794 Interventional Approaches to Symptomatic Tarlov Cysts: a Five-year Institutional Experience

Abstract

INTRODUCTION: Tarlov cysts are perineural collections of cerebrospinal fluid most often affecting sacral nerve roots. Up to 4.6% of the general population has one or more Tarlov cysts, with 20% of cysts becoming symptomatic, causing back pain, extremity paresthesias and weakness, bladder/bowel dysfunction, and sexual dysfunction. The most effective treatment of symptomatic Tarlov cysts, with options including nonsurgical management, cyst aspiration and injection of fibrin glue, cyst fenestration, and nerve root imbrication, is debated. METHODS: Retrospective chart review was conducted for 50 patients with Tarlov cysts seen at our institution in the last 5 years. Clinical outcome was determined based on improvement in one or more symptoms. RESULTS: 36 patients with symptomatic Tarlov cysts were identified.The average age of patients with symptomatic Tarlov cysts was 55.67 years (range, 2–77). Common symptoms were back pain/sacrococcygeal (94.4%), radiculopathy (66.7%), and bladder/bowel dysfunction (33.3%). 12% of patients had underlying connective tissue disorders (CTD), 44% of patients had bilateral cysts, and 16% of patients had cysts in multiple regions. 47.2% of patients with symptomatic Tarlov cysts were managed nonsurgically; 50% were managed with CT-guided aspiration of the cyst with or without injection of fibrin glue. Of patients treated interventionally, 47.4% saw lasting clinical improvement, with the most improvement in patients after aspiration with fibrin glue injection, 10.5% saw improvement for ≥ 6 months, and 36.8% saw no improvement or temporary improvement for < 6 months. CONCLUSIONS: Patients with symptomatic Tarlov cysts who underwent cyst aspiration with injection of fibrin glue saw the most clinical improvement. As a significant portion of patients with Tarlov cysts have CTD, evaluation by rheumatology may be warranted.