title: Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant.
abstract: OBJECTIVE
  There has been a steady progression of case reports and a small surgical series that report successful surgical treatment of Tarlov cysts with concomitant relief of patients' symptoms and improvement in their neurological dysfunction, yet patients are still told that these lesions are asymptomatic by physicians. The purpose of this study was to analyze the efficacy and safety of intervention in 213 consecutive patients with symptomatic Tarlov cysts treated by CT-guided 2-needle cyst aspiration and fibrin sealing.
  
  
  METHODS
  This study was designed to assess outcomes in patients who underwent CT-guided aspiration and injection of ≥1 sacral Tarlov cyst at Johns Hopkins Hospital between 2003 and 2013. In all, 289 cysts were treated in 213 consecutive patients. All these patients were followed for at least 6 months, 90% were followed for 1 year, and 83% were followed for 3-6 years. The aspiration-injection procedure used 2 needles and was performed with the patients under local anesthesia and intravenous anesthesia. In the fibrin-injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH).
  
  
  RESULTS
  One year postprocedure, excellent results were obtained in 104 patients (54.2% of patients followed), and good or satisfactory results were obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At 3-6 years postprocedure, 74.0% of patients followed were satisfied with treatment. There were no clinically significant complications.
  
  
  CONCLUSIONS
  The aspiration-injection technique described herein constitutes a safe and efficacious treatment option that holds promise for relieving cyst-related symptoms in many patients with very little risk.
authors.affiliation: From the Department of Radiology (K.M., G.E.), University of Toronto, Toronto, Ontario, Canada Kieran.murphy@uhn.ca.
authors.forename: K
authors.initials: K
authors.lastname: Murphy
authors.affiliation: Departments of Neurology (A.L.O.) Pathology (Neuropathology) (A.L.O.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: A L
authors.initials: AL
authors.lastname: Oaklander
authors.affiliation: From the Department of Radiology (K.M., G.E.), University of Toronto, Toronto, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Elias
authors.affiliation: Russell H Morgan Department of Radiology and Radiological Science (S.K.), Johns Hopkins Hospital, Baltimore Maryland.
authors.forename: S
authors.initials: S
authors.lastname: Kathuria
authors.affiliation: Neuroscience Consults (D.M.L.), Lutherville, Maryland.
authors.forename: D M
authors.initials: DM
authors.lastname: Long
mesh_terms: D000328:Adult; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012447:Sacrum; D013396:Suction; D025321:Surgery, Computer-Assisted / Q000379:methods*; D052958:Tarlov Cysts / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive