Zeitschrift für Wirbelsäulen- und Neurochirurgie

Microsurgical Treatment of a Complex Sacral Perineural Cyst Using Paraspinous Muscle Flap: Technical Note

Jayesh P Thawani, Hovik John Ashchyan, John Pierce, Nikhil R Nayak, John F Burke, Suhail K Kanchwala and William C Welch

Microsurgical Treatment of a Complex Sacral Perineural Cyst Using Paraspinous Muscle Flap: Technical Note

Dr. I.M. Tarlov first described perineural (Tarlov) cysts in 1938. Symptomatic Tarlov cysts are common incidental findings yet uncommon clinical/pathologic entities. Microsurgical treatment of Tarlov cysts is even more rare. We report the microsurgical treatment of a symptomatic complex Tarlov cyst as a case. The patient presented with sacral pain, bilateral sciatica (S1-type), urinary retention, rectal pain with intercourse, gluteal heaviness, and intermittent burning in the S2-4 dermatome. MR imaging revealed a complex sacral Tarlov cyst with bony erosion. The patient was treated microsurgically and had a paraspinous muscle flap advancement procedure performed in conjunction with Plastic Surgery. The patient experienced a positive clinical outcome.