Tarlov cysts and surgical treatment

Andrzej Maciejczak, MD, PhD, is a professor and head of the Department of Neurosurgery at the University of Rzeszów, Poland.

Are Tarlov cysts likely to produce pain symptoms? Should they be treated surgically?

The vast majority of the total of cysts are clinically silent and do not produce any problems. It happens that Tarlov cysts may produce compression up on the surrounding nerve roots—it happens if you live with large Tarlov cysts. Then, the patient may require a surgery, but the surgery is a really, really huge challenge because the rate of complications after cyst removal—operation of the cyst—is really high.

You can even put the glue into the cyst or inject glue into the cyst percutaneously, or you can try to wrap the cyst with some glues and other material, but you are not able to cure the cyst completely unless you excise it. But excision of a cyst carries a high risk of neurologic complications, deficit, because the cyst contains axons, neural fibers, within the wall. That is a problem.