Giant Tarlov cyst during pregnancy: case report and literature review

To analyze the diagnostic approach, considerations regarding delivery and treatment for Tarlov cysts during pregnancy, through a case report and literature review.

We present the case of a 31-year-old woman who was referred to a tertiary care general hospital at 33 weeks of gestation due to a pelvic cystic mass. Magnetic resonance imaging revealed a cystic lesion in continuity with the thecal sac, associated with osseous remodeling of the L4, L5, and sacral vertebral bodies, with presacral extension and displacement of the rectum to the right. A Tarlov cyst was diagnosed. The pregnancy was terminated by cesarean section under general anesthesia at 37 weeks due to mechanical dystocia and the high risk of cyst puncture and subsequent cerebrospinal fluid fistula. A healthy newborn weighing 2,420 g was delivered, and both maternal and neonatal outcomes were satisfactory. At the four-month postoperative follow-up, the patient reported low back pain and was awaiting neurosurgical management. A literature search was conducted in Medline via PubMed, Lilacs, SciELO, and ScienceDirect using the terms “Pregnancy” and “Tarlov cysts.” Case reports, case series of pregnant patients with Tarlov cysts, and literature reviews were included. Titles and abstracts were screened, and data were extracted independently by two authors. Extracted data included study characteristics, patient demographics, diagnosis, obstetric management, treatment, and prognosis of Tarlov cysts. A descriptive summary of the findings is presented.

The review identified five cases which met the inclusion criteria. Simple magnetic resonance imaging was used for diagnosis in all cases. Vaginal delivery was performed in two cases. Neuraxial anesthesia was administered without complications in three cases. No direct maternal-fetal complications attributable to the cysts were reported. None of the cases reported interventions for the cyst during pregnancy.

Tarlov cysts during pregnancy are rare. Non-contrast magnetic resonance imaging is the safest and most effective diagnostic option for this condition during pregnancy. The Tarlov cyst could not increase the risk of perinatal complications or related with the cyst complications. Further reports and multicenter studies are needed to establish optimal obstetric and anesthetic strategies.