Tarlov cysts, also referred to as perineural or sacral nerve root cysts, are cerebrospinal-fluid filled sacs that occur as dilatations of nerve root sheaths at the dorsal root ganglion. They commonly occur at the sacral spine especially around S1, S3. However, they can occur at any level of the spine. In fact, approximately 11% of people with the condition have multiple cysts distributed along the cervical, thoracic, and lumbar vertebrae as well.
Tarlov cysts are relatively rare with an annual incidence of approximately 5 % and are more common in women than in men. The etiology and the process of formation of these cysts are not well defined. However, several hypotheses have been postulated, including the obstruction of venous drainage in the perineum due to the deposition of hemosiderin as a result of trauma, congenital origin and hemorrhagic infiltration of spinal tissue following trauma.
Signs and Symptoms of Tarlov Cyst
The condition has no obvious signs and symptoms and, in most cases, people with the condition will not realize that they have it. Therefore, it frequently goes undiagnosed. However, as time progresses, the cerebrospinal fluid within the cyst builds up resulting in the compression of surrounding nerve roots. Signs and symptoms such as intense lower back pain, sciatica (following the compression of the sciatic nerve), urinary incontinence, headaches, sexual dysfunction, constipation, and some loss of feeling or control of movement in the leg and/or foot are indications. These symptoms can also be triggered by several other conditions including trauma, heavy lifting, epidural, and childbirth.
Treatment of Tarlov Cysts
There are several treatment and management options for Tarlov cysts. These can either be conservative (non-surgical) or surgical. Conservative management involves only symptomatic treatment through the administration of analgesics to reduce pain, muscle relaxants to reduce muscle tightness and physiotherapy. Surgical treatment is only offered to individuals who have gone through conservative management but did not respond appropriately. It is also recommended for patients with much more complicated symptoms such as urinary retention. Studies have shown that only a few patients who undergo conservative management eventually get full relief of their signs and symptoms.
Surgical Management of Tarlov Cysts
There are several surgical techniques that can be used in the management of Tarlov cysts. The choice of technique will depend on factors such as the patient’s age and general health condition, the progression of the disease and the compression on surrounding structures. They include:
Fibrin Glue Therapy
This form of treatment aims to deflate the cyst in order to relieve its compression effects on surrounding tissues. It involves the aspiration of cerebrospinal fluid and the application of a fibrin glue at the puncture point to prevent the continuous leakage of CSF. However, this form of treatment is quite risky as the glue can dislodge easily and travel to other locations along the spinal canal where it could cause a condition known as adhesive arachnoiditis. Adhesive arachnoiditis is characterized by pain that is spread over different dermatomes.
Microsurgical Excision of Tarlov Cyst
This involves the surgical removal of the cyst. A study conducted to evaluate its effectiveness in the management of the condition showed that 82 % (9/11) of test participants had significant symptomatic relief. This study published in the journal Neurosurgery Journal in 2007 involved 11 patients who had undergone the surgical procedure and were followed post-surgically for 6 months to 10 years depending on year of surgery.
Surgical Clipping of Tarlov Cyst
This method is mainly used for very large cysts. It involves removal of vertebral bones over the cyst to expose it. The cyst is then incised and drained. Its walls are then collapsed and circumferentially reinforced and sutured or the surgeon could decide to pack the region with fat or tissue adhesive to prevent it from filling with CSF again. A Study that involved 19 patients who had undergone the procedure showed that none of the patients had signs of CSF leakage even 25 years after the procedure. It is, therefore, one of the most effective methods in the management of Tarlov Cysts.