Tarlov cysts also known as perineurial cysts are fluid-filled nerve root cysts found usually at the sacral or base of the spine. The cerebrospinal fluid-filled sacs are present in the spinal canal of the S1-S4 region of the spinal cord. They can be distinguished from other types of cysts like meningeal cysts with the help of their nerve fiber filled walls. Tarlov cysts are cysts that are formed within the nerve-root sheath at the dorsal root ganglion. These cysts are asymptomatic and are usually more common than other neurological cysts.
Recent surveys reveal that Tarlov cysts affect an estimated 86.6 percent of females and 13. 4 percent of males, thus it shows that mostly women are affected. The cysts are mainly found in women in the age group of 31-60 years. 33 percent of patients were diagnosed with Tarlov cysts in other parts of the body mostly hands, abdomen and wrists.
Tarlov Cyst Types
Tarlov Cysts are considered to be the Type II lesions. They are known as extra-dural meningeal cysts wit nerve fibers.
The Type II Tarlov Cysts are further divided into two types-
Tarlov Perineurial Cysts
They are usually located in a posterior manner to the root ganglion with nerve fibers inside or nerve tissue in the walls. They are not connected with the perineurial arachnoid space.
This second variant is located in an anterior manner, connected to the nerve root ganglion with the help of nerve fibers inside and communicates with the subarachnoid space.
Tarlov Cyst Symptoms
An increase in pressure on the cysts can increase symptoms and also bring about nerve damages. Patients with Tarlov Cysts may find that normal activities like sitting, walking, standing and bending are quite painful.
The most common symptoms of Tarlov Cysts are-
- Back pain
- Urinary Incontinence
- Radicular pain
- Retrograde ejaculation
- Perineal pain
- Motor disorders in lower limbs and in the genitals
- Buttocks pain
- Difficulty in walking
- Pain in lower abdomen
Patients who have developed symptomatic Tarlov Cysts may have the following symptoms-
- Pain in the area where the cysts have gathered especially in the buttocks area.
- Pain in the legs, groin area and bones which make it difficult to sit for prolonged period.
- Pain that spread from the cyst region and spread to the lower abdomen through hips.
- Abnormal sexual functions.
- Abnormal bladder functions including increased frequency of clearing the bladder.
- Loss of sensation on the skin along with loss of reflexes.
- Weakness in muscles of legs.
- Changes in normal functions of the bowel leading to constipation.
Tarlov Cyst Causes
The reason behind the occurrence of Tarlov Cyst is still unknown and there aren’t any theories. However, in several documented cases it has been found out that accidents or sudden falls which injures the tailbone area of the spine which have not been diagnosed properly might lead to formation of Tarlov Cysts.
Tarlov Cyst Diagnosis
It is difficult to diagnose Tarlov Cyst at first shot since there is little information about the condition. The symptoms are not enough to recognize the disease because they can indicate other diseases as well. But, these days the two most effective methods to diagnose Tarlov Cysts are MRI and CT. These methods offer a clear picture and allow the doctors to detect the extradural spinal masses.
MRI offers better resolution of tissue density, and there is no bone interference in this method. Plain films show the bony erosion of the spinal canal or of the sacral foramina. A computed tomography or CT show sacral erosion clearly and also the cystic masses are prominent. However, these methods are not useful in detecting the difference among Tarlov Cysts and other cysts. These methods are also unable to detect the nerve fibers in the walls. Thus, the final diagnosis can be done in the radiological method that shows the posterior extra-ovarian cystic mass. The features of the cyst will be widened and more prominent. Another method which is used is the histopathological diagnosis. Other possible diagnoses which can reveal the presence of Tarlov Cysts are Urodynamics where the bladder is filled with water through a catheter, Cytoscopy which involves insertion of a tube with video camera into the bladder or conduction of a kidney ultrasound which might show if urine is travelling up back to the kidney.
Tarlov Cyst Treatment
Most of the time, Tarlov Cysts do not require any treatment. The treatment options that are available for patients with Tarlov Cysts are as follows-
- Lidoderm patches applied to the area that is affected with the cystic formation. IT will provide temporary relief from pain and discomfort.
- Prescribed medications like anti-depressants, anti-seizure medications may be sued to treat pain.
- TENS r Transcutaneous electrical nerve stimulation or electric impulses may be delivered through the skin to control the pain.
- A needle may be used to drain the cyst filled with cerebrospinal fluid to relieve the painful symptoms.
- Also Corticosteroid injections or other medicated injections may be applied to eliminate pain.
However, none of the above options are fully successful to stop a recurrence of this condition. There is an option of surgery which can be opted.
Tarlov Cyst surgery making a cut in the skin where the spine is located and exposing the cyst affected region. The cyst is opened and the fluid residing inside is drained out. To prevent the fluid from returning, the cyst is occluded or blocked with the help of a fibrin glue injection or other matter. The Neurosurgical techniques for symptomatic Tarlov cyst comprise of cyst or nerve root excision, decompressive laminectomy, imbrication and cyst fenestration.
It has been found after study that, large Tarlov Cysts associated with bladder malfunction and bowel pain have benefited from this surgery.
Post Operation Result
CSF leak is the most common complications that occur after operation. In some cases the leaks get healed on their own. Also, there is a risk of developing bacterial meningitis. Although some patients have found that the pain has decreased considerably but the symptoms do not go away completely. Sometimes a surgery may aggravate an existing symptom giving rise to another one.
The rate of morbidity is found to be more amongst people who have developed bilateral cysts at the same spinal level. On the other hand, if all treatment options fail, it is important for the patient to make changes in his or her lifestyle or undertake a pain management strategy with his or her physician. To improve the quality of life of the patient, it is necessary that the patient be provided support and supervision of pain management treatment.