Tarlov cysts, also known as perineural cysts, are cerebrospinal fluid (CSF)-filled lesions that most commonly develop in the sacral region of the spinal canal (S1–S5), and less frequently in the cervical, thoracic, or lumbar spine. These cysts form as dilations of the nerve root sheath near the dorsal root ganglion, specifically within the perineural space between the endoneurium and perineurium. A defining feature is that the cyst walls contain nerve fibers, which often line the inner cavity of the cyst itself. This involvement of neural elements distinguishes Tarlov cysts from other extradural meningeal cysts, such as meningeal diverticula, which do not contain nerve fibers. The etiology of these cysts is not well understood; some current theories explaining this phenomenon include increased spinal fluid pressure, filling of congenital cysts with one-way valves, and/or inflammation in response to trauma and disease. They are named after an American neurosurgeon Isadore Tarlov, who described them in 1938. These cysts are often detected incidentally during MRI or CT scans for other medical conditions. They are also observed using magnetic resonance neurography with communicating subarachnoid cysts of the spinal meninges. Cysts with diameters of 1cm or larger are more likely to be symptomatic; although cysts of any size may be symptomatic dependent on location and etiology. Some 40% of patients with symptomatic Tarlov cysts can associate a history of trauma or childbirth. Current treatment options include CSF aspiration, Aspiration and Fibrin Glue Injection (AFGI), laminectomy with wrapping of the cyst, among other surgical treatment approaches. Interventional treatment of Tarlov cysts is the only means by which symptoms might permanently be resolved due to the fact that the cysts often refill after aspiration. Tarlov cysts often enlarge over time, especially if the sac has a check valve type opening. They are differentiated from other meningeal and arachnoid cysts because they are innervated and diagnosis can in cases be demonstrated with subarachnoid communication. Tarlov perineural cysts have occasionally been observed in patients with connective tissue disorders such as Marfan syndrome, Ehlers–Danlos syndrome, and Loeys–Dietz syndrome.
History
… excerpt ends here. Continue reading the full article.



