Letter to editor regarding “Management of perineural (Tarlov) cysts: a population-based cohort study and algorithm for the selection of surgical candidates”

Excerpt

We read with great interest a recent paper published by Fletcher-Sandersjöö et al. [2] entitled “Management of perineural (Tarlov) cysts: a population-based cohort study and algorithm for the selection of surgical candidates.” In this retrospective cohort study spanning over 16 years, authors have included 39 patients with perineural cysts (Tarlov cysts, TC). In this study, myelography was performed in 92% patients (n = 36) and 72% (n = 28) underwent cyst aspiration based on myelography findings. Of these 28 patients, 24 patients were offered surgical intervention based on clinical improvement following cyst aspiration. Microsurgical cyst fenestration was the surgical procedure performed in this series. Authors have proposed an algorithm based on this model: Symptomatic TC based on history, clinical exam, and imaging ➔ myelography ➔ cyst aspiration ➔ clinical assessment ➔ surgery vs. conservative management. Using this algorithm, symptomatic improvement following surgery was noted in 94% of patients and 40% of patients in the conservative group showed progression of symptoms. In our recently published meta-analysis [8], we noted symptomatic improvement in 83.5% of patients using either surgical or percutaneous management. However, incidence of cyst recurrence was lower (8% vs. 20%) with higher incidence of complications (21% vs. 12.5%) in the surgical cohort, compared with that in patients who underwent percutaneous management for TCs [8]. …