阴部神经痛是一种涉及阴部神经皮区的疼痛性神经病。Tarlov囊肿在文献中已被报道为慢性腰骶部和骨盆疼痛的另一个潜在原因。值得注意的是,它们通常位于S2,S3和S4骶神经根的阴部神经起源的分布中,并且推测它们可能引起与阴部神经痛相似的症状。关于囊肿的临床相关性以及它们是否与症状有关,文献一直不一致。
评价阴部神经痛患者阴部神经起源(S2-S4骶神经根)S2-S4Tarlov囊肿的发生率,并建立患者症状与Tarlov囊肿位置的关联。
对2010年1月至2012年11月进行盆腔磁共振成像的242例阴部神经痛患者进行了回顾性研究。专用磁共振成像审查评估是否存在,level,site,和Tarlov囊肿的大小.在那些有明显囊肿的人中,收集随后的影像学数据,并将其与患者的临床症状相关.使用χ2、Pearsonχ2和Fisher精确检验进行统计学分析以评估显著性。
39例(16.1%)患者出现至少1个骶骨Tarlov囊肿;38例患者有完整的疼痛记录,31人(81.6%)的调查结果不匹配。在整个患者队列中鉴定出总共50个Tarlov囊肿。大多数Tarlov囊肿在S2-S3水平发现(32/50;64%)。17例患者(44.7%)表现出单侧不一致的发现:与Tarlov囊肿相反的单侧症状。此外,14例(36.8%)患者被发现有双侧不一致的结果:11例(28.9%)有单侧Tarlov囊肿的双侧症状,3例(7.9%)出现单侧症状并伴有双侧囊肿。仅在7例患者(18.4%)中证实了一致的发现。在囊肿大小和疼痛偏侧性之间没有发现显着关联(P=0.161),囊肿体积和疼痛位置(P=.546),或囊肿大小和单侧vs双侧疼痛(P=.997)。
Tarlov囊肿的患病率增加可能不是阴部神经痛的病因,然而,两者可能是由于部分局灶性或全身性疾病的相似发病机制。
Pudendal neuralgia is a painful neuropathic condition involving the pudendal nerve dermatome. Tarlov cysts have been reported in the literature as another potential cause of chronic lumbosacral and pelvic pain. Notably, they are often located in the distribution of the pudendal nerve origin at the S2, S3, and S4 sacral nerve roots and it has been postulated that they may cause similar symptoms to pudendal neuralgia. Literature has been inconsistent on the clinical relevance of the cysts and if they are responsible for symptoms.
To evaluate the prevalence of S2-S4 Tarlov cysts at the pudendal nerve origin (S2-S4 sacral nerve roots) in patients specifically diagnosed with pudendal neuralgia, and establish association of patient symptoms with location of Tarlov cyst.
A retrospective study was performed on 242 patients with pudendal neuralgia referred for pelvic magnetic resonance imaging from January 2010 to November 2012. Dedicated magnetic resonance imaging review evaluated for presence, level, site, and size of Tarlov cysts. Among those with demonstrable cysts, subsequent imaging data were collected and correlated with the patients\' clinical site of symptoms. Statistical analysis was performed using χ2, Pearson χ2, and Fisher exact tests to assess significance.
Thirty-nine (16.1%) patients demonstrated at least 1 sacral Tarlov cyst; and of the 38 patients with complete pain records, 31 (81.6%) had a mismatch in findings. A total of 50 Tarlov cysts were identified in the entire patient cohort. The majority of the Tarlov cysts were found at the S2-S3 level (32/50; 64%). Seventeen patients (44.7%) revealed unilateral discordant findings: unilateral symptoms on the opposite side as the Tarlov cyst. In addition, 14 (36.8%) patients were detected with bilateral discordant findings: 11 (28.9%) had bilateral symptoms with a unilateral Tarlov cyst, and 3 (7.9%) had unilateral symptoms with bilateral cysts. Concordant findings were only demonstrated in 7 patients (18.4%). No significant association was found between cyst size and pain laterality (P = .161), cyst volume and pain location (P = .546), or cyst size and unilateral vs bilateral pain (P = .997).
The increased prevalence of Tarlov cysts is likely not the etiology of pudendal neuralgia, yet both could be due to similar pathogenesis from part of a focal or generalized condition.