Disclosures: Keely Coxon, BS, MS4: No financial relationships or conflicts of interest

Objective: Assess current diagnostic workup and management of symptomatic Tarlov cysts, including comparison of risks, benefits and reported patient outcomes post-treatment. Modalities studied include conservative management, minimally-invasive percutaneous procedures (MIPPs) and surgical interventions.

Design: Narrative literature review of English language papers on MEDLINE. Inclusion criteria were case reports, cohort or retrospective studies of management modalities and treatment outcomes for patients with symptomatic Tarlov cysts. Ninety-seven papers were reviewed, with 64 deemed suitable for inclusion. Setting : Various medical settings, including inpatient and outpatient. Participants : More than two hundred participants were included in the various case reports and studies, all of whom with symptomatic Tarlov cysts.

Interventions: Included conservative therapy (medical management, physical therapy, “watch and wait” approach), MIPPs (e.g., ultrasound-guided injection of anti-inflammatory medication) or surgery (e.g., cyst fenestration and/or excision).

Main Outcome Measures: Primarily patient self-reported symptom relief; clinical signs – such as improvement on neurologic or musculoskeletal assessment – were also included when available.

Results: Surgery, including cyst fenestration and excision, offered the most favorable results (75-80% rate of symptom resolution). MIPPs averaged a 50-60% rate of complete symptom resolution. Nearly all patients undergoing such procedures reported some degree of relief. Conservative therapy had the lowest rate of symptom resolution, with results varying from no relief to spontaneous resolution of symptoms. Conclusions: Surgery appears to offer the most reliably-positive outcomes. MIPPs likewise offered a favorable prognosis, although not as uniformly successful. Conservative therapy was the least reliable approach to treatment, although certain conservative approaches (such as novel use of gabapentin) may offer value to patients who are not surgical candidates.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/symptomatic-tarlov-perineural-cysts-diagnostic-workup-and-comparison-of-outcomes-by-treatment-modality/