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Spine
Diagnosis
Neoplasms, Cysts, and Other Masses
Nonneoplastic Cysts and Tumor Mimics
Cysts
Perineural Root Sleeve Cyst
Perineural Root Sleeve Cyst
Kevin R. Moore, MD; Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Spinal nerve root diverticulum
                • Tarlov cyst
                • Perineural cyst

              • Definitions

                • Dilatation of arachnoid and dura of spinal posterior nerve root sheath, containing nerve fibers

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nonvascular Interventions

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Hulens M et al: Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review. Eur Spine J. 28(10):2237-48, 2019
                                                2. Sharma M et al: A systematic comparative outcome analysis of surgical versus percutaneous techniques in the management of symptomatic sacral perineural (Tarlov) cysts: a meta-analysis. J Neurosurg Spine. 1-12, 2019
                                                3. Haber MD et al: Differentiation of idiopathic spinal cord herniation from CSF-isointense intraspinal extramedullary lesions displacing the cord. Radiographics. 34(2):313-29, 2014
                                                4. Padma S et al: Multilocular disseminated tarlov cysts: importance of imaging. World J Nucl Med. 13(1):67-70, 2014
                                                5. Sivakumar W et al: Intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage. J Clin Neurosci. 21(6):1063-5, 2014
                                                6. Lohani S et al: Intrasacral meningocele in the pediatric population. J Neurosurg Pediatr. 11(6):615-22, 2013
                                                7. Lucantoni C et al: Tarlov cysts: a controversial lesion of the sacral spine. Neurosurg Focus. 31(6):E14, 2011
                                                8. Merlini L et al: Look for the nerves! MR neurography adds essential diagnostic value to routine MRI in pediatric practice: a pictorial overview. J Neuroradiol. 38(3):141-7, 2011
                                                9. Murphy KJ et al: Tarlov cysts: an overlooked clinical problem. Semin Musculoskelet Radiol. 15(2):163-7, 2011
                                                10. Mitra R et al: Conservative management of perineural cysts. Spine (Phila Pa 1976). 33(16):E565-8, 2008
                                                11. Langdown AJ et al: The clinical relevance of Tarlov cysts. J Spinal Disord Tech. 18(1):29-33, 2005
                                                12. Acosta FL Jr et al: Diagnosis and management of sacral Tarlov cysts. Case report and review of the literature. Neurosurg Focus. 15(2):E15, 2003
                                                13. Caspar W et al: Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases. Surg Neurol. 59(2):101-5; discussion 105-6, 2003
                                                14. Kumar K et al: Symptomatic spinal arachnoid cysts: report of two cases with review of the literature. Spine. 28(2):E25-9, 2003
                                                15. Voyadzis JM et al: Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg. 95(1 Suppl):25-32, 2001
                                                16. Mummaneni PV et al: Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery. 47(1):74-8; discussion 78-9, 2000
                                                17. ArunKumar MJ et al: Sacral nerve root cysts: A review on pathophysiology. Neurol India. 47(1):61-4, 1999
                                                18. Paulsen RD et al: Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR Am J Neuroradiol. 15(2):293-7; discussion 298-9, 1994
                                                19. Davis SW et al: Sacral meningeal cysts: evaluation with MR imaging. Radiology. 187(2):445-8, 1993
                                                20. Araki Y et al: MRI of symptomatic sacral perineural cyst. Radiat Med. 10(6):250-2, 1992
                                                21. Nabors MW et al: Updated assessment and current classification of spinal meningeal cysts. J Neurosurg. 68(3):366-77, 1988
                                                22. Goyal RN et al: Intraspinal cysts: a classification and literature review. Spine. 12(3):209-13, 1987
                                                23. Willinsky RA et al: Computed tomography of a sacral perineural cyst. J Comput Assist Tomogr. 9(3):599-601, 1985
                                                24. Dastur HM: The radiological appearances of spinal extradural arachnoid cysts. J Neurol Neurosurg Psychiatry. 26:231-5, 1963
                                                25. Abbott KH et al: The role of perineurial sacral cysts in the sciatic and sacrococcygeal syndromes; a review of the literature and report of 9 cases. J Neurosurg. 14(1):5-21, 1957
                                                26. Tarlov IM: Cysts (perineurial) of the sacral nerve roots: another cause of the sciatic or sacral cauda equina syndrome. J Neuropathol Exp Neurol. 11(1):88-9, 1952
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Synonyms

