title: Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature.
abstract: OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: John F
authors.initials: JF
authors.lastname: Burke
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Jayesh P
authors.initials: JP
authors.lastname: Thawani
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Ian
authors.initials: I
authors.lastname: Berger
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Nikhil R
authors.initials: NR
authors.lastname: Nayak
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: James H
authors.initials: JH
authors.lastname: Stephen
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Tunde
authors.initials: T
authors.lastname: Farkas
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Hovik John
authors.initials: HJ
authors.lastname: Aschyan
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Pierce
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Suhail
authors.initials: S
authors.lastname: Kanchwala
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: Donlin M
authors.initials: DM
authors.lastname: Long
authors.affiliation: University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.
authors.forename: William C
authors.initials: WC
authors.lastname: Welch
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D064170:Paraspinal Muscles / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D052958:Tarlov Cysts / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
keywords: CSF = cerebrospinal fluid; TC = Tarlov cyst; Tarlov cyst; lumbar; perineural cyst