Tarlov神经周脊髓囊肿(TC)是脊髓神经性症状的未被认识到的原因。TC在感觉神经根袖内形成,CSF向远端延伸并可在病理上积聚。通常,它们在神经根处于最高静水压力下并且缺乏封闭的椎骨孔处发展。总的来说,90%的病人是女性,和削弱结缔组织的遗传疾病,例如,Ehlers-Danlos综合征,传达相当大的风险。大多数小TC无症状,不需要治疗,但即使是偶然的可视化也应记录,以防以后出现症状。有症状的TC最常见的是引起骶骨盆皮瘤神经性疼痛,以及膀胱,肠,和性功能障碍。大囊肿通常通过压缩腹侧运动根而导致肌肉萎缩和无力,和多个囊肿或一根大囊肿的多根压迫可导致更大的马尾综合症。很少,巨大的囊肿侵蚀骶骨或延伸为骨盆内肿块。禁用TC需要考虑手术干预。作者对治疗的系统评价分析了31例介入经皮手术和开放手术。手术系列较小,并报告了一些更好的结果,长期随访,但风险略高。当缺乏数据时,作者的专业知识和病例报告详细介绍了具体的介入和手术技术,以及医疗,物理,和心理管理。囊肿包裹手术似乎通过永久减小囊肿大小和重建神经根袖来提供最佳的长期结果。这减少了轴突的持续损伤和神经元死亡,还可能促进轴突再生,以改善躯体和自主神经的功能。
Tarlov perineurial spinal cysts (TCs) are an underrecognized cause of spinal neuropathic symptoms. TCs form within the sensory nerve root sleeves, where CSF extends distally and can accumulate pathologically. Typically, they develop at the sacral dermatomes where the nerve roots are under the highest hydrostatic pressure and lack enclosing vertebral foramina. In total, 90% of patients are women, and genetic disorders that weaken connective tissues, e.g., Ehlers-Danlos syndrome, convey considerable risk. Most small TCs are asymptomatic and do not require treatment, but even incidental visualizations should be documented in case symptoms develop later. Symptomatic TCs most commonly cause sacropelvic dermatomal neuropathic pain, as well as bladder, bowel, and sexual dysfunction. Large cysts routinely cause muscle atrophy and weakness by compressing the ventral motor roots, and multiple cysts or multiroot compression by one large cyst can cause even greater cauda equina syndromes. Rarely, giant cysts erode the sacrum or extend as intrapelvic masses. Disabling TCs require consideration for surgical intervention. The authors\' systematic review of treatment analyzed 31 case series of interventional percutaneous procedures and open surgical procedures. The surgical series were smaller and reported somewhat better outcomes with longer term follow-up but slightly higher risks. When data were lacking, authorial expertise and case reports informed details of the specific interventional and surgical techniques, as well as medical, physical, and psychological management. Cyst-wrapping surgery appeared to offer the best long-term outcomes by permanently reducing cyst size and reconstructing the nerve root sleeves. This curtails ongoing injury to the axons and neuronal death, and may also promote axonal regeneration to improve somatic and autonomic sacral nerve function.