Glue That Pain: A Case Report and Review of Literature

  • Umar Farooq University hospital Coventry and Warwickshire
  • Asad Abbas Jinnah Postgraduate Medical Center, Karachi
  • Asfand Baig Mirza University hospital Coventry and Warwickshire
  • Faiza Nazir
  • Hiten Mehta University hospital Coventry and Warwickshire
  • Amjad Shad, Prof University hospital Coventry and Warwickshire
Keywords: Tarlov cyst, sacral lesion, fibrin glue, percutaneous injection

Abstract

Tarlov cysts are cystic lesions of the nerve root sheath in the lower spine. With a reported incidence ranging from 1 to 5%, these lesions are fairly rare, benign and often asymptomatic. When they cause neural compression they may become symptomatic with sensory, motor, bowel/bladder and sexual dysfunction. The treatment of symptomatic Tarlov cysts is a controversial issue, ranging from conservative management and local steroid injections to a bewildering assortment of surgical options including CSF diversion procedures and advance microsurgical approaches with various ways of cyst manipulation. All these surgical modalities carry a high risk of serious complications, recurrence with need of a redo operation and a very variable rate of symptomatic relief ranging from 38 – 100 % in different series. Developing from the CT guided needle aspiration of the cyst which suffered disappointment in the form of re accumulation and heralded by earlier reports of aseptic meningitis, CT guided aspiration and subsequent filling of the cyst with fibrin glue has now emerged as a safe, highly effective and first line of treatment for symptomatic Tarlov cyst.

References

1.
Hoshino Y, Edakuni H, Shimada H, et al. Sacral arachnoid cyst associated with Marfan syndrome. Intern Med 2005;44:271–73
2.Acosta Jr FL, Quinones-Hinojosa A, Schmidt MH, Weinstein PR. Diagnosis and management of sacral Tarlov cysts: case report and review of the literature. Neurosurgical focus. 2003;15(2):1–7.
3.Goyal RN, Russell NA, Benoit BG, et al: Intraspinal cysts: a classification and literature review. Spine 12:209–213, 1987 40:1067–1074, 1938
4.Guo D, Shu K, Chen R, Ke C, Zhu Y, Lei T. Microsurgical treatment of symptomatic sacral perineurial cysts. Neurosurgery 2007;60:1059-65.
5.Langdown AJ, Grundy JR, Birch NC. The clinical relevance of Tarlov cysts. J Spinal Disord Tech 2005;18:29 –33
6.Mummaneni PV, Pitts LH, McCormack BM, et al: Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery 47:74 79, 2000
7.Murphy K, Nussbaum D, Schnupp S, Long D. Tarlov Cysts: An Overlooked Clinical Problem. Seminars in Musculoskeletal Radiology. 2011 Apr;15(02):163–7.
8.Nabors MW, Pait TG, Byrd EB, Karim NO, Davis DO, Kobrine AI, et al : Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68 : 366-377, 1988
9.Nishiura I, Koyama T, Handa J: Intrasacral perineurial cyst. Surg Neurol 23:265–269, 1985
10.Padma S, Palaniswamy SS. Multilocular disseminated Tarlov cysts: Importance of imaging and management options. Indian J Nucl Med 2012;27:111-4
11.Park HJ, Jeon YH, Rho MH, Lee EJ, Park NH, Park SI, et al. Incidental findings of the lumbar spine at MRI during herniated intervertebral disk disease evaluation. AJR Am J Roentgenol 2011;196:1151-5.
12.Patel MR, Louie W, Rachlin J. Percutaneous fibrin glue therapy of meningeal cysts of the sacral spine. AJR Am J Roentgenol 1997; 168:367– 370
13.Paulsen RD, Call GA, Murtagh FR: Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR 15:293 297, 1994
14.Shao Z, Wang B, Wu Y, Zhang Z, Wu Q, Yang S. CT-Guided Percutaneous Injection of Fibrin Glue for the Therapy of Symptomatic Arachnoid Cysts. American Journal of Neuroradiology. 2011 Sep 1;32(8):1469–73.
15.Strully KJ, Heiser S: Lumbar and sacral cysts of meningeal origin. Radiology 62:544 549, 1954
16.Strully KJ. Meningeal diverticula of sacral nerve roots (perineural cysts). JAMA 1956;161:1147–52
17.TanakaM,NakaharabS,ItoY,etal.Surgicalresultsofsacralperineural(Tar- lov) cysts. Acta Med Okayama 2006;60:65–70
18.Tarlov IM: Cyst of the sacral nerve roots: clinical significance and pathogenesis. Arch Neurol Psychiatry 68:94 108, 1952
19.Tarlov IM: Perineural cysts of the spinal nerve roots. Arch Neurol Psychiatry 40:1067 1074, 1938
20.Tarlov IM: Sacral Nerve-Root Cysts: Another Cause of the Sciatic or Cauda Equina Syndrome. Springfield, IL: Charles C. Thomas, 1953, pp 56 116
21.TarlovIM.SacralNerveRootCysts:AnotherCauseoftheSciaticaorCaudaEquina Syndrome. Springfield, Illinois: Charles C. Thomas; 1953:56 –116
22.WilliamsB.Sciaticacausedbysacral-nerve-rootcysts.Lancet1971;1:137
Published
2021-01-01
Section
Case Reports