                                                              • Spinal nerve root diverticulum
                                                              • Tarlov cyst
                                                              • Perineural cyst

                                                            • Definitions

                                                              • Dilatation of arachnoid and dura of spinal posterior nerve root sheath, containing nerve fibers

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Nonvascular Interventions

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Hulens M et al: Symptomatic Tarlov cysts are often overlooked: ten reasons why-a narrative review. Eur Spine J. 28(10):2237-48, 2019
                                                                                              2. Sharma M et al: A systematic comparative outcome analysis of surgical versus percutaneous techniques in the management of symptomatic sacral perineural (Tarlov) cysts: a meta-analysis. J Neurosurg Spine. 1-12, 2019
                                                                                              3. Haber MD et al: Differentiation of idiopathic spinal cord herniation from CSF-isointense intraspinal extramedullary lesions displacing the cord. Radiographics. 34(2):313-29, 2014
                                                                                              4. Padma S et al: Multilocular disseminated tarlov cysts: importance of imaging. World J Nucl Med. 13(1):67-70, 2014
                                                                                              5. Sivakumar W et al: Intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage. J Clin Neurosci. 21(6):1063-5, 2014
                                                                                              6. Lohani S et al: Intrasacral meningocele in the pediatric population. J Neurosurg Pediatr. 11(6):615-22, 2013
                                                                                              7. Lucantoni C et al: Tarlov cysts: a controversial lesion of the sacral spine. Neurosurg Focus. 31(6):E14, 2011
                                                                                              8. Merlini L et al: Look for the nerves! MR neurography adds essential diagnostic value to routine MRI in pediatric practice: a pictorial overview. J Neuroradiol. 38(3):141-7, 2011
                                                                                              9. Murphy KJ et al: Tarlov cysts: an overlooked clinical problem. Semin Musculoskelet Radiol. 15(2):163-7, 2011
                                                                                              10. Mitra R et al: Conservative management of perineural cysts. Spine (Phila Pa 1976). 33(16):E565-8, 2008
                                                                                              11. Langdown AJ et al: The clinical relevance of Tarlov cysts. J Spinal Disord Tech. 18(1):29-33, 2005
                                                                                              12. Acosta FL Jr et al: Diagnosis and management of sacral Tarlov cysts. Case report and review of the literature. Neurosurg Focus. 15(2):E15, 2003
                                                                                              13. Caspar W et al: Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases. Surg Neurol. 59(2):101-5; discussion 105-6, 2003
                                                                                              14. Kumar K et al: Symptomatic spinal arachnoid cysts: report of two cases with review of the literature. Spine. 28(2):E25-9, 2003
                                                                                              15. Voyadzis JM et al: Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg. 95(1 Suppl):25-32, 2001
                                                                                              16. Mummaneni PV et al: Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery. 47(1):74-8; discussion 78-9, 2000
                                                                                              17. ArunKumar MJ et al: Sacral nerve root cysts: A review on pathophysiology. Neurol India. 47(1):61-4, 1999
                                                                                              18. Paulsen RD et al: Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR Am J Neuroradiol. 15(2):293-7; discussion 298-9, 1994
                                                                                              19. Davis SW et al: Sacral meningeal cysts: evaluation with MR imaging. Radiology. 187(2):445-8, 1993
                                                                                              20. Araki Y et al: MRI of symptomatic sacral perineural cyst. Radiat Med. 10(6):250-2, 1992
                                                                                              21. Nabors MW et al: Updated assessment and current classification of spinal meningeal cysts. J Neurosurg. 68(3):366-77, 1988
                                                                                              22. Goyal RN et al: Intraspinal cysts: a classification and literature review. Spine. 12(3):209-13, 1987
                                                                                              23. Willinsky RA et al: Computed tomography of a sacral perineural cyst. J Comput Assist Tomogr. 9(3):599-601, 1985
                                                                                              24. Dastur HM: The radiological appearances of spinal extradural arachnoid cysts. J Neurol Neurosurg Psychiatry. 26:231-5, 1963
                                                                                              25. Abbott KH et al: The role of perineurial sacral cysts in the sciatic and sacrococcygeal syndromes; a review of the literature and report of 9 cases. J Neurosurg. 14(1):5-21, 1957
                                                                                              26. Tarlov IM: Cysts (perineurial) of the sacral nerve roots: another cause of the sciatic or sacral cauda equina syndrome. J Neuropathol Exp Neurol. 11(1):88-9, 1952