Generality
Tarlov cysts - also known as perineural cysts - are cystic lesions containing cerebrospinal fluid, which form at the level of the spine, particularly in the sacral area.
As an indication, it is estimated that the incidence of Tarlov cysts in the adult population is 5%, but of this percentage, only 1% has the symptomatic form.
Causes
Even today, the causes responsible for the formation of Tarlov cysts remain a mystery, although the hypotheses made on the subject are many.
For example, some authors hypothesize that Tarlov cysts can be caused by: anomalies in the production and reabsorption of liquor by the meninges; alterations in the pressure of the cerebrospinal fluid itself; meningeal fragility and / or viral infections sustained by Herpes simplex .
In some cases reported in the literature, on the other hand, Tarlov cysts (not previously diagnosed) showed their symptoms following traumas reported at the coccygeal area.
Therefore, the appearance of Tarlov cysts and the manifestation of their symptomatology could be caused not by a single cause, but by a set of different factors.
Symptoms
As mentioned, Tarlov cysts are cystic lesions containing cerebrospinal fluid, located along the vertebral column and asymptomatic in most cases.
However, it may happen that these cysts increase their size over time and put pressure on the bones and spinal nerves where they form. This compression, in turn, can lead to the onset of radiculopathies.
Given the pressure exerted by the Tarlov cysts on the nerves, it can be said that the main symptom they cause is neuropathic pain. However, depending on the areas on which the Tarlov cysts exert pressure, more specific symptoms may appear, such as:
- Thinning and bone erosion (especially when the Tarlov cysts are located at the sacral level);
- Low back pains;
- sciatica;
- Pain in the lower limbs;
- Paresthesia or hypoesthesia of the lower limbs;
- Paraplegia;
- Spastic tetraparesis;
- hyperreflexia;
- Perineal pain;
- Stiffness in the muscles of the back and neck;
- Neck pain;
- Muscular atrophy and paralysis;
- Headache related to intracranial hypotension;
- Dizziness;
- Cervical pain.
It is useless to underline how these symptoms can negatively affect the life of the patients who are afflicted.
The symptoms related to Tarlov cysts can also lead to serious consequences, such as walking problems, bladder dysfunction, sphincter disorders and erectile dysfunction.
Diagnosis
The Tarlov cysts constitute a real pathology, which unfortunately is still little known and does not show visible symptoms that help to predict, or in any case identify, the onset in a timely manner. In fact, in most cases, the Tarlov cysts are discovered by chance during tests carried out to identify other pathologies and, very often, they are defined as "occasional findings".
Image of a Sacral Tarlov cyst, obtained by magnetic resonance. From the site: tarlovcyst.eu
However, the main method by which Tarlov cysts can be diagnosed is the execution of an MRI.
Treatment
Once diagnosed, the treatment of Tarlov cysts may depend on several factors, including the site at which they were formed, the symptoms presented by the patient and the severity of the disease.
In some cases, it is possible to resort to surgery, but the results are not always the desired ones.
As far as pharmacological therapy is concerned, instead, this consists substantially in a palliative type of treatment, aimed at giving relief to patients from the continuous neuropathic pain that afflicts them.
The main drugs used in the treatment of neuropathic pain are:
- Tricyclic antidepressants, such as clomipramine;
- Antidepressants selective inhibitors of serotonin and noradrenaline (or SNRI) reuptake, such as duloxetine;
- Anticonvulsants, such as gabapentin and pregabalin;
- Opioid painkillers, such as tramadol;
- Local anesthetics, such as lidocaine.
Furthermore, depending on the case, the doctor may also prescribe the administration of muscle relaxants, such as, for example, baclofen.
Finally, in patients with Tarlov cysts it may be necessary to resort to psychological support, given the decidedly negative repercussions that this pathology may have on their quality of life.
