Title : The coincidence between spinal perineural cysts, increased intracranial pressure and the appearance of small fiber neuropathy. Exploring the relationship and (surgical) lessons to be learned
Abstract:
Tarlov cysts remain a topic of controversy, from the first publication of Tarlov in 1938 and even now a myriad of treatments have been proposed for larger sacral cysts. For several reasons which will be discussed, Tarlov cysts have the tendency to be regarded as incidental findings. However with a comprehensive history taking and perineal nerve conduction studies we might be able to distinguish better the symptomatic perineural cysts from the truly incidental finding.
As these cysts are being considered as dilations of the nerve root sleeve the hydrostatic pressure together with pulsatile/dynamic features are coined to be the generators of the cysts and growth mechanism. An increase in intracranial pressure has been measured in our case series and with positive effects on the symptoms with CSF evacuation and Acetamolozide. Even small cysts seems to react positively on these diagnostic tests.
Although the Tarlov cysts may not cause radicular pain in the corresponding dermatomes directly, individuals with Tarlov cysts frequently report a range of symptoms that have previously been linked to symptomatic Tarlov Cysts, including bladder, bowel, sphincter, and sexual symptoms, as well as local pain. Additionally, seemingly unrelated symptoms, such as headaches, fatigue, cognitive difficulties, neuropathic pain localized in other parts of the body, and autonomic dysfunctions, are commonly reported. These symptoms may be associated with elevated cerebrospinal fluid pressure within the nerve root sheath. Elevated pulsatile cerebrospinal fluid pressure underlies the formation of Tarlov Cysts at the dorsal root ganglion and may gradually contribute to small-fiber dysfunction by irritating, compressing and damaging small nerve fibers within the dorsal root ganglion.
As several studies show radiculopathy and axial pain as a general finding in idiopathic intracranial hypertension an “idiopathic cerebrospinal pressuredysregulation syndrome” might be proposed as a common denominator. In our presentation we will show our own results together with a literature study leading to the new insights as described above.
