Transcatheter arterial embolization for a symptomatic Tarlov cyst with hemorrhage due to an underlying arteriovenous fistula.

Symptomatic sacral perineural cysts (Tarlov cysts) accompanied by intra-cyst hemorrhage are rare. The treatment strategies have not been established. We report a 57-year-old woman with severe back pain due to a Tarlov cyst accompanying intracyst hemorrhage. Computed tomography angiography revealed an arteriovenous fistula (AVF) at the area surrounding the cyst. The patient underwent transcatheter arterial embolization for the AVF. Thereafter, the hematoma and cyst decreased in size, and clinical symptoms markedly improved with no additional surgery. Transcatheter arterial embolization may be an effective alternative to surgery for Tarlov cysts with vascular disease, including AVF.