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Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature.
J Neurosurg Spine. 2016 May; 24(5):700-7.JN

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+Show Affiliations

University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.University of Pennsylvania, Pennsylvania Hospital, Philadelphia, Pennsylvania.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

26745352

Citation

Burke, John F., et al. "Microsurgical Treatment of Sacral Perineural (Tarlov) Cysts: Case Series and Review of the Literature." Journal of Neurosurgery. Spine, vol. 24, no. 5, 2016, pp. 700-7.
Burke JF, Thawani JP, Berger I, et al. Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature. J Neurosurg Spine. 2016;24(5):700-7.
Burke, J. F., Thawani, J. P., Berger, I., Nayak, N. R., Stephen, J. H., Farkas, T., Aschyan, H. J., Pierce, J., Kanchwala, S., Long, D. M., & Welch, W. C. (2016). Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature. Journal of Neurosurgery. Spine, 24(5), 700-7. https://doi.org/10.3171/2015.9.SPINE153
Burke JF, et al. Microsurgical Treatment of Sacral Perineural (Tarlov) Cysts: Case Series and Review of the Literature. J Neurosurg Spine. 2016;24(5):700-7. PubMed PMID: 26745352.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature. AU - Burke,John F, AU - Thawani,Jayesh P, AU - Berger,Ian, AU - Nayak,Nikhil R, AU - Stephen,James H, AU - Farkas,Tunde, AU - Aschyan,Hovik John, AU - Pierce,John, AU - Kanchwala,Suhail, AU - Long,Donlin M, AU - Welch,William C, Y1 - 2016/01/08/ PY - 2016/1/9/entrez PY - 2016/1/9/pubmed PY - 2016/12/15/medline KW - CSF = cerebrospinal fluid KW - TC = Tarlov cyst KW - Tarlov cyst KW - lumbar KW - perineural cyst SP - 700 EP - 7 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 24 IS - 5 N2 - 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. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/26745352/Microsurgical_treatment_of_sacral_perineural__Tarlov__cysts:_case_series_and_review_of_the_literature_ L2 - https://thejns.org/doi/10.3171/2015.9.SPINE153 DB - PRIME DP - Unbound Medicine ER -