Department of Neurosurgery, Nagoya University, Nagoya, Japan.
Department of Neurosurgery, Nagoya University, Nagoya, Japan.
World Neurosurg. 2021 Jan;145:306-310. doi: 10.1016/j.wneu.2020.09.098. Epub 2020 Sep 25.
This manuscript discusses the case of huge presacral Tarlov cysts (TCs) and the substantial neurologic recovery noted in the patient following spontaneous rupture of the most prominent cyst. Perineural or TCs are nerve root cysts, which are usually incidental findings on magnetic resonance imaging (MRI) and are most frequently observed in the sacral spine. Symptomatic lesions are rarely encountered.
In this case, a 44-year-old woman presented with anal and vulva pain on the right side, and bladder and bowel dysfunction. MRI of the lumbosacral spine showed multiple huge bilateral TCs located within the presacral space from S1-3. There was a substantially large right-sided S3 cyst that was presumed to be responsible for her symptoms. Surgical intervention was considered; however, her symptoms improved significantly during the waiting period for surgery because of spontaneous rupture of the right-sided S3 cyst, as confirmed on follow-up MRI. On follow-up over a 1-year period, the patient had been very well with no recurrent symptoms.
To our knowledge, this is the first report of spontaneous cyst rupture and resultant neurologic improvement in a case of symptomatic presacral TCs.
本文讨论了巨大的骶前 Tarlov 囊肿（TCs）病例，以及该患者在最显著的囊肿自发破裂后出现的显著神经恢复。神经周围或 TCs 是神经根囊肿，通常在磁共振成像（MRI）上偶然发现，最常发生在骶骨脊柱。症状性病变很少见。
在本例中，一名 44 岁女性出现右侧肛门和外阴疼痛，以及膀胱和肠道功能障碍。腰骶部 MRI 显示多个双侧巨大 TCs 位于 S1-3 骶前间隙内。有一个明显的右侧 S3 囊肿，被认为是导致她症状的原因。考虑手术干预；然而，由于右侧 S3 囊肿自发破裂，正如后续 MRI 所证实的那样，她在手术等待期间症状显著改善。在为期 1 年的随访中，患者情况良好，无复发症状。
据我们所知，这是首例报告的症状性骶前 TCs 囊肿自发破裂和由此导致的神经改善病例。
