Sacral Tarlov cysts: Neurophysiology abnormalities and correlation with pelvic sensory and visceral symptoms

• Published in: European journal of neurology Vol. 30; no. 9; pp. 2838 - 2848
• Main Authors: Hentzen, Claire, Cabrilo, Ivan, Malladi, Prasad, Simeoni, Sara, Amarenco, Gérard, Zaidman, Nathalie, Pakzad, Mahreen, Shah, Sachit, Casey, Adrian T., Panicker, Jalesh N.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01-09-2023
• Subjects: Abnormalities; Adult; Cross-Sectional Studies; Cysts; Electromyography; Evoked potentials; Female; Humans; Innervation; lower urinary tract symptoms; Magnetic resonance imaging; Middle Aged; Nerves; Neurophysiology; Pain; Pain - complications; pelvic neurophysiology; Retrospective Studies; Sacrum; Sphincter; spinal nerve roots; Tarlov cysts; Tarlov Cysts - complications; Tarlov Cysts - diagnostic imaging; Urinary Incontinence; Variance analysis; pelvic neurophysiology; lower urinary tract symptoms; Tarlov cysts; sacrum; spinal nerve roots
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.15869

Background and purpose
Recent 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.
Methods
Consecutive 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.
Results
Sixty‐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.
Conclusions
Contrary 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.
This study demonstrates objective neurological impairment of sacral root functions on pelvic neurophysiology assessment in nearly 60% of patients with symptomatic sacral TCs, particularly of the sensory innervation. No association was found with MRI or voiding dysfunction.