Okumura Eitaro, Kubota Motoo, Hashimoto Ryo
Spinal Surgery, Kameda Medical Center, Kamogawa, JPN.
Cureus. 2025 Apr 8;17(4):e81909. doi: 10.7759/cureus.81909. eCollection 2025 Apr.
Perineural cysts are meningeal protrusions at nerve roots that can be asymptomatic but may require surgical intervention. Tarlov cysts, specifically located at sacral nerve roots, lack a consensus on optimal surgical treatment. This case report describes surgical management of a giant Tarlov cyst. A 29-year-old woman with infertility, low back pain, and constipation was found to have an 11 cm giant pelvic cyst originating from the left S3 nerve root. Preoperative imaging and symptoms suggested a perineural cyst. Intraoperative electromyographic monitoring revealed that the S2 nerve root could compensate for S3 function. Consequently, we performed radical ligation of the cyst neck together with the left S3 nerve root. Postoperatively, the patient's sensory disturbance in the posterior left thigh improved. Two months after surgery, the cyst remained regressed, constipation had improved, and the patient showed a favorable outcome. This case demonstrates successful surgical ligation of a giant Tarlov cyst, suggesting that when intraoperative nerve monitoring confirms compensatory nerve root function, radical nerve root ligation can be a viable surgical option.
神经周围囊肿是神经根处的脑膜突出物，可能无症状，但可能需要手术干预。塔尔洛夫囊肿，具体位于骶神经根，在最佳手术治疗方面缺乏共识。本病例报告描述了巨大塔尔洛夫囊肿的手术治疗。一名29岁患有不孕症、腰痛和便秘的女性被发现有一个起源于左S3神经根的11厘米巨大盆腔囊肿。术前影像学检查和症状提示为神经周围囊肿。术中肌电图监测显示S2神经根可代偿S3功能。因此，我们对囊肿颈部连同左S3神经根进行了根治性结扎。术后，患者左大腿后部的感觉障碍有所改善。术后两个月，囊肿持续消退，便秘有所改善，患者预后良好。本病例证明了巨大塔尔洛夫囊肿手术结扎的成功，表明当术中神经监测证实神经根具有代偿功能时，根治性神经根结扎可能是一种可行的手术选择。
