Successful spinal anaesthesia in a patient with a Tarlov cyst

Perineural (Tarlov) cysts are cerebrospinal fluid-containing perineural sacs that are usually located in the sacral spine. While often asymptomatic, they can cause progressive neurological symptoms including pain, paraesthesia and weakness. We present a case of a 24-year-old patient who had uneventful spinal anaesthesia at the L3-4 level for an elective caesarean section. Prior to her procedure, she had reported a two-year history of intermittent back pain and lower-limb paraesthesia, secondary to an S1 segment perineural cyst. Recurrent cyst-related symptoms were managed using serial radiologically-guided injection and cerebrospinal fluid aspiration, rather than a more invasive neurosurgical approach. Successful neuraxial anaesthesia for caesarean section, in the context of Tarlov cysts, is described; and the management options are discussed.