David Abraham Nussbaum MD, Presenter: Nothing to Disclose

Kieran J. Murphy MD, Abstract Co-Author: Nothing to Disclose

Philippe Gaillloud MD, Abstract Co-Author: Nothing to Disclose

Donlin Martin Long MD, PhD, Abstract Co-Author: Nothing to Disclose

Susan Schnupp, Abstract Co-Author: Nothing to Disclose

Symptomatic Tarlov cysts typically cause chronic pelvic and lower extremity pain. Current surgical treatment involves significant patient morbidity. The isolated case reports of CT-guided needle aspirations offer limited evidence of treatment efficacy and safety. We report the outcome of 128 patients with symptomatic Tarlov cysts treated at our institution by CT fluoroscopic guided needle aspiration and fibrin injection, surgical laminectomy and cyst fenestration, or both.          

The retrospective analysis involved symptomatic patients with image-proven Tarlov/perineural cysts treated from April, 2004 to November, 2007. In total, 128 patients were evaluated for treatment by CT fluoroscopic guided needle aspiration and fibrin injection vs. surgical laminectomy and cyst fenestration. Contraindications to needle aspiration included wide communication with the thecal sac and thick bone overlying the cyst. When pain was not relieved by aspiration, the patient often underwent subsequent surgery. Perioperative pain as well as improvement in pre-operative symptoms were assessed.    

82% of patients were female. 127 aspiration/fibrin injection procedures were performed on 102 patients. 72 utilized a novel two-needle technique. Eight patients who failed aspiration underwent surgical laminectomy/cyst fenestration. Nineteen patients were candidates for aspiration and were treated by surgical laminectomy and cyst fenestration. The aspiration group demonstrated a 67% improvement in symptoms with complete resolution of pain in 20%. Perioperative pain was limited and improved with the use of the two-needle technique. The sole complication was a patient who developed post-operative urticaria of unknown etiology. In comparison, 37% of patients who underwent surgical repair improved post-operatively. Symptoms did not resolve in any surgically-treated patient. In addition, 48% of surgical patients developed post-operative CSF leaks and pseudomeningocele formation that required an average of 2 additional procedures to repair.

In this series of 128 patients, CT-fluoroscopic guided needle aspiration and fibrin injection of symptomatic Tarlov cysts improved symptoms in 67% of patients. Surgical treatment improved symptoms in 37% and was associated with a 48% complication rate

CT-fluoroscopic guided needle aspiration and fibrin injection is a highly effective first-line treatment for symptomatic Tarlov/perineural cysts.

Nussbaum, D, Murphy, K, Gaillloud, P, Long, D, Schnupp, S, Efficacy and Safety of CT Fluoroscopic-guided Needle Aspiration and Fibrin Injection of Symptomatic Tarlov Cysts: A Retrospective Analysis of 128 Patients.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6018064.html