Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, Arizona.
Department of Radiology, Saint Joseph's Hospital and Medical Center, Phoenix, Arizona.
Am J Obstet Gynecol. 2020 Jan;222(1):70.e1-70.e6. doi: 10.1016/j.ajog.2019.07.021. Epub 2019 Jul 15.
Pudendal neuralgia is a painful neuropathic condition involving the pudendal nerve dermatome. Tarlov cysts have been reported in the literature as another potential cause of chronic lumbosacral and pelvic pain. Notably, they are often located in the distribution of the pudendal nerve origin at the S2, S3, and S4 sacral nerve roots and it has been postulated that they may cause similar symptoms to pudendal neuralgia. Literature has been inconsistent on the clinical relevance of the cysts and if they are responsible for symptoms.
To evaluate the prevalence of S2-S4 Tarlov cysts at the pudendal nerve origin (S2-S4 sacral nerve roots) in patients specifically diagnosed with pudendal neuralgia, and establish association of patient symptoms with location of Tarlov cyst.
A retrospective study was performed on 242 patients with pudendal neuralgia referred for pelvic magnetic resonance imaging from January 2010 to November 2012. Dedicated magnetic resonance imaging review evaluated for presence, level, site, and size of Tarlov cysts. Among those with demonstrable cysts, subsequent imaging data were collected and correlated with the patients' clinical site of symptoms. Statistical analysis was performed using χ, Pearson χ, and Fisher exact tests to assess significance.
Thirty-nine (16.1%) patients demonstrated at least 1 sacral Tarlov cyst; and of the 38 patients with complete pain records, 31 (81.6%) had a mismatch in findings. A total of 50 Tarlov cysts were identified in the entire patient cohort. The majority of the Tarlov cysts were found at the S2-S3 level (32/50; 64%). Seventeen patients (44.7%) revealed unilateral discordant findings: unilateral symptoms on the opposite side as the Tarlov cyst. In addition, 14 (36.8%) patients were detected with bilateral discordant findings: 11 (28.9%) had bilateral symptoms with a unilateral Tarlov cyst, and 3 (7.9%) had unilateral symptoms with bilateral cysts. Concordant findings were only demonstrated in 7 patients (18.4%). No significant association was found between cyst size and pain laterality (P = .161), cyst volume and pain location (P = .546), or cyst size and unilateral vs bilateral pain (P = .997).
The increased prevalence of Tarlov cysts is likely not the etiology of pudendal neuralgia, yet both could be due to similar pathogenesis from part of a focal or generalized condition.
阴部神经痛是一种涉及阴部神经皮节的疼痛性神经病变。文献中报道 Tarlov 囊肿是慢性腰骶部和骨盆疼痛的另一个潜在原因。值得注意的是，它们通常位于 S2、S3 和 S4 骶神经根的阴部神经起源处分布，并且有人假设它们可能引起类似于阴部神经痛的症状。文献对囊肿的临床相关性及其是否引起症状的一致性不一致。
评估在专门诊断为阴部神经痛的患者中，阴部神经起源处（S2-S4 骶神经根）的 S2-S4 Tarlov 囊肿的患病率，并确定囊肿位置与患者症状之间的关联。
对 2010 年 1 月至 2012 年 11 月因阴部神经痛而接受盆腔磁共振成像检查的 242 名患者进行了回顾性研究。专门的磁共振成像评估了囊肿的存在、水平、部位和大小。在那些可检测到囊肿的患者中，收集了后续的影像学数据，并与患者的临床症状部位相关联。使用 χ2、Pearson χ2 和 Fisher 确切检验进行统计分析以评估显著性。
39 名（16.1%）患者至少有 1 个骶骨 Tarlov 囊肿；在 38 名有完整疼痛记录的患者中，31 名（81.6%）的检查结果与发现不匹配。在整个患者队列中总共发现了 50 个 Tarlov 囊肿。大多数 Tarlov 囊肿位于 S2-S3 水平（32/50；64%）。17 名患者（44.7%）出现单侧不匹配发现：囊肿对侧出现单侧症状。此外，14 名患者（36.8%）出现双侧不匹配发现：11 名患者（28.9%）单侧症状伴单侧囊肿，3 名患者（7.9%）单侧症状伴双侧囊肿。仅在 7 名患者（18.4%）中发现了一致性发现。囊肿大小与疼痛侧性之间无显著相关性（P=.161），囊肿体积与疼痛部位之间无显著相关性（P=.546），囊肿大小与单侧与双侧疼痛之间无显著相关性（P=.997）。
Tarlov 囊肿的高发率可能不是阴部神经痛的病因，但两者都可能是由于局部或全身性疾病的相似发病机制所致。
