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• W3012405854 abstract "To the Editor: In recent years, there has been a renewed interest in symptomatic Tarlov cysts (TCs) and their management. Indeed, this is an entity that can be often overlooked. Tarlov in the first instance described this entity in 1938 as “a chance encounter at autopsy” and initially thought that it was of no clinical significance.1 However, 10 yr later, Tarlov in person revised his initial thoughts reporting the first case of symptomatic TC in a patient presenting with sciatica.2 I read with great interest the article recently published in Neurosurgery3 regarding the natural history of TCs. Yang et al3 have reviewed in retrospect 131 consecutive patients referred for symptomatic TCs. They have identified 28 symptomatic patients with 42 TCs. The authors have followed these patients up with serial magnetic resonance imaging (MRI) scans over a period of 6 yr, and they have found that in 5/28 patients a millimetric enlargement of the cyst was demonstrated. Most patients presented with a combination of axial and radicular pain, as well as sensory-motor symptoms and 3/28 (11%) patients also suffered orthostatic headache; this symptom was found to be a statistically significant predictor of growth. The authors3 have suggested that perhaps surgery should be considered in the case of symptomatic and enlarging cysts, although, indeed, there is no consensus on the surgical management of this condition. The authors3 must be commended for this meticulous study, in which they have been able to reliably identify relatively small changes in the size of TCs. This study, indeed, sheds more light on the natural history of TCs and makes the neurosurgical community aware of the possibility of enlargement of these cysts. In fact, enlargement of TCs is a very rare occurrence only recently documented.4 Furthermore, this study gives more clinical insight on symptoms potentially predicting cyst enlargement. A few questions have arisen while reading this study.3 It is not clear in the methods whether postcontrast MRI has been carried out in this cohort of patients, and I wonder whether the authors would recommend postcontrast imaging in the case of enlargement of TC, to confirm that we are actually dealing with simple cysts rather than cystic tumors. I also wonder whether the authors have obtained intraoperative specimens for histology analysis. Notwithstanding that the focus of this paper is the natural history of TCs, it would be interesting to know how the authors have managed the remaining 23 symptomatic patients. Finally, considering that TCs can be a possible spinal manifestation of connective tissue disorders,5 I wonder whether the authors have ruled out this possibility in the 5 patients presenting with an enlargement of cysts. Disclosures The author has no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article." @default.
• W3012405854 created "2020-03-23" @default.
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• W3012405854 date "2020-03-20" @default.
• W3012405854 modified "2023-10-17" @default.
• W3012405854 title "Letter: Growth of Lumbosacral Perineural (Tarlov) Cysts: A Natural History Analysis" @default.
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• W3012405854 doi "https://doi.org/10.1093/neuros/nyaa060" @default.
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