Thecaloscopy Reduces the Risk of Recurrent Perineural (Tarlov) Cysts after Microsurgical Resection
Sacral Tarlov cysts (TCs), often asymptomatic, can cause significant pain and severe
neurological dysfunction. Conventional treatments are generally associated with high recurrence
and complication rates. Specifically, the substantial recurrence rates, which can reach as high as
50%, significantly impact long-term outcomes. Recent evidence increasingly supports the hypothesis
that the formation of Tarlov cysts (TCs) may be associated with inflammatory processes within
the nerve root sheath, further exacerbated by elevated cerebrospinal fluid (CSF) pressure. This
retrospective study explores thecaloscopy, combined with surgical techniques, as a more effective
alternative. We observed a total of 78 patients, 48 of whom underwent endoscopic fenestration of
the arachnoid sheath in addition to microsurgical resection of the TC. We found that the fenestration
of the arachnoid sheath at the level of lumbosacral spinal nerve root entry led to a significantly
decreased risk of developing recurrent TCs (5/48 vs. 9/30). Only one of the patients suffered from a
persistent new bladder dysfunction after microsurgical resection. This presented technique provides
a promising treatment path for the future management of TCs, offering a safe and more effective
treatment option compared to previous methods. Additionally, the advantages of the thecaloscopy
provide pathophysiological implications regarding the development of perineural cysts.