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BMC Anesthesiology Oct 2023Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression.
BACKGROUND
Cauda Equina Syndrome (CES) after Combined Spinal-Epidural Anesthesia (CSEA) is a rare disease that most of the time need surgery to relieve spinal cord compression.
CASE PRESENTATION
A 34-year-old male patient underwent a procedure for prolapse and hemorrhoids (PPH) under CSEA. Anesthesia and surgery were uneventful. However, the patient gradually experienced urinary retention, lower abdomen and back pain, changes in bowel habits and neurological dysfunction of the lower limbs when the catheter was removed. It was later determined that the patient had Tarlov cyst at the left S1 level in the sacral canal. Finally, the patient completely recovered 20 days after drug conservative therapy onset.
CONCLUSION
This case suggests that CES might occur even after ordinary CSEA. The risk factors are drug neurotoxicity to ropivacaine and Tarlov cyst, which helped to accumulate ropivacaine. The development of ultrasound-guided CSEA and an ultrasound atlas of the spinal canal are required.
Topics: Male; Humans; Adult; Ropivacaine; Cauda Equina Syndrome; Tarlov Cysts; Anesthesia, Spinal; Anesthesia, Epidural
PubMed: 37907852
DOI: 10.1186/s12871-023-02311-w -
Acta Neurochirurgica Sep 2019Perineural cysts, also known as Tarlov cysts, are cerebrospinal fluid-filled growths that develop at the intersection of a dorsal root ganglion and posterior nerve root....
OBJECTIVE
Perineural cysts, also known as Tarlov cysts, are cerebrospinal fluid-filled growths that develop at the intersection of a dorsal root ganglion and posterior nerve root. They are typically an asymptomatic and incidental finding during routine spine imaging. For symptomatic perineural cysts, there is little evidence on which treatment is most effective or when it is indicated. The aim of this study was to review our experience from a population-based cohort of patients with symptomatic perineural cysts and to propose an algorithm that could be used in the selection of surgical candidates.
METHODS
A retrospective review was conducted of all adult (≥ 15 years) patients with symptomatic perineural cysts who were referred to Karolinska University Hospital between 2002 and 2018.
RESULTS
Thirty-nine patients were included. The most common symptom was sciatica (n = 22). Cyst aspiration was performed in 28 patients, 24 of whom showed clinical improvement and were offered surgery. Microsurgical cyst fenestration was performed in 17 patients, 16 of whom showed clinical improvement at long-term follow-up. There were no surgical complications. Ten of the patients who were offered surgery chose to be treated conservatively instead, four of whom showed progression of symptoms at long-term follow-up.
CONCLUSIONS
Microsurgical cyst fenestration seems to be a safe and effective option for symptomatic relief in patients with perineural cysts. Based on the results from our series and those of others, we propose an algorithm for the selection of surgical candidates.
Topics: Adolescent; Adult; Aged; Algorithms; Cohort Studies; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Microsurgery; Middle Aged; Myelography; Neurosurgical Procedures; Patient Selection; Retrospective Studies; Suction; Tarlov Cysts; Treatment Outcome; Young Adult
PubMed: 31270612
DOI: 10.1007/s00701-019-04000-5 -
Journal of Orthopaedic Case Reports Jun 2023Tarlov cysts are rare perineural cysts noted as an incidental finding in approximately 1% of lumbar magnetic resonance imaging (MRI) arising from extradural components...
INTRODUCTION
Tarlov cysts are rare perineural cysts noted as an incidental finding in approximately 1% of lumbar magnetic resonance imaging (MRI) arising from extradural components near the dorsal root ganglion. Due to its localization, it may cause sensory symptoms in some cases. However, most of these cysts are asymptomatic.
CASE REPORT
We present the case of a 55-year-old woman with complaints of severe pain localized to the inner aspect of the thigh and gluteal region for the past 6 months, which has not been relieved by conservative management. On examination, there was a loss of sensation around the S2 and S3 dermatome with preserved motor functions. MRI showed a cystic lesion occupying the spinal canal with a size of about 1.3 × 0.7 cm with remodeling changes around the S2 vertebra. The cyst appears hypointense on T1 and hyperintense T2-weighted images. The diagnosis of the symptomatic Tarlov cyst was made and was managed with an epidural steroid injection. The patient was relieved of symptoms and remained asymptomatic till the latest follow-up at 1 year.
