case_images: PMC11090592_01
case_images: Coronal (a), sagittal (b), and axial (c) views showing the perineural cyst and its relationship with the neighboring structures; (d and e) magnetic resonance imaging with fiber-tracking sequences displaying a small left L5 peri-radicular cyst at filled with cerebrospinal fluid and thus in communication with the subarachnoid space (red arrows). This finding confirms the diagnosis of the Tarlov cyst.
case_images: SNI-15-137-g001.jpg
case_images: PMC11090592_01_SNI-15-137-g001.jpg
case_images: F1
case_images: The contrast-enhanced magnetic resonance imaging (MRI) showed a small left L5 peri-radicular cyst that extended into the extraforaminal space and presacral region [Figure 1].
case_images: Percutaneous trans-sacral approach: (a and b) After the drilling of the sacrum, two needles were advanced into the cyst; (c) the edge of the cyst was opacified with iodinated contrast agent until its extravasation; and (d) confirming the lack of significant subarachnoid connectivity.
case_images: SNI-15-137-g002.jpg
case_images: PMC11090592_01_SNI-15-137-g002.jpg
case_images: F2
case_images: However, the secondary percutaneous CT-guided transsacral approach that required drilling of the sacrum under local anesthesia for the placement of fibrin glue into the Tarlov cyst succeeded (i.e., 1.5 mL of fibrin glue injected through a 20-gauge needle) [Figures 2a-d].
case_images: (a-c) A 2-month post-procedure magnetic resonance imaging (MRI) displaying a complete resolution of the pre-sacral component of the cyst and a size reduction of the nerve root and the cyst passing from 18 to 12 mm. Coronal (a) and sagittal (b) and axial (c) views; (d-f) comparison between T2-weighted MRI, axial sequences, (d) before the procedure, (e) at two months follow-up and (f) at nine months follow-up. (d) The L5 peri-radicular cyst extending from the preforaminal recessal level to the presacral region is shown before the procedure (black arrow); (e) MRI at two months follows, showing the complete resolution of the pre-sacral component of the cyst and a size reduction of the nerve root (black arrowhead); (f) 9 months follow-up: the MRI showed the complete disappearance of Tarlov's cyst with L5 G root remaining thickened without edematous suffering (black arrowhead).
case_images: SNI-15-137-g003.jpg
case_images: PMC11090592_01_SNI-15-137-g003.jpg
case_images: F3
case_images: The MRI 2 months later showed complete resolution of the pre-sacral component of the cyst and was accompanied by further reduction of nerve root compression from the cyst (i.e., reduced from 18 to 12 mm) [Figures 3a-c]. After nine months, the patient was asymptomatic, and the MRI showed complete resolution of the Tarlov cyst [Figures 3d-f].