Incidental 99mTc-DTPA Uptake in Tarlov Cysts on Radionuclide SPECT/CT Cisternography

Abstract In children, hypothalamic-hypophyseal syndromes such as diabetes insipidus, precocious puberty, growth retardation, and panhypopituitarism can be due either to structural lesions or to functional disorders of the cerebral endocrine complex. When clinical and endocrinological parameters fail to distinguish between these etiologies, neuroradiographical diagnosis becomes extremely important. Although conventional intravenously enhanced computed tomography (IVCT) is satisfactory for the diagnosis of lesions larger than 1 cm, metrizamide CT cisternography (MCTC) greatly improves the diagnostic yield for smaller juxtapituitary masses in the suprasellar cistern, clearly defines their sizes and relationships with contiguous structures, and definitively confirms the diagnosis of empty sella syndrome. Six patients with endocrinopathies and normal or ambiguous IVCT findings are presented to illustrate how MCTC can influence their management and outcome without the patient discomfort and technical complexity associated with pneumoencephalography.

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Pelvic pain from a giant presacral Tarlov cyst successfully obliterated using aneurysm clips in a patient with Marfan syndrome

Journal of Neurosurgery Spine ◽

10.3171/2014.8.spine148 ◽

2014 ◽

Vol 21 (5) ◽

pp. 833-836 ◽

Cited By ~ 9

Author(s):

Bonnie Wang ◽

Seong-Jin Moon ◽

William C. Olivero ◽

Huan Wang

Keyword(s):

Marfan Syndrome ◽

Pelvic Pain ◽

Surgical Care ◽

Late Life ◽

Genital Prolapse ◽

Cardiovascular Complications ◽

Tarlov Cyst ◽

Tarlov Cysts ◽

Bladder Symptoms ◽

The Right

Patients with Marfan syndrome used to succumb early in life from cardiovascular complications. With the current rapid advance in medical and surgical care, such patients may now have near-normal longevities. Consequently, rare late-life complications are emerging in these patients and represent challenges to clinicians for their diagnoses and treatments. The authors report a rare case of pelvic pain and genital prolapse from a giant presacral Tarlov cyst in a 67-year-old patient with Marfan syndrome. This 67-year-old Caucasian female presented with progressively severe pelvic pain, intermittent explosive diarrhea, and dysuria. Physical and bimanual examination demonstrated genital prolapse and a nontender, cyst-like mass fixed in the midline. She underwent ultrasound, CT, and eventually MRI evaluations that led to the diagnosis of a giant (6.7 × 6.4 × 6.6 cm) Tarlov cyst originating from the right S-2 nerve root sleeve/sacral foramen with intrapelvic extension. She underwent S1–S2 and S2–S3 laminectomy with obliteration of the Tarlov cyst using aneurysm clips. Postoperatively, her pelvic pain and bowel symptoms resolved and the bladder symptoms improved. The 3-month follow-up CT of abdomen/pelvis demonstrated resolution of the cyst. The present case illustrates that clinicians caring for elderly patients with Marfan syndrome need to increasingly recognize such unusual late-life complications. Also, these large Tarlov cysts can be simply and effectively obliterated with aneurysm clips.

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Metrizamide CT Cisternography in the Diagnosis and Localization of Cerebrospinal Fluid Rhinorrhea

Journal of Computer Assisted Tomography ◽

10.1097/00004728-198006000-00003 ◽

1980 ◽

Vol 4 (3) ◽

pp. 306-310 ◽

Cited By ~ 26

Author(s):

K. Ghoshhajra

Keyword(s):

Cerebrospinal Fluid ◽

Ct Cisternography ◽

Cerebrospinal Fluid Rhinorrhea ◽

Metrizamide Ct Cisternography

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Symptomatic Tarlov Cysts: an MRI evaluation of case series and literature review

Asian Journal of Medical Sciences ◽

10.3126/ajms.v4i3.8056 ◽

2013 ◽

Vol 4 (3) ◽

pp. 35-42

Author(s):

Netra Rana ◽

Shao Hui Ma ◽

Ming Zhang ◽

Subesh Dahal ◽

Zhi-Gang Min

Keyword(s):

Cyst Wall ◽

Nerve Root ◽

Signal Intensity ◽

Case Series ◽

Treatment Method ◽

Outcome Data ◽

Hyperintense Signal ◽

Tarlov Cysts ◽

Post Operation ◽

Histological Confirmation

Corrections: on Page 38 in the 4th line of text, the information in brackets (Figure 1, 2, 3a and 4) was replaced on 24th June 2013 with (Figure 1. 2 3b and 4). The number of the references has also been changed. The corrected PDF is available by clicking the link below.Aim: To analyze the characteristics of symptomatic Tarlov cysts by MRI. Materials and Methods: Neuroimaging and clinical outcome data were reviewed of 48 consecutive patients treated for symptomatic Tarlov cysts. All patients were scanned under Philips Gyroscan Intera 1.5T scanner with spinal surface coils. Two widely used surgical procedures were performed, 1) incision and drainage of the cyst with imbrication of the redundant nerve root sheath, and 2) exposure of the cyst, drainage of cyst contents, identification of nerve roots, and cyst wall resection combined with duraplasty. The post-operation follow-up was obtained from return visits to the neurosurgery and orthopaedic out-patient department or by telephone questionnaires. Results: All cystic lesions showed hypointense signal intensity on T1WI and hyperintense signal intensity on T2WI, but the nerve root showed iso-intensity on T1WI and low signal intensity on T2WI. They were linear in shape on sagittal view, and hypo intense dotted spots within the cysts on traverse view. Surrounding structures of the larger cysts were compressed and had bone erosions in some cases; the spinal canal and the intervertebral foramen on the affected side were enlarged. The lesions/cyst wall showed no enhancement after gadolinium administration. Conclusion: MRI will give a definite diagnosis of Tarlov cysts if nerve root presents within the cyst cavity or in the cyst wall; eliminating the need for histological confirmation. A correct analysis of the characteristics of symptomatic Tarlov cysts by MRI, will document its usefulness in noninvasive diagnosis and aid in exploration of the simplest treatment method. DOI: http://dx.doi.org/10.3126/ajms.v4i3.8056 Asian Journal of Medical Sciences 4(2013) 35-42

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