Giant symptomatic Tarlov cysts: A case report and literature review
Published: January 24 2024
Authors: Hao Han , Ran Li , Dongming Fu et al.
In 1938, Tarlov first accidentally discovered and described these cysts in a postmortem study [1].
Tarlov cysts, a rare type of cysts in the nerve roots, are typically small in size and communicate with
cerebro-spinal fluid (CSF) [2]. In the vast majority of cases, they are asymptomatic and are incidentally
found on lumbosacral imaging studies [3]. A recent meta-analysis of 13,266 subjects found a global
prevalence of 4.2 % for Tarlov cysts [4]. They are less common in Asia, with a prevalence of 3.3 % [4].
They are more prevalent in females (5.8 %) compared to males (3.0 %) [4]. However, only 15.6 % of
Tarlov cyst patients are symptomatic [4]. Some Tarlov cyst patients may experience symptoms due to
compression of nerve roots, including back pain, abnormal sensations and weakness in limbs, bowel and
bladder incontinence, and sexual dysfunction [3,5–8]. Other complications include erosion of the sacrum
and bone remodeling, leading to insufficiency fractures of the sacrum [9,10]. The possible etiology of
Tarlov cysts is diverse and includes factors such as a hereditary weakness in local connective tissue,
allowing the cyst to form [11]; acting as a valve mechanism that allows CSF to enter while restricting its
outflow, communicating with the subarachnoid space [12]; and trauma-induced hemorrhage in the subarachnoid
space [13].
The treatment of symptomatic Tarlov cysts still varies greatly in different practices, and thus, there is
controversy regarding the optimal method due to difficulty in comparing treatment modalities. This article
reports a case of symptomatic giant Tarlov cysts and provides a literature review on the treatment of
symptomatic Tarlov cysts.