Conservative Management of Symptomatic Sacral Tarlov Cyst - A Rare Case Report

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.

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.

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.