Tarlov cysts: endoscope-assisted obliteration of the communication with the spinal subarachnoid space.

Background And Objective: The physiopathology of Tarlov or perineural cyst (PC) symptoms is unknown, but probably its filling and distention with spinal cerebrospinal fluid makes them symptomatic. The objective of this study is to describe the endoscope-assisted obliteration of the communication between PCs and the spinal subarachnoid space (SSS).

Patients And Methods: From 2007 to 2011, four male and two female patients (median age: 45 years) with PCs were treated. They complained of lumbar, sciatic, and/or perineal pain. Physical examination was normal. The diagnosis was made by magnetic resonance imaging (MRI). All the cysts were located in the midline between S1 and S3. An endoscope-assisted obliteration between PC and SSS was performed. The outcome was evaluated clinically with the Odom scale and radiologically with an MRI.

Results: After a median follow-up of 25.83 months, the outcome was excellent (four cases), good (one case), and poor (one case). There were no complications. The postoperative MRI showed size and signal intensity changes in all PCs reflecting their exclusion from the SSS.

Conclusions: The endoscope-assisted obliteration of the communication between PCs and the SSS is a simple technique that rendered excellent to good results in 83% of the cases.