigger that elicited or aggravated their symptoms.…”

“…However, the majority (86.6%) of the patients could not lie down for long periods of time because of local pain on pressure points (e.g., the sacrum and the greater trochanter). In women, the symptoms may be exacerbated during pregnancy [30]. Among our patients, 12 out of the 16 women who had been pregnant reported pelvic or lower back pain during pregnancy.…”

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

“…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.…”