Symptomatic
Tarlov cysts typically cause chronic pelvic and lower extremity
pain and sacral nerve root
radiculopathy. Historically, open surgical treatment involved significant patient morbidity, particularly postoperative cerebrospinal fluid (CSF) leaks and
infection. These CSF leaks often required multiple
surgical procedures to seal. Over the past 20 years, there have been two or three isolated case reports of computed tomography (CT)-guided needle aspirations that offered limited evidence of treatment efficacy and safety. Some have reported high rates of postprocedure
aseptic meningitis that were not well explained. These poor results dissuaded physicians from caring for these patients. As a group these patients are usually treated dismissively and told their
cysts are asymptomatic and their
pain must be coming from somewhere else. Many of them have had an unnecessary
discectomy or a
spinal fusion, and when these procedures did not relieve their
pain they were told they are a "failed back patient." We have treated more than a hundred patients with symptomatic
Tarlov cysts by CT fluoroscopic-guided needle aspiration and
fibrin injection and have had excellent results with no meaningful complications and never a case of
aseptic meningitis. We believe this is a safe, highly effective first-line treatment for symptomatic
Tarlov cysts.