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2015, Number 2

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Acta Med 2015; 13 (2)

Symptomatic Tarlov cyst: A challenge for diagnosis and management

Domínguez-Gasca LG, Hasslacher-Arellano JF, Arellano-Aguilar G, Mora-Constantino J, Domínguez-Carrillo LG

Language: Spanish
References: 40
Page: 104-108
PDF size: 188.65 Kb.


ABSTRACT

Background: Perineural (Tarlov) cysts are meningeal dilations of the posterior spinal nerve root sheath that most often affect sacral roots and can cause a progressive painful radiculopathy. Tarlov cysts (TC) are most commonly diagnosed by lumbosacral magnetic resonance imaging and can often be demonstrated by myelotomography to communicate with the spinal subarachnoid space. The cyst can enlarge via a net inflow of cerebrospinal fluid, eventually causing symptoms by distorting, compressing, or stretching adjacent of nerve roots. It is generally agreed that asymptomatic TC do not require treatment. When symptomatic, the potential surgery related benefit and the specific surgical intervention is controversial. Clinical case: Female of 46 years old with sacro-coccygodynia, without irradiations and 8 months evolution, exacerbated by bipedal position, ambulation, Valsalva maneuver and jugulars veins compression, improvement with lateral decubitus position, the patient was revised and treated by gastroenterology, proctology, gynecology, neurology and psychiatry without changes in symptoms. RM study a Talorv cyst is detected. Treated with physical medicine with exercises a physical therapy without changes. The patient was canalized to Neurosurgical center with experience in TC treatment. Conclusions: It is generally agreed that asymptomatic Tarlov cysts do not require treatment. When symptomatic, the potential surgery related benefit and the specific surgical intervention remain controversial. Medical treatment of TC for patient and physician is frustrates.


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