Surgical Excision of a Symptomatic Thoracic Nerve Root Perineural Cyst Resulting in Complete Resolution of Symptoms: A Case Report.

Alae Yaseen,Jessica Simpson,Maxwell Boakye,Zaid Aljuboori

doi:10.7759/cureus.1343

Abstract

Tarlov (perineural) cysts of the nerve root are common and usually incidental findings during magnetic resonance imaging (MRI) of the lumbosacral spine. There are a few case reports where symptomatic thoracic perineural cysts have been described in the literature. We report a case of a high thoracic nerve root perineural cyst that failed conservative therapy, requiring surgical intervention. Our patient presented with radicular symptoms involving the left hand. Imaging workup revealed a cystic lesion of the left T1 nerve root at the level of the foramen. Surgical resection resulted in significant improvement in patient symptoms, and pathology revealed a perineural cyst. We conclude that a thoracic perineural (Tarlov) cyst can be symptomatic by causing nerve root compression and can be mistaken as a nerve root sheath tumor on imaging. Surgical treatment can be curative.

Highlights

Spinal extradural perineural cysts were initially described by Tarlov [1]
We report a case of a high thoracic nerve root perineural cyst that failed conservative therapy, requiring surgical intervention
We conclude that a thoracic perineural (Tarlov) cyst can be symptomatic by causing nerve root compression and can be mistaken as a nerve root sheath tumor on imaging

Summary

Introduction

Spinal extradural perineural cysts were initially described by Tarlov [1]. They are classified as type II meningeal cysts [2], most frequently found in the sacrum and very rarely in the thoracic spine. We present a case of a symptomatic thoracic nerve root perineural cyst treated with surgical excision. How to cite this article Aljuboori Z, Yaseen A, Simpson J, et al (June 12, 2017) Surgical Excision of a Symptomatic Thoracic Nerve Root Perineural Cyst Resulting in Complete Resolution of Symptoms: A Case Report. The patient had a cervical spine MRI, which showed a 1.25 x 1.25 cm homogenous cystic mass involving the left T1 spinal nerve within the neuroforamen. It appeared hypointense and hyperintense on T1W and T2W imaging respectively (Figure 1). We show an area of fibrous tissue with fibrin deposition and minimal scattered inflammatory cells infiltrate (H&E X 20)

Discussion

Disclosures

Tarlov IM

Findings