The following information may help to address your question:
What are Tarlov cysts?
are fluid-filled sacs that most commonly are found at the base of the spine (the sacrum). They affect the nerve roots in the sacrum, whereas the spinal nerve roots are embedded within the cyst wall or within the cyst cavity.
A person can have one Tarlov cyst or multiple cysts, and symptoms may or may not be present, depending on the size and location of the cyst(s).
In general, the larger the cyst is, the more likely it is to cause symptoms.
In some cases, a cyst begins to cause symptoms following trauma or in response to a buildup of cerebrospinal fluid
Examples of symptoms caused by a Tarlov cyst include pain when moving or changing position (especially in the buttocks or lower back), muscle weakness, headaches, impaired reflexes, numbness or other sensation abnormalities, loss of bladder or bowel control, sexual dysfunction (impotence
), or other neurologic problems.
Symptoms generally occur in the area of the body served by the involved nerves.
Diagnosing a Tarlov cyst can take a long time because there is limited awareness among primary care physicians and symptoms are similar to those of many other disorders or health problems. In some cases, a person may be misdiagnosed as having herniated discs, arachnoiditis
, or gynecological conditions (in females). The diagnosis may ultimately be made following an MRI
and/or CT myelogram
due to pain, or sometimes following tests performed by a urologist
due to bladder problems.
The exact cause of Tarlov cysts is not currently known.
Treatment depends on the symptoms and size of the cyst(s). Many methods have been described with variable results.
Non-surgical treatment options may include pain management, lumbar drainage of CSF, CT scan
-guided cyst aspiration
, and removing the CSF from inside the cyst and injecting the space with a fibrin sealant. However, these options do not prevent symptoms from returning. Surgical options may include opening and draining the cyst before filling it with fibrin sealant, laminectomy
, removing the cyst or nerve roots, and other neurosurgical techniques.
The long-term outlook (prognosis
) varies from person to person depending on the severity of symptoms and effectiveness of treatment. Following surgery, some people have considerable relief of pain, while others have no change in symptoms. In some cases, surgery causes different symptoms or worsens existing symptoms.
Residual symptoms following treatment may require continued pain management and changes in lifestyle. If left untreated, a Tarlov cyst can cause permanent neurological damage.
Last updated: 8/9/2018
Is there a cure for Tarlov cysts?
While there is no cure for Tarlov cysts, there are several treatment options which have delivered mixed results in controlling the symptoms of the condition.
Last updated: 3/28/2016
How might Tarlov cysts be treated?
While there is no standard accepted treatment for individuals with symptomatic Tarlov cysts, many different therapies have been tried.
Tarlov cysts may be drained and shunted to relieve pressure and pain, but relief is often only temporary and fluid build-up in the cysts will recur. Corticosteroid
injections may also temporarily relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDS) may be prescribed to treat chronic pain and inflammation. Injecting the cysts with fibrin glue (a combination of naturally occurring substances based on the clotting factor in blood) may provide temporary relief of pain. Microsurgical removal of the cyst wall may be an option in select individuals who do not respond to conservative treatments and who continue to experience pain or progressive neurological damage.
Transcutaneous Electrical Nerve Stimulation (TENS
) has been proven useful for some in pain management. TENS devices deliver electrical impulses through the skin to the nerves to control pain. Unlike medications and topical ointments, TENS does not have any known side effects, other than skin irritation from the electrodes in some patients.
A recent review analyzed the different surgical options, including the following:
- Sacral laminectomy with microsurgical cyst fenestration and cyst imbrication
- Sacral laminectomy with resection of the sacral cyst
- Microsurgical excision of the cyst along with duraplasty or plication of the cyst
- Release of the valve and imbrication of the sacral cysts with laminectomies
- Total or partial cyst wall removal, arranging the remaining nerve sheath, and repairing the local defect with muscle, gelfoam and fibrin glue
- Removing of the cyst and closure of defect by fibrin glue
- Microscopic cyst resection and closure of defect by fibrin glue
- Microsurgical fenestration from the cyst to the thecal sac
- Fenestration of the cyst and closure of the opening by stitches and glue
- Cyst remodeling around the root using titanium clips
- Cyst excision and occlusion of its neck.
The authors of this review concluded that the best results are obtained with the complete removal of the cyst and closure of the defect by fibrin glue, microscopic cyst resection and closure of the defect by fibrin glue, or cyst removal with closure of its neck.
Last updated: 5/25/2016
Are there surgical options for treatment of Tarlov cysts?
There are a small number of physicians in the world who have surgical expertise in the treatment for Tarlov cysts. The short-term and long-term outcome of surgery is improving but variable in individual patients at this time.
You can find the most recent articles on Tarlov cyst treatment through PubMed.gov, a database of biomedical journal articles. Click here
to view a sample search.
Last updated: 3/28/2016
Who may be involved in the management of a patient with Tarlov cysts?
Neurosurgeons and interventional neuroradiologists
may treat individuals with Tarlov cysts. It is important that the treating physician is knowledgeable about the symptomatology of the cysts and the extended ramifications of untreated cysts that are present with no other spinal pathology. Pain management specialists are vital to the treatment of symptomatic Tarlov cysts. Family practice physicians (or other primary health care providers) play a key role in management of symptoms, including bowel and bladder dysfunction. A urologist might be consulted if the cysts are interfering with bladder function (urinary retention
, increased frequency of urinary tract infections, or incontinence).
Last updated: 3/28/2016
How can I find a physician who is knowledgeable about Tarlov cysts?
Last updated: 1/30/2013
We hope this information is helpful. We strongly recommend you discuss this information with your doctor. If you still have questions, please
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