Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Neurosurgery. 2020 Jan 1;86(1):88-92. doi: 10.1093/neuros/nyy586.
Tarlov cysts (TC) are commonly found spinal perineural cysts. Symptomatic TCs are rare, however, and there is no consensus on their pathogenesis and optimal management.
To characterize cyst growth in patients with symptomatic TCs.
This is a retrospective cohort study of 28 subjects, evaluated for symptomatic TCs (2011-2017). Each of the subjects had multiple magnetic resonance imaging (MRIs) across time and was included in a natural history analysis.
A total of 42 TCs were identified across the 28 subjects, of which 7 cysts (17%) across 5 subjects demonstrated growth. Across a mean follow-up of 4.7 ± 1.8 years, TCs grew at a relative rate of 2.9 ± 2.6% in the anteroposterior, 4.3 ± 3.8% in the craniocaudal, and 1.4 ± 1.4% in the transverse dimensions per year. None of the cysts decreased in size between successive MRIs. Symptoms of cerebrospinal fluid (CSF) hypotension (positional headaches) were positive predictors of prior cyst growth on logistic regression (P = 0.02, odds ratio = 10). A total of 2 of the 5 subjects were initially asymptomatic from their TCs, and developed symptoms during the period of cyst growth, whereas 2 others experienced worsening of their symptoms during cyst growth.
We report on the growth of TCs, which is consistent with a widely-held theory that hydrostatic and pulsatile forces of CSF along with a ball-valve phenomenon allow for continuous dilation of TCs.
Tarlov 囊肿（TC）是常见的脊神经周围囊肿。然而，症状性 TC 较为罕见，其发病机制和最佳治疗方法尚未达成共识。
描述症状性 TC 患者囊肿的生长情况。
这是一项回顾性队列研究，纳入了 28 名在 2011 年至 2017 年间接受症状性 TC 评估的患者。每位患者均有多次 MRI 检查结果，且纳入自然病史分析。
在 28 名患者中共发现了 42 个 TC，其中 5 名患者的 7 个囊肿（17%）出现了生长。在平均 4.7±1.8 年的随访期间，TC 在前后方向上的生长速度为每年 2.9±2.6%，在头足方向上为每年 4.3±3.8%，在横断方向上为每年 1.4±1.4%。在连续的 MRI 检查中，没有一个囊肿的体积减小。脑脊液（CSF）压力降低（体位性头痛）的症状是囊肿生长的logistic 回归阳性预测因子（P=0.02，比值比=10）。在这 5 名患者中，有 2 名患者最初无症状，在囊肿生长期间出现了症状，而另外 2 名患者在囊肿生长期间症状恶化。
我们报告了 TC 的生长情况，这与一种广泛持有的理论一致，即 CSF 的静压和脉动压力以及球阀现象允许 TC 持续扩张。
