gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Tarlov cysts: Long-term follow-up after microsurgical inverted plication and sacroplasty

Meeting Abstract

  • Ralf Weigel - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany; Neurochirurgische Gemeinschaftspraxis, St. Katharinen Krankenhaus, Frankfurt am Main, Germany
  • Manolis Polemikos - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany
  • Nesrin Uksul - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany
  • Joachim K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.14.06

doi: 10.3205/16dgnc079, urn:nbn:de:0183-16dgnc0794

Published: June 8, 2016

© 2016 Weigel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Surgical treatment of Tarlov cysts is still a matter of debate. Published literature thus far includes mainly small case series with retrospective evaluation and short-term follow-up. We present a novel microsurgical technique that combines decompression of the nerve fibers in the cyst wall by inverted plication with prevention of recurrence by a fat graft and autologous or xenologous sacroplasty. Long-term follow-up is provided.

Method: The indication for surgery was incapacitating pain refractory to medical therapy over a period of at least 6 months. The surgical technique consisted in microsurgical opening of the cyst and drainage of CSF followed by secured inverted plication of the cyst wall and packing of the space that was created thereby with a fat graft and sacroplasty. Pain and neurological deficits were evaluated according to a modified Barrow National Institute score (BNI score, 0-5) and the Departmental Neuro Score (DNS score, 0-20) during regular follow-up visits.

Results: A total of 13 patients with symptomatic Tarlov cysts were included from 2001 - 2013 and followed up to 14 years (mean FU 5.3 years). Mean age at surgery was 51.8 (± 14) years. Pain and neurological deficits improved significantly in 11/13 patients (BNI score pre-OP 5 vs 3.1 ± 1.2 at 1-year-FU, and 2.8 ± 1.2 at last follow-up visit; DNS score pre-OP 5.5 ± 1.5 vs 2.8 ± 2.1 at 1-year follow-up, and 2.6 ± 2.2 at last follow-up visit. Two patients needed revision surgery due to reoccurrence of the cyst. One patient suffered deterioration of preexisting neurological deficit.

Conclusions: The inverted plication technique combined with sacroplasty appears to be a promising technique in the treatment of symptomatic Tarlov cysts. It improves pain and neurological deficits over time in the majority of affected patients. With regard to the possible occurrence of surgical complications, patient selection is crucial. Future studies are needed to confirm the efficacy of surgical treatment of Tarlov cysts refractory to conservative therapy.