CONCLUSION
Symptomatic presentation of Tarlov cyst though rare should be considered and managed appropriately if identified as the source of symptoms. Conservative management with epidural steroids is a successful method in the management of smaller cysts without motor symptoms.
PubMed: 37398541
DOI: 10.13107/jocr.2023.v13.i06.3694 -
Journal of Medical Case Reports Oct 2023Here we report the only formally documented case in the United Kingdom, to our knowledge, of a cerebral fat embolism secondary to non-iatrogenic trauma through a Tarlov...
BACKGROUND
Here we report the only formally documented case in the United Kingdom, to our knowledge, of a cerebral fat embolism secondary to non-iatrogenic trauma through a Tarlov cyst. This case demonstrates the pathology clearly giving an excellent opportunity to demonstrate a rarely seen pathology as well as illustrating the importance of the patient history to guiding further management.
CASE PRESENTATION
A middle-aged patient was admitted on the acute medical take complaining of severe headache with photophobia, having just returned after a skiing holiday. Computerised tomography scan of the head showed fat within the anterior horn of both lateral ventricles, and within the subarachnoid space. Re-discussion with the patient and subsequent MRI (Magnetic Resonance Imaging) of the spine identified the pathogenesis of her symptoms: a sacral insufficiency fracture through a Tarlov cyst, causing subarachnoid fat embolism and symptoms of a low-pressure headaches due to a dural leak. Patient was medically managed and discharged with planned follow-up. Due to the Coronavirus pandemic and resolution of the patient's symptoms, they declined further follow up imaging.
CONCLUSIONS
The case demonstrates a rarely seen pathology as cause of a common presenting problem, headache. Emphasizing the importance of history taking and appropriate investigations in medical cases that do not conform to the usual diagnosis.
Topics: Middle Aged; Female; Humans; Tarlov Cysts; Spinal Fractures; Headache Disorders; Embolism, Fat; Headache
PubMed: 37803426
DOI: 10.1186/s13256-023-04142-2 -
PloS One 2012There has been no consensus on the optimal treatment of symptomatic sacral perineural cysts. Most previous reports concerning the management methods were either sporadic...
BACKGROUND
There has been no consensus on the optimal treatment of symptomatic sacral perineural cysts. Most previous reports concerning the management methods were either sporadic case reports or a series of limited cases. This study is to further optimize the management for patients with symptomatic sacral perineural cysts by analyzing the outcomes of a cohort of patients who were treated with different strategies.
METHODS AND FINDINGS
We reviewed the outcomes of 15 patients with symptomatic sacral perineural cysts who were managed by three different modalities from 1998 through 2010. Six patients underwent microsurgical cyst fenestration and cyst wall imbrication. Seven patients underwent a modified surgical procedure, during which the cerebrospinal fluid leak aperture was located and repaired. Two patients were treated with medication and physical therapy. Outcomes of the patients were assessed by following up (13 months to 10 years). All of the six patients treated with microsurgical cyst fenestration and cyst wall imbrication experienced complete or substantial relief of their preoperative symptoms. However, the symptoms of one patient reappeared eight months after the operation. Another patient experienced a postoperative cerebrospinal fluid leakage. Six of the seven patients treated with the modified surgical operation experienced complete or substantial resolution of their preoperative symptoms, with only one patient who experienced temporary worsening of his preoperative urine incontinence, which disappeared gradually one month later. No new postoperative neurological deficits, no cerebrospinal fluid leaks and no recurrence were observed in the seven patients. The symptoms of the two patients treated with conservative measures aggravated with time.
CONCLUSIONS
Microsurgical operation should be a treatment consideration in patients with symptomatic sacral perineural cysts. Furthermore, the surgical procedure with partial cyst removal and aperture repair for prevention of cerebrospinal fluid leakage seemed to be more simple and effective.
