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Symptomatic lumbosacral perineural cysts: A report of three cases and review of literature.

Sharma M, Velho V, Mally R, Khan SW - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica.Symptomatic lumbosacral Tarlov's cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica.Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India.

ABSTRACT
Lumbosacral perineural cysts (Tarlov's cysts) are nerve root cysts, which are usually asymptomatic and are detected incidentally on imaging. These cysts are rare with an incidence of 4.6%. We report three cases of Lumbosacral Tarlov's cysts, which presented with cauda equina syndrome and radicular pain syndrome. Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica. Complete excision of the cyst was achieved in two patients and marsupialization of the cyst was done in another patient due to its large size and dense adherence to the sacral nerve roots. All the patients were relieved of the radicular pain with no new neurological deficit following surgery. Symptomatic lumbosacral Tarlov's cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica. Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms. Complete Surgical excision of these symptomatic cysts is the treatment of choice to achieve a cure.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging scan (T2-weighted sequence, sagittal view) of the lumbosacral spine showing a well-defined cystic lesion along the traversing left L4 nerve root suggestive of perineural cyst
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Figure 1: Magnetic resonance imaging scan (T2-weighted sequence, sagittal view) of the lumbosacral spine showing a well-defined cystic lesion along the traversing left L4 nerve root suggestive of perineural cyst

Mentions: A 42-year-old male patient admitted with a history of low back pain of 2 weeks duration. The pain was sudden in onset and radiating to the left lower limb. There was associated numbness on the medial aspect of the left lower limb. There was no history of trauma or lifting heavy weights. On examination, power was normal in both lower limbs. Pain and temperature sensations were diminished along left L4 dermatome by 50%. Reflexes were normal in both lower limbs and plantars were downgoing bilaterally. Magnetic resonance imaging (MRI) (T2-weighted) of the lumbosacral spine showed a well-defined cystic lesion along the traversing left L4 nerve root suggestive of Tarlov's cyst [Figure 1]. Electromyography and nerve conduction studies were suggestive of left L4 radiculopathy. The patient was operated on by left L3 hemilaminectomy and medial facetectomy. The cyst was anterolateral to the nerve root during intraoperative excision. The cyst was thin-walled, translucent and the content was clear jelly-like fluid. Complete excision of the cyst was achieved.


Symptomatic lumbosacral perineural cysts: A report of three cases and review of literature.

Sharma M, Velho V, Mally R, Khan SW - Asian J Neurosurg (2015 Jul-Sep)

Magnetic resonance imaging scan (T2-weighted sequence, sagittal view) of the lumbosacral spine showing a well-defined cystic lesion along the traversing left L4 nerve root suggestive of perineural cyst
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553737&req=5

Figure 1: Magnetic resonance imaging scan (T2-weighted sequence, sagittal view) of the lumbosacral spine showing a well-defined cystic lesion along the traversing left L4 nerve root suggestive of perineural cyst
Mentions: A 42-year-old male patient admitted with a history of low back pain of 2 weeks duration. The pain was sudden in onset and radiating to the left lower limb. There was associated numbness on the medial aspect of the left lower limb. There was no history of trauma or lifting heavy weights. On examination, power was normal in both lower limbs. Pain and temperature sensations were diminished along left L4 dermatome by 50%. Reflexes were normal in both lower limbs and plantars were downgoing bilaterally. Magnetic resonance imaging (MRI) (T2-weighted) of the lumbosacral spine showed a well-defined cystic lesion along the traversing left L4 nerve root suggestive of Tarlov's cyst [Figure 1]. Electromyography and nerve conduction studies were suggestive of left L4 radiculopathy. The patient was operated on by left L3 hemilaminectomy and medial facetectomy. The cyst was anterolateral to the nerve root during intraoperative excision. The cyst was thin-walled, translucent and the content was clear jelly-like fluid. Complete excision of the cyst was achieved.

Bottom Line: Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica.Symptomatic lumbosacral Tarlov's cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica.Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Grant Medical College and Sir J. J. Group of Hospitals, Mumbai, Maharashtra, India.

ABSTRACT
Lumbosacral perineural cysts (Tarlov's cysts) are nerve root cysts, which are usually asymptomatic and are detected incidentally on imaging. These cysts are rare with an incidence of 4.6%. We report three cases of Lumbosacral Tarlov's cysts, which presented with cauda equina syndrome and radicular pain syndrome. Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica. Complete excision of the cyst was achieved in two patients and marsupialization of the cyst was done in another patient due to its large size and dense adherence to the sacral nerve roots. All the patients were relieved of the radicular pain with no new neurological deficit following surgery. Symptomatic lumbosacral Tarlov's cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica. Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms. Complete Surgical excision of these symptomatic cysts is the treatment of choice to achieve a cure.

No MeSH data available.


Related in: MedlinePlus