3. Sacral Perineurial Tarlov Cyst Case Presentation
By Tariq Elemam Elshafey Awad Assist. Prof. of Neurosurgery Suez Canal University

4. C/O primary Enuresis (mainly nocturnal, occasionally diurnal)
History
7 yrs male child
C/O primary Enuresis (mainly nocturnal, occasionally diurnal)
Occasional diurnal passage of stool
No psychological troubles in the family
Med. ttt was started ( fluid restriction after sunset, Oxybutynin HCL, desmopressin acetate for 2 years with no response)
O/E motor and senory exam of both LL intact
Lab : urine analysis (no infection – sp. Gravity 1025), stool analysis (N), normal glucose serum level

5. Radiology

6. Radiology

7. Operative Methods
Sacral incision between 5–7 cm
Subperiosteal dissection of the paravertebral Ms exposes the sacral roof.
Bony erosion by the cyst (paper –thin bone) + blue-grey cyst wall
The sacral lamina are cut, usually at two-levels, for en bloc removal of the roof .
Microsurg. (the potential + of sacral nerve root fibers running in or adjacent to the cyst).
The thin, transparent cyst wall is opened widely with microscissors
dissection of the internal portion of the cyst reveals a discrete connection between the cyst & SA space
closure with non-absorbable 6–0 monofilament suture + local fat graft and gelatin sponge

8. intraoperative

9. routine lumbar subarachnoid drain to prevent CSF leak

10. Post operative

11. Sacral perineurial cyst or Tarlov cyst
a cystic lesion of the nerve root, common in the sacrum.
named after Tarlov (1938) during autopsy study of the filum terminal.
incidental findings on (MRI) 1.5% - 4.6%
Most of them are asymptomatic but < 1% may cause significant clinical symptoms like local or radicular pain, sensory or motor deficits and even bladder dysfunction.

12. Sacral perineurial cyst or Tarlov cyst
surgical strategies
equalization of the CSF pressure between the cephalad thecal sac and the cyst e.g. cyst- arachnoid shunt and the lumboperitoneal shunt .
closure of the cyst-arachnoid communication sacrificing the parent root.
microsurgical fenestration or excision.

13. Up to date, literature review yield only around 100 cases treated surgically by different approaches.

14. Difference between Meningeal diveerticulum and Tarlov Cyst

15. Thanks