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.
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.
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.
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.
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.