Abstract
Purpose
Symptomatic Tarlov cysts in children with a possible underlying one-way check-valve mechanism are very rare. We aim to introduce a new variation of the surgical technique to overcome a check-valve mechanism.
Methods
A 15-years-old girl presented with double incontinence and anogenital numbness due to a large sacral Tarlov-cyst with possibly underlying one-way check valve mechanisms as suggested by preoperative computed tomography myelography. Intraoperatively, one-way check-valve was confirmed and could be eliminated by creating an artificial inner ostium between the Tarlov cyst and thecal sac with blunt perforation.
Results
Postoperatively, the patient had established normal sphincter control and sensation in the anogenital region.
Conclusion
One-way check-valve mechanism might contribute to the symptomatology of large sacral Tarlov cysts in children. Our new variation of a surgical technique enables elimination of the check-valve mechanism without the necessity to open and close the typically very thin and fragile cyst surface and is therefore an efficacious and simple option in this situation.
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Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- CSF:
-
Cerebrospinal fluid
- Cm:
-
Centimetre
- CT:
-
Computed tomography
- IONM:
-
Intraoperative neurophysiologivcal monitoring
- MRI:
-
Magnetic resonance imaging
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Acknowledgements
We kindly thank all colleagues involved in the multidisciplinary treatment of the patient described in this case report.
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SS—Writing—Original draft write up, Data curation, patient care—Neurosurgical Spine Surgeon; JF—Writing—Original draft write up, Data curation; SW—Data curation; AM—Data curation, patient care—Neurosurgical Spine Surgeon; TB—Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing–review & editing, Patient Care—Orthopaedic Spine Surgeon; DL—Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing–review & editing, Patient Care—Orthopaedic Spine Surgeon; JB—Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing–review & editing, Patient Care—Orthopaedic Spine Surgeon; all authors contributed to the article and approved the submitted version.
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Siller, S., Funnell, J.P., Bishop, T. et al. Large symptomatic sacral Tarlov cyst in a paediatric patient: case report and technical note on a new variation of surgical technique to overcome one-way check-valve mechanism. Eur Spine J (2024). https://doi.org/10.1007/s00586-023-08102-8
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DOI: https://doi.org/10.1007/s00586-023-08102-8