Keynote speaker for surgery conference - Ricky Rasschaert

Title: Tarlov Cysts and the Idiopathic Cerebrospinal Pressure Dysregulation Syndrome

Ricky Rasschaert

ZNA Middelheim, Belgium

Biography

Dr. Ricky Rasschaert is a neurosurgeon and spine surgeon at the ZNA Middelheim Hospital, the largest non-academic teaching hospital in Antwerp. The use of minimally invasive techniques and spinal reconstructive surgery is his main interest.He is member of several Neurosurgical and Spine societies and elected as an IM board representative for the EANS.  He also has teaching positions and does research involving the treatment of Tarlov cysts and on neuromonitoring in spine surgery cases.  There also is an active participation in the Spine Tango project, an international registry for spine surgery with the intention of improving quality of given care. Other interests are department and hospital management as well as medico-legal expertise.Dr. Rasschaert is co-founder of the SpineCare@CURE project, trying to improve Neurosurgical care in sub Saharan Africa.

Abstract

Tarlov cysts remain a topic of controversy, from the first publication of Tarlov in 1938 and even now a myriad of treatments has 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studies we might be able to distinguish better the symptomatic perineural cysts from the truly incidental finding (unpublished data).

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 Acetazolomide. Even small cysts seem to react positively on these diagnostic tests.

As several studies show radiculopathy and axial pain as a general finding in idiopathic intracranial hypertension an “idiopathic cerebrospinal pressure dysregulation syndrome” might be proposed as a common denominator, for example in chronic fatigue syndrome and fibromyalgia.