title: Pelvic pain from a giant presacral Tarlov cyst successfully obliterated using aneurysm clips in a patient with Marfan syndrome.
abstract: Patients with Marfan syndrome used to succumb early in life from cardiovascular complications. With the current rapid advance in medical and surgical care, such patients may now have near-normal longevities. Consequently, rare late-life complications are emerging in these patients and represent challenges to clinicians for their diagnoses and treatments. The authors report a rare case of pelvic pain and genital prolapse from a giant presacral Tarlov cyst in a 67-year-old patient with Marfan syndrome. This 67-year-old Caucasian female presented with progressively severe pelvic pain, intermittent explosive diarrhea, and dysuria. Physical and bimanual examination demonstrated genital prolapse and a nontender, cyst-like mass fixed in the midline. She underwent ultrasound, CT, and eventually MRI evaluations that led to the diagnosis of a giant (6.7 × 6.4 × 6.6 cm) Tarlov cyst originating from the right S-2 nerve root sleeve/sacral foramen with intrapelvic extension. She underwent S1-S2 and S2-S3 laminectomy with obliteration of the Tarlov cyst using aneurysm clips. Postoperatively, her pelvic pain and bowel symptoms resolved and the bladder symptoms improved. The 3-month follow-up CT of abdomen/pelvis demonstrated resolution of the cyst. The present case illustrates that clinicians caring for elderly patients with Marfan syndrome need to increasingly recognize such unusual late-life complications. Also, these large Tarlov cysts can be simply and effectively obliterated with aneurysm clips.
authors.affiliation: Departments of 1 Internal Medicine and.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wang
authors.forename: Seong-Jin
authors.initials: SJ
authors.lastname: Moon
authors.forename: William C
authors.initials: WC
authors.lastname: Olivero
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008382:Marfan Syndrome / Q000150:complications*; D017699:Pelvic Pain / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D013525:Surgical Instruments; D052958:Tarlov Cysts / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Marfan syndrome; Tarlov cyst; aneurysm clip; sacral