Diagnosis and Management of Sacral Tarlov Cysts

Frank L. Acosta, Jr.; MD, Alfredo Quinones-Hinojosa, MD; Meic H. Schmidt, MD; Philip R. Weinstein, MD


Neurosurg Focus. 2003;15(2) 

In This Article


Tarlov cysts are a documented cause of sacral radiculopathy and other radicular pain syndromes. These lesions are diagnosed with MR imaging, which should be followed by CT myelography to demonstrate communication with the spinal subarachnoid space. Although first described over 60 years ago, there is still no uniform opinion on the origin of these cysts; they may be caused by inflammation, trauma, or congenital weakness of the dura mater combined with elevated CSF hydrostatic pressure.

Symptomatic Tarlov cysts have been treated with various techniques, including CSF drainage, percutaneous aspiration, and, excision. We have described the case of a woman with a symptomatic sacral Tarlov cyst treated successfully with cyst fenestration, cyst wall resection, and closure with myocutaneous flap reinforcement to prevent cyst recurrence or CSF leakage. Electrophysiological monitoring is necessary to minimize damage to sacral nerve roots. Patients with radicular symptoms exacerbated by postural changes and Valsalva maneuvers are the best candidates for surgery.


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