Sometimes and due to certain types of organic anomalies, our body produces and develops a series of abnormal masses formed by membranous bags that house substances or liquid elements produced by the body itself. Although in most cases they do not pose a danger to the person’s physical integrity, their effects can be quite annoying. This is the case of Tarlov cysts abnormal formations that can appear in the lumbar or sacral area.
Throughout this article we will talk about the characteristics of these malformations, as well as the symptoms associated with them, their causes and possible treatments.
Also diagnosed under the label of Perineural, periradicular, or extradural arachnoid cysts Tarlov cysts constitute small bodies that contain a small amount of cerebrospinal fluid inside.
These cysts are formed by a dilation of the dura mater, which is why they are classified as a pathology of the dura mater. These are anomalous formations that also have a stem or extension that keeps them connected to the spinal subarachnoid space also located around the nerves of the sacral and lumbar area which are pressed or compressed by these cysts.
Although, as just mentioned, Tarlov cysts usually affect the nerves located in the lower area of the spine, these abnormal bodies are completely asymptomatic in the first phase of their development. That is, they do not have to lead to the appearance of symptoms that give them away.
However, in cases where the person suffers trauma or inflammation, or when the compression of the nerves is very severe, the patient may experience pain in the lower back. As well as symptoms of sciatica, urinary incontinence or headaches among many others that will be mentioned in the next point.
These pathological formations of the dura mater, which They are named after the American neurosurgeon Isadore Tarlov have a much higher incidence in women and their symptoms can be reduced through an alkaline diet or diet, among many other treatments.
What is the symptomatology?
The main characteristic of Tarlov cysts is that they are usually asymptomatic, at least in 70% of people who suffer from them. However, in other cases they can be highly annoying.
Due to the discretion with which they develop, in most cases they are discovered accidentally when the person undergoes some type of neuroimaging test such as a nuclear magnetic resonance and they tend to be evaluated as formations without any type of pathological importance.
In some cases, during the first stages of its formation, symptoms may appear that develop either gradually or, on the contrary, symptoms may appear. a painful clinical picture, suddenly. Likewise, the severity or intensity with which the symptoms affect the person will largely depend on the size to which the Tarlov cysts develop.
In most patients, Symptoms begin with mild pain experienced at the same level as the cyst followed by a series of alterations in all those organs or functions related to the nerve on which the pressure is exerted.
Although at first they do not pose a threat or danger to the person’s physical health, without effective treatment, Tarlov cysts can cause very severe complications that seriously compromise the patient’s quality of life, which is susceptible to developing any type of dependency or physical disability, both partial and complete.
As a result, people who suffer from Tarlov cysts experience great difficulty carrying out certain movements or postures such as standing or trying to sit. In the same way, walking, bending or lying down can be a great torment due to the painful sensations they cause.
What causes does it have?
At the moment, a completely reliable cause of Tarlov cysts has not been established. However, over time different theories have been developed whose main hypotheses relate these cysts to a traumatic, congenital and hemorrhagic origin.
1. Congenital hypothesis
This first theory points to the idea that certain irregularities in the formation of the membranes that surround the brain known as meninges may be the main cause of the formation of these cysts; O well a congenital alteration in the most superficial of these membranes the dura mater;
2. Traumatic hypothesis
On the other hand, the traumatic hypothesis describes that injuries caused by spinal punctures, anesthetics applied in the epidural area or in the spinal area, as well as trauma affecting the sacral area They may also be the origin of the appearance of these cerebrospinal fluid masses.
3. Hemorrhagic hypothesis
As its name indicates, the hemorrhagic hypothesis is based on the assumption that the cyst It is caused by a subarachnoid hemorrhage
How can it be diagnosed?
As noted above, in most cases Tarlov cysts They are usually diagnosed accidentally when the person undergoes some type of neuroimaging test carried out in the area where the masses are located.
However, in cases where the person begins to experience the first symptoms functional magnetic resonance imaging will be necessary Furthermore, in order to rule out the possibility that it is any other type of condition, a computerized myelography must be performed to reveal a connection between the cyst and the subarachnoid space.
Is there a treatment?
Choosing one of the possible treatments for Tarlov cysts is subject to the type of effects and symptoms the patient experiences, as well as the size of the cyst and the results of physical tests.
In smaller cysts that do not cause very large or bothersome symptoms, intervention through physiotherapy is usually resorted to, together with the administration of anti-inflammatory medication or analgesic. Recent studies have revealed that gabapentin, traditionally used for the treatment of epilepsy and neuropathic pain, is highly effective in reducing the effects of cysts.
However, in more serious cases, it is very possible that the patient will need to undergo surgery. Using a technique known as fenestration, the surgeon can pierce the cyst and drain the cerebrospinal fluid which is found inside. Next, it is sealed to avoid the possibility of the liquid filling it again.
Finally, a treatment that has been quite effective in alleviating the pain of Tarlov cysts is transcutaneous electrical nerve stimulation. An intervention that has no side effects and consists of the application of small electrical currents through the skin.
