Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature

Burke, John F

Thawani, Jayesh P

Berger, Ian

Nayak, Nikhil R

Stephen, James H

Farkas, Tunde

Aschyan, Hovik John

Pierce, John

Kanchwala, Suhail

Long, Donlin M

Welch, William C

2019-10-24T18:25:42Z

2019-10-24T18:25:42Z

2016-05

2019-10-24T18:25:41Z

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Tarlov cysts (TCs) occur most commonly on extradural components of the sacral and coccygeal nerve roots. These lesions are often found incidentally, with an estimated prevalence of 4%–9%. Given the low estimated rates of symptomatic TC and the fact that symptoms can overlap with other common causes of low-back pain, optimal management of this entity is a matter of ongoing debate. Here, the authors investigate the effects of surgical intervention on symptomatic TCs and aim to solidify the surgical criteria for this disease process.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed a retrospective review of data from consecutive patients who were surgically treated for symptomatic TCs from September 2011 to March 2013. Clinical evaluations and results from surveying pain and overall health were used. Univariate statistical analyses were performed.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Twenty-three adults (4 males, 19 females) who had been symptomatic for a mean of 47.4 months were treated with laminectomy, microsurgical exposure and/or imbrication, and paraspinous muscle flap closure. Eighteen patients (78.3%) had undergone prior interventions without sustained improvement. Thirteen patients (56.5%) underwent lumbar drainage for an average of 8.7 days following surgery. The mean follow-up was 14.4 months. Univariate analyses demonstrated that an advanced age (p = 0.045), the number of noted perineural cysts on preoperative imaging (p = 0.02), and the duration of preoperative symptoms (p = 0.03) were associated with a poor postoperative outcome. Although 47.8% of the patients were able to return to normal activities, 93.8% of those surveyed reported that they would undergo the operation again if given the choice.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This is one of the largest published studies on patients with TCs treated microsurgically. The data suggest that patients with symptomatic TCs may benefit from open microsurgical treatment. Although outcomes seem related to patient age, duration of symptoms, and extent of disease demonstrated on imaging, further study is warranted and underway.</jats:p></jats:sec>

1547-5654

https://hdl.handle.net/10161/19438

Journal of Neurosurgery Publishing Group (JNSPG)

Journal of Neurosurgery: Spine

10.3171/2015.9.spine153

Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature

Journal article

Berger, Ian|0000-0002-6271-0548

700

707

5

Staff

Duke

Surgery

Clinical Science Departments

School of Medicine

Published

24