Tag: Perineural cyst

Neurosurgery 98:1156–1165, 2026

This prospective longitudinal study reports clinical and patient-reported health-related quality-of-life outcomes for 417 adults who underwent surgical treatment for symptomatic sacral Tarlov cysts, with standardized assessments at baseline and 3, 6, 12, and 24 months. Using the disease-specific TCQoL alongside SF-36, ODI, and VAS, the study demonstrates statistically significant and clinically meaningful improvements across most domains, low complication rates, and no radiographic cyst recurrence at early follow-up.

The authors detail a microsurgical posterior sacral laminectomy technique with cyst decompression, dural sleeve wrapping, and laminar reconstruction, and report sustained benefits through 2 years, including increased tolerated sitting time and reduced opioid use. Limitations include attrition and missing data addressed by imputation, and the paper advocates broader adoption of the TCQoL for standardized Tarlov cyst research.

Study aim Assess whether surgical treatment for symptomatic sacral Tarlov cysts improves validated general and disease-specific health-related quality of life (HRQoL) through 2 years post-op, and whether outcomes change from year 1 to year 2.

Design & cohort Retrospective analysis of prospectively collected longitudinal outcomes for adults undergoing first-time surgery for ≥1 sacral Tarlov cyst (2008–2023), performed by a single neurosurgeon; 417 patients (mean age 52.5, 91.1% female).

Outcome measures Primary outcome was the TCQoL (11-item disease-specific scale); secondary measures included VAS pain (rest/activity), ODI, and SF-36, collected pre-op and at 3, 6, 12, and 24 months.

Surgical technique Posterior sacral laminectomy with microsurgical dissection, cyst drainage to normalize root caliber, wrapping the cystic nerve root with bovine pericardium dural substitute sleeve to limit refilling, and covering the laminar window with a resorbable plate/screws.

2-year improvements (key metrics) Significant improvements from pre-op to 2 years in TCQoL (3.2→2.1), VAS pain at rest (4.5→2.3) and activity (5.7→3.1), and ODI (45.5→31.6) (all P<.001).

SF-36 domains Improvement occurred in 7/8 SF-36 scales (Physical Functioning, Physical Limitations, Bodily Pain, Vitality, Social Functioning, Emotional Limitations, Mental Health), while General Health was not statistically significant in the imputed analysis.

Year 1 to year 2 change Most subscales did not change significantly from 1 to 2 years; significant further gains were seen in physical functioning and social functioning (P=.040 and P=.016, respectively).

Sitting tolerance Median tolerated sitting time increased from 15 minutes pre-op to 45 minutes at 2 years post-op.