Occasionally, and due to certain types of organic anomalies, our body produces and develops a series of abnormal masses formed by membranous bags that contain substances or liquid elements produced by the body itself. Although in most cases they do not pose a danger to a person’s physical integrity, their effects can be quite uncomfortable. 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.
What are Tarlov’s cysts?
Also diagnosed under the label of perineural, periradicular or extradural arachnoid cysts , Tarlov’s cysts are small bodies that contain a small amount of cerebrospinal fluid.
These cysts are formed by a dilation of the dura mater, which is why they are catalogued as a dura mater pathology. They are abnormal formations which also have a stem or extension which keeps them connected to the spinal subarachnoid space , also located around the nerves of the sacral and lumbar areas which are pressed or compressed by these cysts.
Despite the fact that, as mentioned above, Tarlov’s cysts usually affect the nerves located in the lower part of the spine, these abnormal bodies are completely asymptomatic in the first phase of their development. That is to say, they do not have to entail the appearance of symptoms that give them away.
However, in cases where the person suffers some trauma or inflammation, or where the compression of the nerves is very severe, the patient may experience pain in the lumbar areas. As well as symptoms typical 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 are named after the American neurosurgeon Isadore Tarlov , have a much higher incidence in women and their symptoms can be reduced by means of a diet or alkaline diet, among many other treatments.
What are the symptoms?
The main characteristic of Tarlov’s cysts is that they are usually asymptomatic in at least 70% of the people who suffer from them. However, in the rest of the cases they can be highly annoying.
Because of the discretion with which they develop, they are most often discovered accidentally when the person undergoes some type of neuroimaging test such as a nuclear magnetic resonance and tend to be evaluated as formations without any pathological significance.
In some cases, during the first stages of its formation, symptoms may appear that develop either gradually or, on the contrary, a painful clinical picture may appear , suddenly. The severity or intensity with which the symptoms affect the person will also depend largely on the size at which the Tarlov cysts develop.
In most patients, the symptoms begin with a 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 they do not initially pose a threat or danger to the physical health of the person, without effective treatment, Tarlov’s cysts can cause very severe complications that seriously compromise the quality of life of the patient, who is susceptible to developing any type of dependency or physical disability, either partial or complete.
Among the main symptoms that can occur are
- Lower back pain or sabra.
- Pain of sciatic character .
- Pain at the level of the buttocks.
- Hip pain.
- Muscle pain in the thighs due to reduced blood flow.
- Complications in the excretory organs.
- Alterations in the reproductive organs.
- Decreased sensitivity or hypesthesia.
- Tingling sensation or paresthesia.
As a result, people suffering from Tarlov’s cysts experience great difficulty in performing certain movements or postures such as standing or trying to sit. In the same way, bending over or lying down can be a great torment because of the painful sensations they cause.
What causes it?
At the moment, no completely reliable cause of Tarlov’s cysts could be 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; or 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, anaesthesia applied to the peridural area or the spinal area, as well as trauma affecting the sacral area may also be the origin of the appearance of these masses of cerebrospinal fluid.
3. Haemorrhagic hypothesis
As its name suggests, the bleeding hypothesis is based on the assumption that the cyst is produced by a subarachnoid haemorrhage .
How can it be diagnosed?
As noted above, Tarlov’s cysts are usually diagnosed accidentally when the person undergoes some type of neuroimaging test performed on the area where the masses are located.
However, in cases where the person begins to experience the first symptoms , a functional magnetic resonance imaging will be necessary. In addition, in order to rule out the possibility of any other type of condition, a computerized myelography should be performed to reveal a connection between the cyst and the subarachnoid space.
Is there a treatment?
The choice of one of the possible treatments that exist for Tarlov’s 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 the physical tests.
In smaller cysts that do not cause very large or troublesome symptoms, , intervention is usually resorted to by means of physiotherapy, together with the administration of anti-inflammatory medication or analgesics. Recent studies have shown 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, the patient may have to undergo surgery. Using a technique known as fenestration, the surgeon can perforate the cyst and drain the cerebrospinal fluid inside. The cyst is then sealed to avoid the possibility of the liquid replenishing it.
Finally, one treatment that has been quite effective in relieving the pain of Tarlov’s cysts is transcutaneous electrical nerve stimulation. This is an operation that has no side effects and consists of the application of small electrical currents through the skin.