Abstract
ObjectivePerineural cysts, also known as Tarlov cysts, are cerebrospinal fluid-filled growths that develop at the intersection of a dorsal root ganglion and posterior nerve root. They are typically an asymptomatic and incidental finding during routine spine imaging. For symptomatic perineural cysts, there is little evidence on which treatment is most effective or when it is indicated. The aim of this study was to review our experience from a population-based cohort of patients with symptomatic perineural cysts and to propose an algorithm that could be used in the selection of surgical candidates.MethodsA retrospective review was conducted of all adult (≥ 15 years) patients with symptomatic perineural cysts who were referred to Karolinska University Hospital between 2002 and 2018.ResultsThirty-nine patients were included. The most common symptom was sciatica (n = 22). Cyst aspiration was performed in 28 patients, 24 of whom showed clinical improvement and were offered surgery. Microsurgical cyst fenestration was performed in 17 patients, 16 of whom showed clinical improvement at long-term follow-up. There were no surgical complications. Ten of the patients who were offered surgery chose to be treated conservatively instead, four of whom showed progression of symptoms at long-term follow-up.ConclusionsMicrosurgical cyst fenestration seems to be a safe and effective option for symptomatic relief in patients with perineural cysts. Based on the results from our series and those of others, we propose an algorithm for the selection of surgical candidates.
Highlights
Perineural cysts, known as Tarlov cysts [24], are cerebrospinal fluid (CSF)-filled growths, originating between the perineurium and endoneurium, which develop at the intersection of a dorsal root ganglion and posterior nerve root [8]
The aim of this study was to review our institutional experience of patients with symptomatic perineural cysts, in order to provide population-based observational data and to propose an algorithm for the selection of surgical candidates
The aim of this study was to present our experience from a population-based cohort of patients with symptomatic perineural cysts and to propose an algorithm for the selection of surgical candidates
Summary
Perineural cysts, known as Tarlov cysts [24], are cerebrospinal fluid (CSF)-filled growths, originating between the perineurium and endoneurium, which develop at the intersection of a dorsal root ganglion and posterior nerve root [8]. Their etiology is largely unknown [9], but cyst growth is believed to be the result of a valve-like microcommunication, allowing CSF influx but restricting efflux [27]. The aim of this study was to review our institutional experience of patients with symptomatic perineural cysts, in order to provide population-based observational data and to propose an algorithm for the selection of surgical candidates
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
