Percutaneous Endoscopic Treatment for a Symptomatic Sacral Tarlov Cyst

Symptomatic sacral Tarlov cysts have been associated with perineal or sacral pain, radiculopathy, and urinary dysfunction. The ideal treatment of symptomatic sacral Tarlov cysts remains a matter of discussion. Various open surgical procedures have been proposed, varying from placement of shunts and clipping to laminectomy and fenestration; however, those procedures are often associated with recurrence, cerebrospinal fluid leakage, infection, and other complications. A percutaneous endoscopic surgical procedure to address this problem has not been described to date.

A 21-year-old man presented with perineal and left lower extremity pain. Magnetic resonance imaging demonstrated a sacral Tarlov cyst protruding through the left S2 canal. Through a small laminectomy at S2, the posterolateral wall of the cyst was exposed. The incision was continued from the neck to caudal of the cyst. The cyst wall was resected step by step. The fenestration was performed at the neck of the cyst with scissors. His lower extremity and perineal pain improved progressively during the first day postoperatively, and there were no signs of cerebrospinal fluid leakage, infection, or other complications. No further cyst formation or complications were recorded after 6 months.

In this case report, we describe a percutaneous endoscopic approach to surgical resection of a Tarlov cyst that was performed safely and effectively. This novel minimally invasive strategy may have broad prospects for symptomatic sacral Tarlov cysts; however, due to the limitations of a single case, more reported cases and further controlled studies of this novel technique are needed.