Tarlov cysts, also known as perineural cysts, are sacs filled with cerebrospinal fluid that develop along the spinal nerve roots, most commonly in the sacral region. They were first described in 1938 as an incidental autopsy finding. Only a small percentage of Tarlov cysts cause symptoms such as low back pain, sciatica, or cauda equina syndrome. Tarlov cysts are diagnosed by excluding other potential causes for a patient's symptoms. Treatment options include conservative measures like oral steroids or epidural injections, or surgery to drain or remove large symptomatic cysts.

1. Perineural (Tarlov) Cysts
Ade Wijaya, MD
March 2019

2. Introduction
 Tarlirst described in 1938 as an
incidental finding at autopsy
 Uncommon
 Only 1 - 4.6 % symptomatic as LBP
 13 % of these cysts are symptomatic
 Diagnostic of exclusion
I.M. Tarlov Perineural cysts of the spinal nerve roots Arch. Neural Psychiatry, 40 (1938), pp. 1067-1074
R.D. Paulsen, G.A. Call, F.R. MurtaghPrevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts) AJNR
Am. J. Neuroradiol., 15 (1994), pp. 293-299
Andrieux, C., Poglia, P., & Laudato, P. (2017). Tarlov Cyst: A diagnostic of exclusion. International journal of surgery case reports, 39, 25-28.
Langdown AJ Grundy JR Birch NC . The clinical relevance of Tarlov cysts . J Spinal Disord Tech 2005 ; 18 ( 1 ): 29 – 33.

3. Definition
type II innervated meningeal cysts,
cerebrospinal-fluid-filled (CSF) sacs
most frequently located in the spinal
canal of the S1-to-S5 region of the
spinal cord (much less often in the
cervical, thoracic or lumbar spine
C.I. Ju, H. Shin, S.W. Kim, H.S. KimSacral perineural cyst accompanying disc herniation J. Korean Neurosurg. Soc., 45 (March (3)) (2009), pp. 185-187

4. Clinical Presentation
Low Back
Pain
Sciatic Pain
Coccydynia
Cauda
Equina
Syndrome
Andrieux, C., Poglia, P., & Laudato, P. (2017). Tarlov Cyst: A diagnostic of exclusion. International journal of surgery case reports, 39, 25-28.

5. Emary, P. C., & Taylor, J. A. (2016). Sciatic neuralgia associated with a perineural (Tarlov) cyst. The Journal of the Canadian Chiropractic Association, 60(3), 263.

8. Management
 Conservative: oral or epidural steroid
 Surgical
Landers J Seex K. Sacral perineural cysts: Imaging and treatment options . Br J Neurosurg 2002 ; 16 ( 2 ): 182– 5.
Gunduz, O. H., Sencan, S., & Kokar, S. (2015). A rare cause of lumbar radiculopathy: perineural cyst. Pain Medicine, 16(1), 199-200.

9. Summary
 Symptomatic sacral perineural cysts are
uncommon in opposition to the AVN of
the femoral head which is a common
diagnosis.
 Tarlov cysts should be considered only
after exclusion the other possibles
diagnostics in the differential diagnosis.
 Symptomatic cases can be treated
surgically although some cases resolve
spontaneously

10. THANK YOU~