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Endoscopic transforaminal treatment of a thoracic perineural cyst: a case report

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Abstract

Background and importance

To describe the first case of a thoracic perineural cyst successfully treated using a direct thoracic transforaminal endoscopic approach.

Methods

Case report.

Clinical presentation

A 66-year-old male presented with right-sided radicular pain in a T4 distribution. MRI of the thoracic spine revealed a right T4 perineural cyst caudally displacing the root in the T4-5 foramen. He had failed attempts at nonoperative management. The patient underwent an all endoscopic transforaminal perineural cyst decompression and resection as a same-day surgical procedure. Postoperatively, the patient noted near complete resolution of the preoperative radicular pain. A thoracic MRI with and without contrast was performed 3 months after surgery and showed no evidence of the preoperative perineural cyst and no symptom recurrence was noted by the patient.

Conclusion

This case report presents the first safe and successful report of an all endoscopic transforaminal decompression and resection of a perineural cyst in the thoracic spine.

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References

  1. Im T (1938) Perineural cysts of the spinal nerve roots. Arch Neurol Psychiatry 40:1067–1074

    Article  Google Scholar 

  2. Dowsett LE, Clement F, Coward S et al (2018) Effectiveness of surgical treatment for Tarlov cysts: a systematic review of published literature. Clin Spine Surg 31(9):377–384. https://doi.org/10.1097/BSD.0000000000000582

    Article  PubMed  Google Scholar 

  3. Jiang W, Hu Z, Hao J (2017) Management of symptomatic Tarlov cysts: a retrospective observational study. Pain Physician 20(5):E653–E660

    PubMed  Google Scholar 

  4. Kozlowski P, Kalinowski P, Kozlowska M et al (2021) Spinal perineural cysts among European patients. J Neurol Surg A Cent Eur Neurosurg 82(5):463–467. https://doi.org/10.1055/s-0040-1722194

    Article  PubMed  Google Scholar 

  5. Voyadzis JM, Bhargava P, Henderson FC (2001) Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg 95(1 Suppl):25–32. https://doi.org/10.3171/spi.2001.95.1.0025

    Article  CAS  PubMed  Google Scholar 

  6. Aljuboori Z, Yaseen A, Simpson J, Boakye M (2017) Surgical excision of a symptomatic thoracic nerve root perineural cyst resulting in complete resolution of symptoms: a case report. Cureus 9(6):e1343. https://doi.org/10.7759/cureus.1343

    Article  PubMed  PubMed Central  Google Scholar 

  7. Guo D, Shu K, Chen R, Ke C, Zhu Y, Lei T (2007) Microsurgical treatment of symptomatic sacral perineural cysts. Neurosurgery 60(6):1059–1065. https://doi.org/10.1227/01.NEU.0000255457.12978.78

    Article  PubMed  Google Scholar 

  8. Mezzadri J, Abbati SG, Jalon P (2014) Tarlov cysts: endoscope-assisted obliteration of the communication with the spinal subarachnoid space. J Neurol Surg A Cent Eur Neurosurg 75(6):462–466. https://doi.org/10.1055/s-0033-1361836

    Article  PubMed  Google Scholar 

  9. Nadler SF, Bartoli LM, Stitik TP, Chen B (2001) Tarlov cyst as a rare cause of S1 radiculopathy: a case report. Arch Phys Med Rehabil 82(5):689–690. https://doi.org/10.1053/apmr.2001.22353

    Article  CAS  PubMed  Google Scholar 

  10. Paulsen RD, Call GA, Murtagh FR (1994) Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR Am J Neuroradiol 15(2):293–297

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Takatori M, Hirose M, Hosokawa T (2008) Perineural cyst as a rare cause of L5 radiculopathy. Anesth Analg 106(3):1022–1023. https://doi.org/10.1213/ANE.0b013e3181632583

    Article  PubMed  Google Scholar 

  12. Telfeian AE, Doberstein C, Oyelese AA, Fridley J, Donahue JE, Gokaslan Z (2019) A transforaminal endoscopic approach for treatment of a lumbar perineural cyst: technical note. World Neurosurg 127:85–91. https://doi.org/10.1016/j.wneu.2019.02.237

    Article  PubMed  Google Scholar 

  13. Zhang B, Dou Q, Feng P, Kong Q (2018) Percutaneous endoscopic treatment for a symptomatic sacral Tarlov cyst. World Neurosurg 116:390–393. https://doi.org/10.1016/j.wneu.2018.05.177

    Article  PubMed  Google Scholar 

  14. Kleib AS, Salihy SM, Hamdi H, Carron R, Soumare O (2018) A rare cause of thoracic spinal cord compression by multiple large Tarlov cysts. Korean J Neurotrauma 14(1):35–38. https://doi.org/10.13004/kjnt.2018.14.1.35

    Article  PubMed  PubMed Central  Google Scholar 

  15. Iwamuro H, Yanagawa T, Takamizawa S, Taniguchi M (2017) Atypical findings of perineural cysts on postmyelographic computed tomography: a case report of intermittent intercostal neuralgia caused by thoracic perineural cysts. BMC Med Imaging 17(1):37. https://doi.org/10.1186/s12880-017-0210-z

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tariq A, Majid A (2020) A case of thoracic perineural (Tarlov) cyst. Am J Respir Crit Care Med 201(11):e79. https://doi.org/10.1164/rccm.201908-1574IM

    Article  PubMed  Google Scholar 

  17. Joshi VP, Zanwar A, Karande A, Agrawal A (2014) Cervical perineural cyst masquerading as a cervical spinal tumor. Asian Spine J 8(2):202–205. https://doi.org/10.4184/asj.2014.8.2.202

    Article  PubMed  PubMed Central  Google Scholar 

  18. Oaklander AL, Long DM, Larvie M, Davidson CJ (2013) Case records of the Massachusetts General Hospital. Case 7–2013. A 77-year-old woman with long-standing unilateral thoracic pain and incontinence. N Engl J Med 368(9):853–861. https://doi.org/10.1056/NEJMcpc1114034

    Article  CAS  PubMed  Google Scholar 

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA

    Raymond J. Gardocki, Philip J. Chandler, Wilson E. Vaughan, Scott L. Zuckerman, Amir M. Abtahi & Byron F. Stephens

  2. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Scott L. Zuckerman, Amir M. Abtahi & Byron F. Stephens

  3. Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA

    Amir M. Abtahi & Byron F. Stephens

Authors
  1. Raymond J. Gardocki
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  2. Philip J. Chandler
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  3. Wilson E. Vaughan
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  4. Scott L. Zuckerman
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  5. Amir M. Abtahi
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  6. Byron F. Stephens
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Corresponding author

Correspondence to Philip J. Chandler.

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Conflict of interest

Dr. Zuckerman reports being an unaffiliated neurotrauma consultant for the National Football League. Dr. Stephens reports educational consulting for Medical Device Business Services and a grant from Stryker Spine [R1160501]. Dr. Gardocki is a teaching surgeon and consultant for Joimax, teaching surgeon and consultant with royalties for Integrity Implants, consultant for Arthrex, and consultant for NuVasive. For the remaining authors, none were declared.

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Gardocki, R.J., Chandler, P.J., Vaughan, W.E. et al. Endoscopic transforaminal treatment of a thoracic perineural cyst: a case report. Eur Spine J 32, 2679–2684 (2023). https://doi.org/10.1007/s00586-023-07582-y

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