Younes M, Korbaa W, Zrour S, Bejia I, Touzi M, Bergaoui N
Service de rhumatologie, EPS de Monastir, 5000 Monastir, Tunisie.
Rev Neurol (Paris). 2009 Mar;165(3):282-7. doi: 10.1016/j.neurol.2008.07.019. Epub 2008 Sep 21.
Tarlov cysts and nerve roots anomalies usually involve lumbosacral roots and are often asymptomatic. MRI has enabled recognition of many conditions that used to be missed by CT or myelography investigations performed for back and leg pain. However, even without additional compressive impingement (disc hernia, spondylolisthesis or lumbar canal stenosis) these anomalies can be responsible for sciatica, motor deficit and bladder sphincter dysfunction. Tarlov cysts are perinervous dilatations of the dorsal root ganglion. CT and especially MRI can reveal these cysts and their precise relations with the neighboring structures. Delayed filling of the cysts can be visualized on the myelogram. MRI is more sensitive than CT myelography for a positive diagnosis of nerve root anomalies, a differential diagnosis with disc hernia and classification of these anomalies. Surgical treatment is indicated for symptomatic Tarlov cysts and nerve root anomalies resistant to conservative treatment. Better outcome is observed in patients with an additional compressive impingement component. We report two cases of sciatica: one caused by Tarlov cysts diagnosed by MRI and the other by nerve root anomalies diagnosed by CT myelography. In both cases, conservative treatment was undertaken. The clinical, radiological and therapeutic aspects of these disorders are discussed.
塔洛夫囊肿和神经根异常通常累及腰骶神经根，且常常无症状。磁共振成像（MRI）已能识别许多过去因腰腿痛而行计算机断层扫描（CT）或脊髓造影检查时被漏诊的疾病。然而，即使没有额外的压迫性撞击（椎间盘疝、椎体滑脱或腰椎管狭窄），这些异常也可能导致坐骨神经痛、运动功能障碍和膀胱括约肌功能障碍。塔洛夫囊肿是背根神经节的神经周围扩张。CT尤其是MRI能够显示这些囊肿及其与邻近结构的精确关系。囊肿延迟显影可在脊髓造影中看到。在神经根异常的阳性诊断、与椎间盘疝的鉴别诊断以及这些异常的分类方面，MRI比CT脊髓造影更敏感。对于有症状的塔洛夫囊肿和对保守治疗耐药的神经根异常，需进行手术治疗。在伴有额外压迫性撞击成分的患者中观察到更好的治疗效果。我们报告两例坐骨神经痛病例：一例由MRI诊断为塔洛夫囊肿所致，另一例由CT脊髓造影诊断为神经根异常所致。两例均采取了保守治疗。本文讨论了这些疾病的临床、影像学和治疗方面的问题。
