Symptomatic sacral Tarlov cyst

Abstract

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Paulsen RD reported the incidence of Tarlov cysts as 4.6% in back pain patients with only 1% of back pain patients were symptomatic[1]. The cysts are usually diagnosed on MRI, which reveals the lesion arising from the sacral nerve root near the dorsal root ganglion. There is no consensus on a single method of treatment. Various methods have been advocated. According to Voyadzis, 70% of patients who underwent sacral laminectomy with resection of the sacral cyst or cysts obtained complete or substantial resolution of their symptoms, with an average follow up of 31.7 months. We present a case of sacral cysts diagnosed with magnetic resonance imaging. The initial symptoms were low back pain and sciatica. Surgical treatment was performed by sacral laminectomy and marsupilation of the left perineural cyst. The neurological deficits were gradually recovered and had not recurred after a follow-up period of ten months.