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Diseases

Genetic and Rare Diseases Information Center (GARD)

Tarlov cysts


Other Names for this Disease
  • Sacral Tarlov cysts
  • Sacral perineural cysts
  • Tarlov cyst
  • Perineural cysts
  • Sacral neural cysts
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.

Your Question

I have been diagnosed with Tarlov cyst disease. Is there a cure for this condition? How is it treated? Are there surgical options? How can I find a doctor who is knowledgeable about Tarlov cysts?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What are Tarlov cysts?

Tarlov cysts are fluid-filled sacs that most often affect nerve roots in the sacrum, the group of bones at the base of the spine. These cysts don't usually cause symptoms, but when compressing nerve roots, they can cause lower back pain, sciatica (shock-like or burning pain in the lower back, buttocks, and down one leg to below the knee), urinary incontinence, headaches, sexual dysfunction, constipation, and some loss of feeling or control of movement in the leg and/or foot. Pressure on the nerves next to the cysts can also cause pain and deterioration of the surrounding bone. Asymptomatic tarlov cysts may become symptomatic following shock, trauma, or exertion that causes the buildup of cerebrospinal fluid. Current information indicates that women are more commonly diagnosed with Tarlov cysts.[1] The reason for this is unknown. Treatment depends on the symptoms and size of the cysts. Many methods have been described for treatment with variable results.[2]
Last updated: 5/25/2016

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.[1][3]
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.[4] 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.[4][1][3]  

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 seen in some patients.[3]

A recent review analized all the different surgical options, including the following:[2]
  • 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 defect by fibrin glue, or  the microscopic cyst resection and closure of defect by fibrin glue, or the 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.[3]

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).[3]
Last updated: 3/28/2016

How can I find a physician who is knowledgeable about Tarlov cysts?

The Tarlov Cysts Disease Foundation has a Physician Finder service which can help you locate a physician who is knowledgeable about Tarlov cysts. Visit the following link to access this service online: 
http://www.tarlovcystfoundation.org/find_a_doctor0.aspx 
Last updated: 1/30/2013

References
Other Names for this Disease
  • Sacral Tarlov cysts
  • Sacral perineural cysts
  • Tarlov cyst
  • Perineural cysts
  • Sacral neural cysts
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.