Clinical experience of symptomatic sacral perineural cyst

Abstract

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst.

Keywords: caudal peridural block; perineural cyst; sacral Tarlov cyst.

Fig. 1

T2 weighted MR images show disc bulging and spinal stenosis of L2-3, L3-4, and L4-5 (line) intervertebral spaces (A). Axial view of T2 weighted MR images at L4-5 intervertebral space shows compressed spinal cords due to spinal stenosis (B). Perineural cyst located on the S2 level is typically seen as well circumscribed and ovoid in shape (arrow, C and D). Water density structures of a cyst appear black in T1 weighted MRI (C) and white in T2 weighted MRI (D).

Fig. 2

C-arm image of caudal peridurography. Contrast injection is seen in lateral view (A). Caudal perineural cyst (arrow) is located on S2 area on anteroposterior view of peridurogram (B).