GJZH
08-29-2007, 12:11 AM
Tarlov Cysts Summary - Georgetown University Hospital
By: Fraser C. Henderson, M.D.
Associate Professor of Neurosurgery
We perform a Tarlov cyst resection twice every month. To date I have
treated approximately 70 cases.
Tarlov cysts are not rare. Very small Tarlov cysts can be found in approximately five percent of the population. However, large symptomatic Tarlov cysts are rare. This is reflected in the lack of knowledge of physicians around the world as to their nature, significance and treatment of Tarlov cysts. Small Tarlov cysts are
usually asymptomatic; some large Tarlov cysts are also asymptomatic.
However, 2/3 of large Tarlov cysts do cause pain in the sacrum, pain and sensory loss in the back of the leg and bowel and bladder difficulties. The urinary bladder difficulties include: frequency, urgency, overflow incontinence and frequent urinary track infections.
Surgery for Tarlov cyst involves a 5-inch incision over the low back/sacrum, removal of the sacral lamina (a thin layer of bone over the Tarlov cyst); the cyst is carefully dissected from the surrounding tissues, opened and inspected under the surgical
microscope. The contents of the cyst undergo a neural stimulation in order to demonstrate important neural elements. The important nerves are preserved; sometimes, unimportant damaged portions of nerves are removed with the cyst wall. The remnant of the cyst is then over- sewn to prevent a spinal fluid leakage, and to protect remaining neural elements (nerves). The wound is carefully closed; the patient is kept at bed rest for 3 days, and then discharged to home.
There are many variations of Tarlov cysts. Sometimes Tarlov cysts extend through the neural foramina and lie anterior to the sacrum. Cysts can be quite large, reaching 6 cm. They can be multiple, or accompanied by meningeal cysts. Tarlov cysts have no direct
communication with the spinal fluid; meningeal cysts have a direct communication. A meningeal cyst, if emptied, will immediately refill with spinal fluid. A Tarlov cyst has an indirect connection with the
spinal fluid; after aspiration it will refill over a period of
several hours. We do not recommend aspiration of Tarlov cysts in the clinical setting: aspiration can cause hemorrhage in the wall of the cyst with increased pain; and it can also cause injury to the contained nerves. We do not recommend filling the cyst with fat or
fibrin glue; even when filled, the cyst often continues to grow and make further treatment much more difficult.
Most patients have very little pain after surgery, and enjoy improvement within a few weeks. Approximately 90% of patients are pleased with their surgery, but 10% have no improvement. The presence of other low back problems including lumbar spinal stenosis, foramenal stenosis, slippage of the vertebrae(spondylolithesis), tethered cord syndrome, chronic low back pain, myofascial syndrome and even conditions in the upper back and neck can affect the outcome following resection of a Tarlov cyst.
Infections such as Lyme's disease, Herpes and other causes of peripheral nerve disease like diabetes, nutritional deficiency, sarcoidosis may influence the outcome of surgery. In general, however, a patient with a Tarlov cyst greater than two centimeters
in size with sacral pain and bladder difficulties will do very well with the surgery, and without complication. The only significant complication of the Tarlov cyst surgery we have encountered was a
woman seven years ago who experienced increased urinary difficulties for several months after surgery.
If you are interested in pursuing surgical treatment for the Tarlov cyst, then please call Kathrin at 202-444-2926 to arrange an appointment. Before surgery you should have a cardiac clearance by a cardiologist or from your family doctor. Seven days before surgery you should stop taking any drugs which thin the blood such as:aspirin, ibuprofen, Toradol, Celebrex (non steroidal anti-inflammatory drugs). Coumadin should be stopped five days before surgery. You should anticipate spending approximately one week in Washington, DC. Please direct all further e-mails to Kathrin Riller.
I look forward to seeing you in clinic. Bring your MRI and other films with you.
Fraser C. Henderson, M.D.
Associate Professor of Neurosurgery
By: Fraser C. Henderson, M.D.
Associate Professor of Neurosurgery
We perform a Tarlov cyst resection twice every month. To date I have
treated approximately 70 cases.
Tarlov cysts are not rare. Very small Tarlov cysts can be found in approximately five percent of the population. However, large symptomatic Tarlov cysts are rare. This is reflected in the lack of knowledge of physicians around the world as to their nature, significance and treatment of Tarlov cysts. Small Tarlov cysts are
usually asymptomatic; some large Tarlov cysts are also asymptomatic.
However, 2/3 of large Tarlov cysts do cause pain in the sacrum, pain and sensory loss in the back of the leg and bowel and bladder difficulties. The urinary bladder difficulties include: frequency, urgency, overflow incontinence and frequent urinary track infections.
Surgery for Tarlov cyst involves a 5-inch incision over the low back/sacrum, removal of the sacral lamina (a thin layer of bone over the Tarlov cyst); the cyst is carefully dissected from the surrounding tissues, opened and inspected under the surgical
microscope. The contents of the cyst undergo a neural stimulation in order to demonstrate important neural elements. The important nerves are preserved; sometimes, unimportant damaged portions of nerves are removed with the cyst wall. The remnant of the cyst is then over- sewn to prevent a spinal fluid leakage, and to protect remaining neural elements (nerves). The wound is carefully closed; the patient is kept at bed rest for 3 days, and then discharged to home.
There are many variations of Tarlov cysts. Sometimes Tarlov cysts extend through the neural foramina and lie anterior to the sacrum. Cysts can be quite large, reaching 6 cm. They can be multiple, or accompanied by meningeal cysts. Tarlov cysts have no direct
communication with the spinal fluid; meningeal cysts have a direct communication. A meningeal cyst, if emptied, will immediately refill with spinal fluid. A Tarlov cyst has an indirect connection with the
spinal fluid; after aspiration it will refill over a period of
several hours. We do not recommend aspiration of Tarlov cysts in the clinical setting: aspiration can cause hemorrhage in the wall of the cyst with increased pain; and it can also cause injury to the contained nerves. We do not recommend filling the cyst with fat or
fibrin glue; even when filled, the cyst often continues to grow and make further treatment much more difficult.
Most patients have very little pain after surgery, and enjoy improvement within a few weeks. Approximately 90% of patients are pleased with their surgery, but 10% have no improvement. The presence of other low back problems including lumbar spinal stenosis, foramenal stenosis, slippage of the vertebrae(spondylolithesis), tethered cord syndrome, chronic low back pain, myofascial syndrome and even conditions in the upper back and neck can affect the outcome following resection of a Tarlov cyst.
Infections such as Lyme's disease, Herpes and other causes of peripheral nerve disease like diabetes, nutritional deficiency, sarcoidosis may influence the outcome of surgery. In general, however, a patient with a Tarlov cyst greater than two centimeters
in size with sacral pain and bladder difficulties will do very well with the surgery, and without complication. The only significant complication of the Tarlov cyst surgery we have encountered was a
woman seven years ago who experienced increased urinary difficulties for several months after surgery.
If you are interested in pursuing surgical treatment for the Tarlov cyst, then please call Kathrin at 202-444-2926 to arrange an appointment. Before surgery you should have a cardiac clearance by a cardiologist or from your family doctor. Seven days before surgery you should stop taking any drugs which thin the blood such as:aspirin, ibuprofen, Toradol, Celebrex (non steroidal anti-inflammatory drugs). Coumadin should be stopped five days before surgery. You should anticipate spending approximately one week in Washington, DC. Please direct all further e-mails to Kathrin Riller.
I look forward to seeing you in clinic. Bring your MRI and other films with you.
Fraser C. Henderson, M.D.
Associate Professor of Neurosurgery