Thecaloscopy Reduces the Risk of Recurrent Perineural (Tarlov) Cysts after Microsurgical Resection

Area of Science:

• Neurosurgery
• Spinal Surgery
• Neurology

Background:

• Sacral Tarlov cysts (TCs) often cause pain and neurological issues.
• Conventional treatments have high recurrence and complication rates, impacting outcomes.
• Inflammation and elevated cerebrospinal fluid (CSF) pressure may contribute to TC formation.

Purpose of the Study:

• To evaluate the efficacy of thecaloscopy combined with microsurgical resection for Tarlov cysts.
• To assess the impact of arachnoid sheath fenestration on TC recurrence rates.
• To determine the safety and effectiveness of this novel surgical approach.

Main Methods:

• Retrospective study of 78 patients with sacral Tarlov cysts.
• Comparison of microsurgical resection alone versus combined with endoscopic fenestration of the arachnoid sheath.
• Thecaloscopy used to guide fenestration at the lumbosacral spinal nerve root entry level.

Main Results:

• The combined thecaloscopy and fenestration group showed significantly lower recurrence rates (5/48) compared to microsurgical resection alone (9/30).
• Only one patient experienced persistent bladder dysfunction after the combined procedure.
• The technique demonstrated a promising reduction in Tarlov cyst recurrence.

Conclusions:

• Thecaloscopy combined with arachnoid sheath fenestration offers a safe and effective treatment for sacral Tarlov cysts.
• This approach significantly reduces the risk of cyst recurrence compared to conventional methods.
• The findings suggest a potential role for inflammatory processes in perineural cyst development.