Treatment of a symptomatic cervical perineural cyst with ultrasound-guided cervical selective nerve root block

Abstract

Rationale:Symptomatic cervical perineural cysts are extremely rare, and they cause radicular pain by compressing the cervical nerve root. Several methods have been applied to manage the radicular pain induced by cervical perineural cysts, including medication, percutaneous procedures, and surgery. However, these methods are associated with various outcomes and complications. The percutaneous procedure is simple and easy to perform, but if the perineural cyst wall is punctured, it can lead to secondary complications, which include aseptic meningitis and intracranial hypotension.Patient concerns:A 51-year-old woman presented with a dull pain in the left shoulder and a tingling sensation in the left dorsal arm, hand, and middle finger.Diagnosis:The patient was diagnosed with left C7 radicular pain caused by a perineural cyst.Interventions:The left C7 radicular pain did not respond to treatment with medication. Therefore, a left C7 nerve root block with local anesthetics and steroids was performed under ultrasound guidance. Adjunctively, real-time fluoroscopy with contrast was used to avoid intravascular injection.Outcome:The symptoms resolved without any complications.Lessons:In this case, perineural cyst-induced radicular pain, which was resistant to medication, was treated using ultrasound guided cervical selective nerve root block with local anesthetics and steroids. Ultrasound guidance can enable successful cervical selective nerve root block without perineural cystic wall puncture. Therefore, ultrasound-guided cervical nerve root block is an effective treatment option for radicular pain caused by a symptomatic perineural cyst.

A Rare Cause of Upper Extremity Pain: Cervical Perineural Cyst

“…9,10 Treatment option includes medication, transforaminal epidural steriod injections, microscopic surgery, percutaneous fibrin injection, selective dorsal root ganglion blockage. [11][12][13][14][15] As mentioned above, few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how they should be managed. Like our patient, some benefit from physical therapy and medications; for patients resistant to therapy, another therapy modality like epidural steroid injection, nerve root block and surgery may be considered.…”

“…Like our patient, some benefit from physical therapy and medications; for patients resistant to therapy, another therapy modality like epidural steroid injection, nerve root block and surgery may be considered. 10,15,16…”

Management of perineural (Tarlov) cysts: a population-based cohort study and algorithm for the selection of surgical candidates

“…However, in the literature, a wide variety of surgical methods have been described with variable rates of success. These include microsurgical cyst excision [6, 20], cyst fenestration [16, 22], anti-inflammatory medication [14], ultrasound-guided selective nerve root block [12], epiduroscopic neural laser decompression [10], CT-guided cyst aspiration [19], percutaneous injection of fibrin sealant [17], cyst-subarachnoid shunts [15, 23], lumboperitoneal shunts, and cyst-peritoneal shunts [3, 5]. In the largest cohort of treated perineural cysts to date, Murphy et al reported clinical improvement in 82% of 213 patients treated with minimally invasive CT-guided two-needle cyst aspiration and fibrin sealant injection [17].…”

“…Several authors emphasize the usefulness of CT-guided percutaneous aspiration as an important prognostic procedure to help identify patients where surgery might be beneficial [11, 26]. Furthermore, a wide variety of surgical methods with variable rates of success have been described, including microsurgical cyst excision [6, 20], cyst fenestration [16, 22], and conservative or minimally invasive methods [3, 5, 11, 12, 14, 15, 17, 19, 23].…”

Cervical tarlov cyst mimicking spinal hydatid disease: case report

“…Jungwon Lee et al 16 Performed ultrasound-guided cervical elective nerve root block using local anesthetics and steroids without fenestration of the cyst in a case of symptomatic cervical TC which was resistant to medication. 16 Therefore, ultrasound-guided cervical selective nerve root block is a safe and effective procedural option for the treatment of symptomatic cervical perineural cysts.…”