Publications
Scientific research on arachnoiditis and Tarlov cysts

Published in:
Neurology International, Volume 16 (2), April 2024

Abstract:
Sacral Tarlov cysts (TCs), often asymptomatic, can cause significant pain and severe neurological dysfunction. Conventional treatments are generally associated with high recurrence and complication rates. Specifically, the substantial recurrence rates, which can reach as high as 50%, significantly impact long-term outcomes. Recent evidence increasingly supports the hypothesis that the formation of Tarlov cysts (TCs) may be associated with inflammatory processes within the nerve root sheath, further exacerbated by elevated cerebrospinal fluid (CSF) pressure. This retrospective study explores thecaloscopy, combined with surgical techniques, as a more effective alternative. We observed a total of 78 patients, 48 of whom underwent endoscopic fenestration of the arachnoid sheath in addition to microsurgical resection of the TC. We found that the fenestration of the arachnoid sheath at the level of lumbosacral spinal nerve root entry led to a significantly decreased risk of developing recurrent TCs (5/48 vs. 9/30). Only one of the patients suffered from a persistent new bladder dysfunction after microsurgical resection. This presented technique provides a promising treatment path for the future management of TCs, offering a safe and more effective treatment option compared to previous methods. Additionally, the advantages of the thecaloscopy provide pathophysiological implications regarding the development of perineural cysts.

Published in:
Interdisciplinary Neurosurgery, Volume 36, June 2024

Abstract:
Tarlov cysts are a rare condition. While they appear asymptomatic mostly, some patients develop severe clinical symptoms. Tarlov cysts can grow over time and may result from disturbances within the spinal CSF system. Due to the rare character, the disease can be a burden for both patients and physicians. Treat or not to treat, and if yes, how to treat is a relevant question. Here, a retrospective, observational study on 49 patients suffering from symptomatic Tarlov cysts treated with a combined endoscopic-microsurgical approach was performed. The microsurgical resection was combined with thecaloscopy inside the lower lumbosacral subarachnoidal space to improve the CSF flow and pressure regulation capability. The purpose was to prove that the surgical method was able to prevent recurrence and gives a major relief of symptoms. Our data suggest that combined interventional treatment of symptomatic Tarlov Cysts is helpful to treat the long-standing symptoms. In all patients we found signs for inflammatory processes at the level of the lumbar leptomeningeal sheets, involving the pia mater and the arachnoid. We found evidence that patients suffering from a slow inflammatory process within the leptomeninges might have increase risk of developing Tarlov cysts. We hypothesized that local CSF flow and pressure regulation mechanism become invalid by the morphological changes at the arachnoid and lose the capability to regulate CSF pressure down by pressing minimal volumes of CSF out of the dural sac at the nerve root exits.

Published in:
Interdisciplinary Neurosurgery, Volume 28, June 2022

Abstract:
Here we describe the case of a 63-year old woman with a sacral perineural cyst presenting with different symptoms such as headache, dizziness, and lower back pain with radiation and neurological claudication. The patient was treated by endoscopic assisted cyst resection and sacrum reconstruction. Histopathological examination of the cyst material revealed a cystic lesion with degenerative changes and hemorrhages. Postoperative course was uneventful, and the patients is free of symptoms three years after surgery. This case illustrates that symptomatic Tarlov cysts with extensive degenerative tissue changes can successfully managed by cyst resection.