Tarlov cysts: long-term follow-up after microsurgical inverted plication and sacroplasty
- 463 Downloads
Surgical treatment of Tarlov cysts is still a matter of debate. Published literature thus far includes mainly small case series with retrospective evaluation and short-term follow-up. We present a novel microsurgical technique that combines the decompression of the nerve fibers with the prevention of recurrence. The long-term follow-up is provided.
The indication for surgery was incapacitating pain refractory to medical therapy for at least 6 months. The surgical technique consisted in microsurgical opening of the cyst, relief of CSF followed by secured inverted plication of the cyst wall, packing of remnant space with fat graft, and sacroplasty. Pain and neurological deficits were evaluated according to a modified Barrow National Institute score (BNI score, 0–5) and the Departmental Neuro Score (DNS score, 0–20).
A total of 13 patients (9 women, 4 men) were operated and followed up to 14 years (mean FU 5.3 years). Mean age at surgery was 51.8 (±14) years. Pain and neurological deficits improved significantly in 11/13 patients (BNI score pre-OP 5 vs 3.1 ± 1.2 at 1-year-FU, and 2.8 ± 1.2 at last follow-up visit; DNS score pre-OP 5.5 ± 1.5 vs 2.8 ± 2.1 at 1-year follow-up, and 2.6 ± 2.2 at last follow-up visit. Two patients needed revision surgery due to reoccurrence of the cyst. One patient suffered deterioration of preexisting neurological deficit.
The inverted plication technique combined with sacroplasty is a promising technique. It improves pain and neurological deficits on the long term in the majority of patients with symptomatic Tarlov cysts.
KeywordsTarlov cyst Perineural cyst Microsurgical treatment Pain Outcome
Compliance with ethical standards
Conflict of interest
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
- 17.Sun JJ, Wang ZY, Teo M, Li ZD, Wu HB, Yen RY, Zheng M, Chang Q, Yisha Liu I (2013) Comparative outcomes of the two types of sacral extradural spinal meningeal cysts using different operation methods: a prospective clinical study. PLoS One 8:e83964. doi: 10.1371/journal.pone.0083964 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Burke JF, Thawani JP, Berger I, Nayak NR, Stephen JH, Farkas T, Aschyan HJ, Pierce J, Kanchwala S, Long DM, Welch WC (2016) Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature. J Neurosurg Spine 24:700–707. doi: 10.3171/2015.9.spine153 CrossRefPubMedGoogle Scholar
- 22.Freidenstein J, Aldrete JA, Ness T (2012) Minimally invasive interventional therapy for Tarlov cysts causing symptoms of interstitial cystitis. Pain Phys 15:141–146Google Scholar
- 44.Wilkins RH (1996) Intraspinal cysts. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 2061–2070Google Scholar