Tarlov cyst

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MRI image of a Tarlov cyst in the sacrum

A Tarlov cyst (also known as a perineural cyst) is a liquor-filled protrusion of the nerve root of the spinal ganglia . These are meningeal cysts of type II. They are located extradurally, but precisely at the exit from the spinal canal in the area of ​​the intervertebral foramina . They occur exclusively on the posterior nerve roots , as only the cell bodies of the sensory nerve cells of the posterior horn ganglia have migrated from the spinal cord and thereby form a bulge in the CSF space. Excessive CSF pressure can cause fluid to collect in these spaces, and since backflow is not possible, as with a pressure relief valve , they can swell into cysts. The pressure is highest in the sacrum area , where Tarlov cysts are most common. Women are affected much more often.

Single cysts often appear, but numerous Tarlov cysts can also develop, often at the level of the thoracic spine. In addition to magnetic resonance imaging , CT myelography is also used for diagnosis . Many cysts can be caused by a genetic connective tissue disease. An association with Tarlov cysts has been described in Marfan's syndrome , Ehlers-Danlos syndrome, and Loeys-Dietz syndrome . In Marfan's syndrome, in particular, there are often other sacral changes, especially sacral ectasia.

The neurosurgeon Isadore M. Tarlov was the first to describe it in 1938.

Tarlov cysts are usually asymptomatic and are usually incidental. Tarlov cysts were found in MRI images of the lumbar spine in 1.5-2.1% of patients. However, if they are large enough, they can cause local pressure effects. Tarlov cysts are rarely the cause of back pain due to pressure on neighboring nerve roots, and then usually in the form of a nerve compression syndrome , e.g. B. as sciatica . But local pain with a diffuse, difficult to localize lumbar pain , or complaints of the thoracic spine, bladder incontinence and fecal incontinence can rarely occur. In the case of sacral Tarlov cysts, the action potential of the sural nerve on the electromyogram may be altered, which can serve as an indication that the cyst is indeed clinically important.

For diagnosis, infiltration of the cyst with local anesthesia , glucocorticoid or fibrin can also be carried out, and the cyst can be punctured or obliterated. However, these measures are rarely of sustained success; the symptoms often relapse as the cyst is filled again. In a case series with radiologically controlled aspiration of the cyst and fibrin injection, a satisfactory pain reduction was found in 65%, however the pain recurred in 23% and only 19% had a complete healing. A small sacral laminectomy can be performed neurosurgery , in which the cyst is opened wide and separated from the spinal canal. In case series, this procedure has brought about a substantial improvement in 80%, in 7% mostly temporary complications.

Individual evidence

  1. ^ Anne Louise Oaklander, Donlin M. Long, Mykol Larvie, Christian J. Davidson: Case 7-2013 - A 77-Year-Old Woman with Long-Standing Unilateral Thoracic Pain and Incontinence . In: The New England Journal of Medicine , Vol. 368 (2013), Issue 9, February 28, 2013, pp. 853-861, ISSN  0028-4793 doi: 10.1056 / NEJMcpc1114034 .
  2. ^ IM Tarlov: Perineural cysts of the spinal nerve roots. In: Archives of Neurology & Psychiatry , Vol. 40 (1938), pp. 1067-1074, ISSN  0096-6754
  3. ^ NINDS Tarlov Cysts Information Page. National Institute of Neurological Disorders and Stroke, June 14, 2012, accessed February 7, 2013 .