Navigating Surgical Strategies for Symptomatic Tarlov Cysts: A Case Report of Successful Microsurgical Excision and Imbrication
DOI:
https://doi.org/10.37275/bsm.v9i10.1413Keywords:
Laminectomy, Microsurgery, Perineural cyst, Radiculopathy, Tarlov cystAbstract
Background: Symptomatic Tarlov (perineural) cysts are a rare but debilitating cause of chronic radicular pain, arising from cerebrospinal fluid (CSF) accumulation within the nerve root sheath. The diagnostic journey is often complex, requiring a definitive link between the lesion and the patient's symptoms, and the optimal surgical strategy remains a subject of considerable debate.
Case presentation: A 56-year-old male presented with a six-month history of intractable right S2 radiculopathy (VAS 8/10) and severe functional impairment (Oswestry Disability Index 78%), which had failed a comprehensive trial of conservative management. Magnetic resonance imaging revealed a large cystic lesion at the right S2 level, with features characteristic of a Tarlov cyst, causing severe nerve root compression. Following a thorough discussion of the risks and benefits, the patient underwent an S2 laminectomy with microsurgical partial cyst excision and wall imbrication. Postoperative histopathology confirmed the diagnosis of a perineural cyst, identifying nerve fibers within the fibroconnective tissue of the cyst wall.
Conclusion: The patient experienced immediate and sustained resolution of his radicular pain (VAS 0/10) and a profound improvement in functional status (ODI 12%) at one-year follow-up, with radiological confirmation of successful cyst obliteration. This case highlights the potential of a direct microsurgical approach, guided by a strong clinical-radiological correlation and confirmed by histopathology, to provide a durable and life-altering cure for patients disabled by symptomatic Tarlov cysts.
Authors
- Arip Heru Tripana1*
- Tondi Maspian Tjili2
- Afdal3
- Ismar4
- Eko Setiawan5
- 1Surgical Resident, Department of Surgery, Faculty of Medicine, Universitas Riau/Arifin Achmad Regional General Hospital, Riau, Indonesia
- 2Department of Neurosurgery, Faculty of Medicine, Universitas Riau/Arifin Achmad Regional General Hospital, Riau, Indonesia
- 3Department of Urology, Faculty of Medicine, Universitas Riau/Arifin Achmad Regional General Hospital, Riau, Indonesia
- 4Department of Pediatric Surgery, Faculty of Medicine, Universitas Riau/Arifin Achmad Regional General Hospital, Riau, Indonesia
- 5Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Riau/Arifin Achmad Regional General Hospital, Riau, Indonesia
Corresponding author Arip Heru Tripana — elfasiry.heru.ah@gmail.com
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