Topics: Adult; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Recurrence; Spinal Cord; Tarlov Cysts; Young Adult
PubMed: 22768183
DOI: 10.1371/journal.pone.0039958 -
Surgical Neurology International 2016Synchronous spinal intradural ependymal cysts and sacral Tarlov cysts in adult onset tethered cord syndrome are extremely rare.
BACKGROUND
Synchronous spinal intradural ependymal cysts and sacral Tarlov cysts in adult onset tethered cord syndrome are extremely rare.
CASE DESCRIPTION
A 23-year-old male presented with back pain radiating into both lower extremities, accompanied by acute onset of gait difficulty and sphincter dysfunction. Magnetic resonance imaging identified a low lying conus medullaris, syringomyelia with septations extending from T12 to S1, a tethered cord, and a thickened filum terminale with a sacral Tarlov cyst. The patient underwent a L3-4 laminectomy for decompression of syringomyelia and excision/biopsy of a space occupying lesion along with S1-2 laminectomy for cord untethering and Tarlov cyst fenestration. Postoperative histopathology confirmed that the lesion was an ependymal cyst. Clinically, patient showed marked improvement in the neurological status.
CONCLUSION
Simultaneous decompressive laminectomy of L3-4 and S1-2 effectively decompressed the syringomyelia while allowing for excision/biopsy of a space occupying lesion at the former and untethering and Tarlov cyst fenestration at the latter levels.
PubMed: 27843691
DOI: 10.4103/2152-7806.191083 -
Current Pharmaceutical Design 2012Pancreatic cancer is one of the most fatal human malignancies. Though a relatively rare malignancy, it remains one of the deadliest tumors, with an extremely high... (Review)
Review
Pancreatic cancer is one of the most fatal human malignancies. Though a relatively rare malignancy, it remains one of the deadliest tumors, with an extremely high mortality rate. The prognosis of patients with pancreatic cancer remains poor; only patients with small tumors and complete resection have a chance of a complete cure. Pancreatic cancer responds poorly to conventional therapies, including chemotherapy and irradiation. Tumor-specific targeted therapy is a relatively recent addition to the arsenal of anti-cancer therapies. It is important to find novel targets to distinguish tumor cells from their normal counterparts in therapeutic approaches. In the past few decades, studies have revealed the molecular mechanisms of pancreatic tumorigenesis, growth, invasion and metastasis. The proteins that participate in the pathophysiological processes of pancreatic cancer might be potential targets for therapy. This review describes the main players in perineural invasion, hypoxia and desmoplasia and the molecular mechanisms of these pathophysiological processes.
Topics: Animals; Antineoplastic Agents; Cell Dedifferentiation; Cell Hypoxia; Fibrosis; Humans; Neoplasm Proteins; Pancreatic Neoplasms; Pancreatic Stellate Cells; Tarlov Cysts
PubMed: 22372500
DOI: 10.2174/13816128112092395 -
Acta Neurochirurgica Jul 2011Surgery for symptomatic sacral perineural cysts remains an issue of discussion. Assuming micro-communications between the cyst and thecal sac resulting in a valve...
BACKGROUND
Surgery for symptomatic sacral perineural cysts remains an issue of discussion. Assuming micro-communications between the cyst and thecal sac resulting in a valve mechanism and trapping of CSF as a pathomechanism, microsurgical fenestration from the cyst to the thecal sac was performed to achieve free CSF communication.
METHODS
In 13 consecutive patients (10 female, 3 male), MRI revealed sacral perineural cysts and excluded other pathologies. Micro-communication between the thecal sac and the cysts was shown by delayed contrast filling of the cysts on postmyelographic CT. Surgical fenestration achieved free CSF communication between the thecal sac and cysts in all patients. The patient histories, follow-up examinations and self-assessment scales were analyzed. Symptoms at initial presentation included lumbosacral pain, pseudoradicular symptoms, genital pain and urinary dysfunction. Mean follow-up was 10.7 ± 6.6 months.
