Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
World Neurosurg. 2018 Feb;110:79-84. doi: 10.1016/j.wneu.2017.10.135. Epub 2017 Nov 2.
A presacral Tarlov cyst is an unusual cause of abdominal pain. The unusual location of a presacral Tarlov cyst can lead to misdiagnosis and inappropriate treatment. To guide appropriate diagnosis and treatment, we reviewed causes, clinical presentations, radiologic features, and management options of this extremely rare lesion.
We performed an English-language literature search using PubMed to identify reports of patients with presacral Tarlov cysts. The diagnosis was based on classic radiologic signs. Seven patients described in 7 publications met the inclusion criteria and were analyzed in conjunction with 3 new patients described by our team.
A congenital arachnoidal defect may be the primary causative factor of a presacral Tarlov cyst. Lumbosacral pain, leg pain, and bowel and bladder dysfunction are common clinical complaints, while abdominal pain is uncommon. Myelography and magnetic resonance imaging are considered useful diagnostic techniques. Myelography provided the definitive diagnosis for 33% of the patients, and magnetic resonance imaging was diagnostic for 67%. Surgical interventions may be appropriate for symptomatic presacral lesions. Two patients who received conservative treatment continued to experience their presenting symptoms, whereas 7 patients who underwent surgical treatment experienced favorable outcomes.
Although extremely rare, presacral Tarlov cysts should be suspected in patients with abdominal pain, especially when pain occurs along with other neurologic symptoms. This review provides a systematic description of this rare disease, which may be helpful in guiding the appropriate diagnosis and treatment.
骶前 Tarlov 囊肿是一种罕见的腹痛原因。骶前 Tarlov 囊肿的位置不常见，可能导致误诊和不当治疗。为了指导适当的诊断和治疗，我们回顾了这种极其罕见病变的病因、临床表现、影像学特征和治疗选择。
我们使用 PubMed 进行了英语文献检索，以确定骶前 Tarlov 囊肿患者的报告。诊断基于典型的影像学征象。7 篇文献中描述的 7 例患者符合纳入标准，并与我们团队描述的 3 例新患者一起进行了分析。
先天性蛛网膜缺陷可能是骶前 Tarlov 囊肿的主要致病因素。腰骶部疼痛、下肢疼痛以及肠和膀胱功能障碍是常见的临床症状，而腹痛并不常见。脊髓造影和磁共振成像被认为是有用的诊断技术。脊髓造影对 33%的患者提供了明确诊断，磁共振成像对 67%的患者提供了明确诊断。对于有症状的骶前病变，手术干预可能是合适的。2 例接受保守治疗的患者继续出现其主要症状，而 7 例接受手术治疗的患者则取得了良好的效果。
尽管极其罕见，但对于出现腹痛的患者，尤其是伴有其他神经症状的患者，应怀疑骶前 Tarlov 囊肿。本综述对这种罕见疾病进行了系统描述，这可能有助于指导适当的诊断和治疗。
