Giant sacral tarlov cyst and renal insufficiency

Perineural sacral cysts also called Tarlov cysts are pathologic collections of cerebrospinal fluid CSF They are typically located at the junction of the dorsal ganglion and the posterior nerve root and use to develop between the endoneurium and perineurium of the nerve root Tarlov cysts were described in as an incidental finding during an autopsy in fillum terminale They occur around of the general population and generally are most commonly small asymptomatic and discovered as an incidental finding on lumbosacral imaging studies obtained for evaluation of degenerative spine disease However in a symptomatic population the prevalence was reported at They are more comom at female patients The most common location in the spine is the sacral region with the S S nerve roots most commonly affected The patient may complain low back pain sciatica coccydinia or cauda equina syndrome The cysts are usually diagnosed on Magnetic Ressonance Image MRI which shows the lesion arising from sacral nerve roots Ten years after his original description Tarlov advised extensive surgery with sacral laminectomy and excision of the cyst along with the nerve root Paulsen reported CT guided percutaneous aspiration of Tarlov cysts for relief of sciatica Recently microsurgical excision of the cyst has been described as well as clipping technique Also closure of the communication between arachnoid and cyst sacrificing near neural roots has been reported