Keywords: Tarlov cyst, perineural cyst, nerve root cyst, genital pain, vulva pain, testicle pain, anus pain, anal pain, enuresis, encopresis, sexual dysfunction, sexual impotence
Tarlov cyst is also called the perineural cyst or nerve root cyst. It can be seen in all regions of the spine, as in sacral (coccyx), lumbar (waist), thoracic (back) or cervical (neck) regions. Tarlov cysts are fluid-filled pouches that affect nerve roots and are more common in the sacral region. There can be a large number of cysts of different sizes. It is thought that they develop in the form of a variation of the normal development of nerve sheaths. Its main cause is unknown. Cyst contains the normal cerebrospinal fluid. Although they do not show any symptoms at first, many small Tarlov cysts can often grow gradually and cause issues by pressing on the neighboring nerve roots.
Findings and complaints
Symptoms depend on the location and size of the cysts. The location and severity of the findings may vary according to where the cyst is located in the spinal column. In general, the larger the Tarlov cyst the more likely it is to cause complaints. Symptoms include pain, loss of sensation, numbness and sensory changes in areas controlled by the affected nerves. Enuresis and encopresis, sexual impotence, and weakness in the legs can be observed.
In symptomatic Tarlov cysts, chronic pain is a common finding. If cysts settle in the cervical area, neck, back, shoulders, arms and hands can be a cause of complaint. Cysts in the lumbar and sacral regions can cause pain that spreads from the waist down to the hips and legs. This pain can increase during walking, standing up and even sitting. It can get worse over time. It can get worse with coughing, sneezing. Cysts can cause severe pain in the genital area, around the vulva and testicles, around the anus and rectum.
Since the Tarlov cyst affects the nerves, neurological losses can also be observed. These include weakness in the legs, enuresis, encopresis, defecation disorders, painful urination. Some patients may be unable to completely empty their bladders and even experience constipation. Sexual dysfunctions may also occur. Sensory disorders such as decreased skin sensation, drowsiness, burning or tingling sensations can be observed.
From the above findings, detailed patient history and neurological examination, Tarlov cysts can be considered. Cysts can be seen in detail in magnetic resonance (MRI) imaging. Computed tomography (CT) and X-ray show the changes that cysts cause over the bony structures.
Tarlov cysts which do not show any symptoms and do not cause any complaints are only followed up with imaging methods such as MRI. In periodic MRI images, the size of the cysts can be monitored. In the surgical treatment of cysts which are large, symptomatic and cause complaints, the contents of the cysts are drained by making an incision.
They are then obliterated with muscle or adipose tissue to prevent refilling. To do this, sometimes muscle flaps can be used. Treatment needs to be done before irreversible nerve damage occurs. If the patient has irreversible nerve damage, the success of the treatment will decrease.