FINDINGS
Besides one CSF fistula, no surgical complications were observed. Five patients did not improve after surgery; in four of these cases multiple cysts were found, but small and promptly filling cysts remained untreated. Seven patients reported lasting benefit following surgery; three of these had single cysts, and all had cysts >1 cm. One patient initially benefited from cyst fenestration but experienced recurrent pain within 2 months postoperatively. Re-myelography revealed delayed contrast filling of the recurrent cyst; however, surgical revision did not lead to an improvement despite successful fenestration and collapse of the cyst revealed by postoperative imaging.
CONCLUSIONS
Microsurgical fenestration of sacral perineural cysts to the thecal sac is a surgical approach that has shown success in the treatment of lumbosacral pain, pseudoradicular symptoms, genital pain and urinary dysfunction associated with sacral perineural cysts. Our analysis, however, shows that mainly patients with singular large cysts benefit from this treatment.
Topics: Aged; Cauda Equina; Dura Mater; Female; Humans; Male; Microsurgery; Middle Aged; Neurosurgical Procedures; Radiography; Retrospective Studies; Spinal Nerve Roots; Tarlov Cysts
PubMed: 21562735
DOI: 10.1007/s00701-011-1043-0 -
PloS One 2013The spinal perineurial cyst (Tarlov) is a dilatation between the perineurium and endoneurium of spinal nerve roots, located at level of the spinal ganglion and filled...
The spinal perineurial cyst (Tarlov) is a dilatation between the perineurium and endoneurium of spinal nerve roots, located at level of the spinal ganglion and filled with cerebrospinal fluid but without communication with the perineurial subarachnoid space. The aim of the study was to evaluate it incidence among East-European patients. The retrospective data collected during various magnetic resonance spinal examinations and stored on the picture archiving and communication system was analyzed for an incidence of perineurial cysts. From among 842 patients that underwent examination, 75 cases perineurial cysts were revealed. In 22 cases single anomalies were found. In remaining 53 cases, multiple uni- or less frequently bilateral changes were noted. The most common position was the sacral canal, particularly the level of S2 and S3. Occasionally, cysts were also visible on the cervical, thoracic and lumbar level. Incidence of sacral perineurial cysts was significantly higher in females than in males. Similar data was found for single and multiple changes despite of their localization. Insignificant changes were seen for patient age and cyst size. Perineurial spinal cysts were the most frequently observed on the sacral level and such changes were more common in females.
Topics: Aged; Europe; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Spinal Nerve Roots; Tarlov Cysts
PubMed: 23936511
DOI: 10.1371/journal.pone.0071514 -
Medicine Nov 2023Caudal epidural block (CEB), which injects drugs into the epidural space through a sacral hiatus, is considered a safer alternative to other approaches. Serious...
RATIONALE
Caudal epidural block (CEB), which injects drugs into the epidural space through a sacral hiatus, is considered a safer alternative to other approaches. Serious complications, such as cauda equina syndrome or spinal cord infarction, have been reported very rarely, but their coexistence after CEB, which may be related to the ruptured perineural cyst, also known as a Tarlov cyst, was not reported.
PATIENT CONCERNS
A 40-year-old male patient presented with bilateral lower extremity radicular pain. CEB was performed without image guidance. The patient exhibited sensory deficits below L2, no motor function (0-grade), hypotonic deep tendon reflexes, and no pathological reflexes.
DIAGNOSES
Spinal cord infarction, cauda equina syndrome, and sacral level perineural cyst with hemorrhage.
INTERVENTION
High doses of steroids and rehabilitation were performed.
OUTCOMES
The patient was discharged after 28 days with persistent bilateral leg paralysis and sensory deficits below the L2 level. The patient demonstrated no neurological improvement.
LESSONS
Magnetic resonance imaging, including the sacral area, should be performed before performing CEB, to confirm the presence of a perineural cyst.
Topics: Male; Humans; Adult; Tarlov Cysts; Cauda Equina Syndrome; Anesthesia, Epidural; Pain; Spinal Cord Ischemia; Ischemic Attack, Transient; Infarction; Cauda Equina
PubMed: 37986362
DOI: 10.1097/MD.0000000000035824