Tarlov cyst

A Tarlov cyst ( also perineural cyst ) is a CSF- sac of the nerve roots of the spinal ganglia. These are meningeal cysts of type II extradural you are located, but just at the exit from the spinal canal in the region of the intervertebral foramen. They occur exclusively on the posterior nerve roots, since only the cell bodies of sensory neurons of the dorsal horn ganglia have migrated from the spinal cord, forming a sac of the CSF space. Due to excessive CSF pressure Fluid may collect in these spaces, and since the reflux is not feasible as a pressure relief valve, it can swell into cysts. The pressure is in the area of the sacrum at its highest, there is Tarlov cysts found most commonly. Women are affected much more frequently.

Often occur in individual cysts, but it can also arise numerous Tarlov cysts, then often also at the level of the thoracic spine. For diagnosis, for example magnetic resonance imaging is also a CT - myelography. In numerous cysts which may be caused by a genetic connective tissue disorder. An association with Tarlov cysts has been described in Marfan syndrome, the Ehlers -Danlos syndrome and the Loeys - Dietz syndrome. Especially when Marfan syndrome often find other religious movements, particularly sacral ectasia.

First to describe the neurosurgeon Isadore M. Tarlov was in 1938.

Tarlov cysts are usually asymptomatic, and usually incidental findings. In MRI scans of the lumbar spine Tarlov cysts found in 1.5 to 2.1 % of patients. They can cause local pressure effects but with appropriate size. Only rarely Tarlov cysts are by pressure on adjacent nerve roots cause of back pain, and then usually in the form of nerve compression syndrome, for example, as sciatica. But also local pain with a diffuse hard to localize back pain, or discomfort in the thoracic spine, urinary incontinence and fecal incontinence may occur rarely. In sacral Tarlov cysts the action potential of sural nerve can be changed in the electromyogram, which may serve as an indication that the cyst is actually clinically significant.

For the diagnosis and infiltration of the cyst with a local anesthetic, glucocorticoid or fibrin can be performed, be punctured or obliterated the cyst. However, these measures are rarely of lasting success, often it comes to relapse of symptoms by re- filling of the cyst. In a case series of radiologically controlled aspiration of the cyst and Fibrininjektion a satisfactory pain reduction was 65%, but had the pain in 23 % again and only 19 % had a complete cure. Neurchirurgisch can be a small laminectomy sacral, wherein the cyst is opened wide, and separated from the spinal canal. This process has brought in case series, a substantial improvement in 80 %, 7% mostly temporary complications.