Tarlov cyst

A type of spinal cyst

Tarlov cysts, also known as perineural cysts, are cerebrospinal fluid-filled sacs located in the spinal canal of the sacral region. These cysts are often found incidentally during imaging studies for other conditions and can be asymptomatic or cause a variety of symptoms depending on their size and location.

Anatomy and Pathophysiology

Tarlov cysts are typically located at the sacral level of the spine, often at the S1 to S4 vertebrae. They are formed within the nerve root sheath and are filled with cerebrospinal fluid (CSF). The exact cause of Tarlov cysts is not well understood, but they are thought to arise from a weakness in the nerve root sheath, allowing CSF to accumulate and form a cyst.

Diagram of a Tarlov cyst in the sacral region.

Symptoms

While many Tarlov cysts are asymptomatic, some can cause symptoms due to compression of nearby nerve roots or spinal structures. Symptoms may include:

• Lower back pain
• Sciatica
• Perineal pain
• Bladder dysfunction
• Bowel dysfunction
• Sexual dysfunction

The severity of symptoms often correlates with the size and location of the cyst.

Diagnosis

Tarlov cysts are usually diagnosed through imaging studies such as MRI or CT scan. An MRI is particularly useful as it can clearly show the cysts and their relationship to surrounding structures.

Sagittal MRI showing Tarlov cysts in the sacral region.

Treatment

Treatment for Tarlov cysts depends on the severity of symptoms. Asymptomatic cysts typically do not require treatment. For symptomatic cysts, treatment options may include:

• Pain management with medications
• Physical therapy
• Surgical intervention to drain or remove the cyst

Surgical treatment is generally considered when conservative measures fail and symptoms significantly impact the patient's quality of life.

Prognosis

The prognosis for individuals with Tarlov cysts varies. Many people with asymptomatic cysts live normal lives without any issues. For those with symptomatic cysts, treatment can often alleviate symptoms, although recurrence is possible.

Related pages

• Spinal cord
• Cerebrospinal fluid
• Nerve root
• Sacrum