Perineural cyst

Last edit by Alaric Steinmetz on

Synonyms: Tarlov cyst

A perineural cyst (Tarlov cyst) is a cyst filled with cerebrospinal fluid, most commonly occurring in the area of the spinal ganglia in the sacral region[^1] [^3].

Symptoms

The symptomatology of sacral Tarlov cysts can vary depending on the exact location and may include low lumbar back pain, coccygodynia, perianal pain, or radicular pain symptoms[^2].

Imaging

Imaging-wise, Tarlov cysts are best visualized on MRI. In a myelography, a delayed filling of contrast medium can occasionally be observed. Typically, Tarlov cysts are associated with signs of remodeling in the adjacent bone[^4].

Tarlov cyst on sagittal T2 MRI
Visualization of a Tarlov cyst (red arrow) on a sagittal T2 MRI image.
Tarlov cyst on MRI
Visualization of a right-sided Tarlov cyst (red arrow) on an axial T2 MRI image.
Bilateral perineural cyst
Bilateral perineural cysts on axial T2-weighted MRI.
Sacral perineural cyst
Depiction of a perineural cyst on a sagittal T2-weighted sequence in the sacral region.

Treatment

Asymptomatic Tarlov cysts do not require surgical intervention. In rare and very selected cases, surgical treatment may be indicated for symptomatic Tarlov cysts[^2].

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