Operative Treatment of Tarlov Cysts -Outcomes and Predictors of Improvementafter Surgery: A Series of 97 ConsecutivePatients and a Systematic Review of Literature
Tarlov cysts are cerebrospinal fluid-filled (CSF) enlargements, which arise between the perineurium and endoneurium of the nerve root sheath and appear at the junction of a posterior nerve root and dorsal root ganglion.1–3 They were originally reported in 1938 by Isadore M. Tarlov4 and are typically found in the sacral region but can occur at any level of the spine.1–5 Tarlov cysts, also named perineural cysts, are defined as Type II
spinal meningeal cysts with nerve fibers inside the cyst or nerve tissue in the walls of the cyst.1 The precise etiology of Tarlov cysts remains undetermined, but cyst enlargement and growth are thought to be the consequence of valve-like micro communication between the cyst and subarachnoid space.2
Tarlov cysts are often incidental findings in magnetic resonance imaging (MRI) or computed tomography (CT).2
The global incidence of Tarlov cysts has been evaluated in a meta-analysis of radiological studies, and the pooled preva-lence was estimated to be 4.2% with a higher prevalence in
women.5 One-fifth of the cysts are regarded as symptomatic,3,5 typically causing lower back pain, sensori-
motor disturbances of the lower limbs as well as bladder, bowel, or sexual dysfunctions.2–4,6 Regardless of the considerable prevalence of symptomatic Tarlov cysts, literature on their treatment is strikingly scarce. A wide array of treatment protocols for symptomatic cysts has been suggested ranging from percutaneous aspiration techniques to micro-surgery with variable success rates and small patient populations.2,3,6–16
Since Tarlov cysts are seen to have a dualistic nature ranging from an incidental finding to a symptomatic pathol-
ogy, there are no established treatment protocols and pre-dictors of outcome. Therefore, we performed a systematic literature review on the treatment of Tarlov cysts. Further-more, we conducted a retrospective study of all patients operated on for Tarlov cysts at BLINDED University Hospital (BLINDED) between 1995 and 2020. The aim was to describe outcomes of the applied surgical practice and to characterize patient-, and treatment-related factors predicting outcomes.