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Sacral Tarlov cysts: Neurophysiology abnormalities and correlation with pelvic sensory and visceral symptoms |
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| Authors: | Claire Hentzen Ivan Cabrilo Prasad Malladi Sara Simeoni Gérard Amarenco Nathalie Zaidman Mahreen Pakzad Sachit Shah Adrian T. Casey Jalesh N. Panicker |
| Affiliation: | 1. Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK;2. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK;3. Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, UK Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, UK;4. GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Sorbonne Université, Paris, France;5. Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK;6. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK Spinal Unit, Wellington Hospital, London, UK |
| Abstract: | Background and purposeRecent studies suggest a possible association between Tarlov cysts (TCs), usually considered as incidental radiological findings, and neurological symptoms such as pain, numbness and urogenital complaints. The aim was to explore the relationship between TCs and sacral nerve root functions using pelvic neurophysiology tests, and to correlate changes with clinical symptoms and magnetic resonance imaging (MRI) findings.MethodsConsecutive patients with sacral TCs, referred for pelvic neurophysiology testing and presenting with at least one symptom related to the pelvic area, participated in a cross-sectional review of symptoms using validated questionnaires. Findings of pelvic neurophysiology (pudendal sensory evoked potentials, sacral dermatomal sensory evoked potentials, external anal sphincter electromyography) and urodynamics testing were collected retrospectively. The relationship between neurophysiology, MRI findings and patients' symptoms was assessed using Fisher and ANOVA tests.ResultsSixty-five females were included (mean age 51.2 ± 12.1 years). The commonest symptom was pain (92%). Urinary (91%), bowel (71%) and sexual (80%) symptoms were also frequently reported. Thirty-seven patients (57%) had abnormal neurophysiology findings reflecting sacral root dysfunction. No association was seen between MRI findings (size, location of the cysts, severity of compression) and neurophysiology. A negative association was observed between neurophysiology abnormalities and occurrence of urgency urinary incontinence (p = 0.03), detrusor overactivity (p < 0.01) and stress urinary incontinence (p = 0.04); however, there was no association with voiding difficulties.ConclusionsContrary to current understanding, TCs are associated with injury to the sacral somatic innervation in the majority of patients with presumed symptomatic cysts. However, urinary incontinence is unlikely to be related to TC-induced nerve damage. |
| Keywords: | lower urinary tract symptoms pelvic neurophysiology sacrum spinal nerve roots Tarlov cysts |