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Case series
Interventional approaches to symptomatic Tarlov cysts: a 15-year institutional experience
  1. Jovanna Tracz1,
  2. Brendan F Judy1,
  3. Kelly J Jiang1,
  4. Chad A Caraway1,
  5. Wuyang Yang1,
  6. Nara Lygia De Macena Sobreira2,
  7. Majid Khan1,
  8. Timothy F Witham1
  1. 1 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Timothy F Witham; twitham2{at}


Background Tarlov cysts are perineural collections of cerebrospinal fluid most often affecting sacral nerve roots, which may cause back pain, extremity paresthesias and weakness, bladder/bowel dysfunction, and/or sexual dysfunction. The most effective treatment of symptomatic Tarlov cysts, with options including non-surgical management, cyst aspiration and injection of fibrin glue, cyst fenestration, and nerve root imbrication, is debated.

Methods Retrospective chart review was conducted for 220 patients with Tarlov cysts seen at our institution between 2006 and 2021. Logistic regression analysis was conducted to determine the association between treatment modality, patient characteristics, and clinical outcome.

Results Seventy-two (43.1%) patients with symptomatic Tarlov cysts were managed non-surgically. Of the 95 patients managed interventionally, 71 (74.7%) underwent CT-guided aspiration of the cyst with injection of fibrin glue; 17 (17.9%) underwent cyst aspiration alone; 5 (5.3%) underwent blood patching; and 2 (2.1%) underwent more than one of the aforementioned procedures. Sixty-six percent of treated patients saw improvement in one or more symptoms, with the most improvement in patients after aspiration of cyst with injection of fibrin glue; however, this association was not statistically significant on logistic regression analysis.

Conclusion Although the subtype of percutaneous treatment was not significantly associated with optimal or suboptimal patient outcomes, cyst aspiration both with and without injection of fibrin glue may serve as a useful diagnostic tool to (1) determine symptom etiology and (2) identify patients who might have achieved temporary improvement between the time of cyst aspiration and refill with cerebrospinal fluid as potential candidates for neurosurgical intervention of cyst fenestration and nerve root imbrication.

  • intervention
  • lumbosacral
  • spinal nerve
  • spine

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  • Contributors Conception and design: JT, BFJ. Acquisition of data: all authors. Drafting the article: JT, BFJ, KJJ. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: TFW. Study supervision: TFW.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests TFW is a member of the Scientific Advisory Board and an investor in Augmedics, Inc. MK is a consultant for Stryker Medical Corporation, Medwaves Avecure, Hyprevention, and Cohere Medical.

  • Provenance and peer review Not commissioned; externally peer reviewed.