Artigo em Inglês:
Tarlov's original description of perineurial cysts was reported in 1938 and based on observations made during dissection of 30 cadaveric terminal filum specimens at the Montreal Neurological Institute. He noted extradural cysts, often multiple, on portions of the posterior sacral and coccygeal nerve roots in five of these specimens. On histological examination, he found that these cysts were located in the perineurial space, between the endo-and perineurium at the junction of the posterior nerve root and its ganglion. In his original description, Tarlov discovered inflammatory cells in some cyst walls and adjacent tissues, leading him to postulate that these cysts were formed by a process of inflammation within the nerve root sheath, followed by inoculation of fluid.
Tarlov cysts are spinal nerve root lesions filled with spinal fluid, found most often at the lower levels of the spine. Other names for Tarlov and related spinal cysts are perineural or perineurial cyst, meningeal cyst, and arachnoid cyst. These cysts typically occur along the posterior nerve roots. The main feature that distinguishes Tarlov cysts from other spinal lesions is the presence of spinal nerve root fibers within the cyst wall, or in the cyst cavity itself.
Most of theses cysts are located in the lumbar, low back, or sacral, tailbone, area. They are located most prevalently at the S2, S3 level of the sacrum and less commonly at S1. The sacrum is a fused triangle-shaped bone comprised of the five sacral vertebrae forming the base of the spine. Cysts are usually small, about the size of a bean, but can grow to enormous size.They are dilations of the nerve root sheaths and are abnormal sacs filled with cerebrospinal fluid that can cause a progressively painful radiculopathy or nerve pain. The largest I have encountered filled the entire abdomen and the patient thought she might be pregnant. Theses cysts are common findings on MRI.
The symtoms of the Tarlov's Cyst
The cysts are then termed symptomatic Tarlov Cysts when there are a number of conditions that can create increased spinal fluid pressure, increasing the flow of cerebrospinal fluid into the cysts and causing them to expand in size and create symptoms. When conditions cause these cysts to fill with spinal fluid and to expand in size, they begin to compress important surrounding nerve fibers, or the cysts may contain nerve fibers, resulting in a variety of symptoms including chronic pain. Pressure on the nerves next to the cysts can also cause pain and deterioration of surrounding bone. Preliminary studies suggest that about 1% of sciatic or sciatic-like symptoms may be caused by Tarlov cysts. It is estimated that 70% of the cysts observed by MRI cause no symptoms.
A person who has a Tarlov cyst and any Tarlov cyst symptom needs evaluation by a specialist who has the expertise to determine if the symptoms are from a Tarlov cyst or another spine condition.
Tell your doctor send you for a MRI if you have any of these symptomps:
- Pain in lower back and in buttocks, legs, and feet.
- Weakness and/or cramping in legs and feet.
- Parasthesias or abnormal sensations in legs and feet.
- Cold feet.
- Pain sitting or standing for even short periods of time.
- Pain when sneezing or coughing.
- Inability to empty the bladder or in extreme cases to urinate at all.
- Changes in bladder function including increased frequency or incontinence.
- Bowel dysfunction. Changes in bowel function such as constipation or diarrhea.
- Swelling over the sacral area.
- Soreness, a feeling of pressure and tenderness over the sacrum and coccyx or tailbone, extending across the hip and into the thigh.
- Headaches.
- The feeling of sitting on a rock.
- Pulling and burning sensation in coccyx or tailbone area, especially when bending.
- Sciatica.
- Vaginal, rectal, and/or abdominal pain.
- Pain in the area of the nerves affected by the cysts, especially the buttocks.
- Weakness of muscles.
- Difficulty sitting for prolonged periods.
- Loss of sensation on the skin.
- Loss of reflexes.
- Changes in sexual function.
An increase in pressure in or on the cysts may increase symptoms and cause nerve damage. Sitting, standing, walking, and bending are typically painful, and often, the only position that provides relief, is reclining flat on one’s side or in 45 degree.
Diagnosis
Tests to detect the Tarlov cyst, may include the following imaging techniques:
- MRI scan — a test that uses magnetic waves to make pictures of structures inside the body.
- Myelogram — an imaging test that uses a special dye to view the spinal cord.
- CT scan — a type of x-ray that uses a computer to make pictures of structures inside the body.
Tarlov cysts are most commonly diagnosed by lumbosacral magnetic resonance imaging and can often be demonstrated by computerized tomography myelography to communicate with the spinal subarachnoid space. Tarlov cysts may be discovered when patients with low back pain or sciatica have a magnetic resonance imaging (MRI) performed. The standard urological tests for Tarlov cyst help determine if the patient has a neurogenic (malfunctioning) bladder. In urodynamics, the bladder is filled with water through a catheter and the responses are noted. Cystoscopy involves inserting a tube with a miniature video camera into the bladder via the urethra. A neurogenic bladder shows excessive muscularity.
Causes and Risks Factors
Often times, the cause is unknown but the cause of a Tarlov cyst may be related to:
- Trauma to the spinal cord.
- Increase in the cerebrospinal fluid pressure.
- Blockage of cerebrospinal fluid.
Once you have a Tarlov cyst, there are several factors that may cause it to become painful, such as:
- Traumatic injury such as a fall, automobile accident
- Heavy lifting
- Childbirth
- Epidural anesthesia
Tarlov Cysts, usually cause no apparent symptoms. Tarlov or perineurial cysts are pathological formations located in the space between the peri-and endoneurium of the spinal posterior nerve root. These lesions have been estimated to affect between 4.6 and 9% of the adult population.Preliminary studies suggest that about 1% of sciatic or sciatic-like symptoms may be caused by Tarlov cysts. Women are at an increased risk for developing Tarlov cysts.
Treatments
Most of the time, the Tarlov's cysts do not require treatments because are asyntomatics.
If you are experiencing symptoms, you have several treatment options:
NONSURGICAL TREATMENT
Corticosteroid injections Corticosteroid injections or other medication injections to relieve pain. Corticosteroid injections, are not good idea because this treatment, several times increase the symtomps.
Prescription medications such as pain medications, antiseizure medications or antidepressants can be used to treat the pain.
Lidoderm patches applied to the sacral area to provide temporary relief of pain and discomfort.
Antiboitics + medication to relieve pain This treatment work better in some pacient but don't prevent symptomatic cyst recurences.
Aspiration of the cyst a needle is used to drain the cyst to relieve symptoms. A minimally invasive procedure for Tarlov cysts involves aspiration of the cyst followed by injection of fibrin glue. This procedure has been effective for some members.
SURGICAL TREATMENT
Surgery Tarlov cyst surgery involves exposing the region of the spine where the cyst is located. The cyst is opened and the fluid drained, and then in order to prevent the fluid from returning, the cyst is occluded with a fibrin glue injection or other matter. Neurosurgical techniques for symptomatic Tarlov cysts include simple decompressive laminectomy, cyst and/or nerve root excision, and microsurgical cyst fenestration and imbrication.
HERBALS AND NATURAL TREATMENTS
Herbals treatments A combination of several herbs work very well and can to prevent recurrence. Pacients that tried this treatment are very happy. See Chapter 3 about the revolutionary herbas and natural treatments.
Supplements The herbals treatments require some dietaries supplement to work better.
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