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

2014 ◽  
Vol 21 (5) ◽  
pp. 833-836 ◽  
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.

scholarly journals Shrinking of a Tarlov cyst

2019 ◽  
Vol 12 (3) ◽  
pp. e227256 ◽  
Author(s):  
Kieran P Murphy ◽  
Susannah Ryan
Keyword(s):  
Minimally Invasive ◽  
Gender Bias ◽  
Delayed Diagnosis ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Tarlov Cyst ◽  
Image Guided ◽  
Tarlov Cysts ◽  
Caucasian Women ◽  
The Right

A 65-year-old patient presenting with left labial and perirectal pain was diagnosed with bilateral Tarlov cysts. Upon treatment of the left Tarlov cyst (the right was asymptomatic) using image-guided aspiration and subsequent injection of the cyst with fibrin sealant, the cyst reduced in size. To our knowledge, there are currently no other documented cases in which the Tarlov cyst reduced in size following this procedure. This case would seem to suggest that clinicians are poorly informed with regard to Tarlov cysts. These cysts are more common in Caucasian women, many of whom are told their cysts are not responsible for their pain or that they are not treatable. However, there is clear evidence that some Tarlov cysts are symptomatic and minimally invasive procedures have been developed to treat them. As they primarily occur in women, it is possible gender bias may also play a role in the delayed diagnosis of the patient’s pain.

Prevention of Cardiovascular Complications in the Marfan Syndrome

2004 ◽  
Vol 1 (1) ◽  
pp. 79-86 ◽  
Author(s):  
L. J. Meijboom ◽  
G. J. Nollen ◽  
B. J.M. Mulder
Keyword(s):  
Marfan Syndrome ◽  
Cardiovascular Complications

scholarly journals Pulsed Radiofrequency Ablation of Pudendal Nerve for Treatment of a Case of Refractory Pelvic Pain

2017 ◽  
Vol 3 (20;3) ◽  
pp. E451-E454 ◽  
Author(s):  
Stephanie Jones
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Pelvic Pain ◽  
Pudendal Nerve ◽  
Pudendal Neuropathy ◽  
Ischial Spine ◽  
Pulsed Radiofrequency ◽  
Pudendal Neuralgia ◽  
Mr Neurography ◽  
The Right

Pudendal neuralgia (PN) is a result of pudendal nerve entrapment or injury, also called “Alcock syndrome.” Pain that develops is often chronic, and at times debilitating. If conservative measures fail, invasive treatment modalities can be considered. The goal of this case report is to add to a small body of literature that a pulsed radiofrequency (PRF) ablation can be effectively used to treat PN and to show that high resolution MR neurography imaging can be used to detect pudendal neuropathy. Case Presentation: We present a case of a 51-year-old woman with 5 years of worsening right groin and vulva pain. Various medication trials only lead to limited improvement in pain. The first diagnostic right pudendal nerve block was done using 3 mL of 0.25% bupivacaine with 6mg of betamethasone using a transgluteal technique and a target of the right ischial spine; this procedure resulted in ~8 hours of > 50% pain relief. The patient was then referred for MR neurography of the lumbosacral plexus. This study revealed increased signal of the right pudendal nerve at the ischial spine and in the pudendal canal, findings consistent with the clinical picture of PN. Six weeks after the initial block, the patient underwent a second right transgluteal pudendal nerve block, utilizing 3 mL of 0.25% bupivacaine with 40 mg of triamcinolone acetonide; this procedure resulted in ~8 hours of 100% pain relief. Satisfied with these results the patient decided to undergo pudendal nerve PRF ablation for possible long-term relief. For this therapeutic procedure, a right transgluteal approach was again utilized. PRF ablation was performed for 240 seconds at 42° Celsius. Following this ablation the patient reported at least 6 weeks of significant (> 50%) pain relief. Discussion and Conclusion: In this paper we presented a case of successful treatment of PN with PRF ablation and detection of pudendal neuropathy on MR neurography. We believe that transgluteal PRF ablation for PN might be an effective, minimally invasive option for those patients that have failed conservative management. MR neurography employed in this case is not only helpful in confirming the diagnosis of PN but could also be useful in ruling out other causes of pelvic pain, such as genitofemoral neuropathy, endometriosis, adenomyosis, or pelvic mass lesion. To conclude, transgluteal PRF ablation can serve as a viable treatment option for mitigating symptoms of pudendal neuropathy and MR neurography is useful in confirming a clinically suspected diagnosis of PN. Key words: Pelvic pain, pudendal neuralgia, MR neurography, pulsed radiofrequency ablation, transgluteal technique, Alcock canal syndrome

scholarly journals Depressive symptomatology in a female patient with Tarlov cyst

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984469
Author(s):  
Konstantinos Kontoangelos ◽  
Marina Economou ◽  
Vasiliki Katsi ◽  
Charalambos Papageorgiou
Keyword(s):  
Depressive Symptomatology ◽  
Sudden Onset ◽  
Spinal Nerve ◽  
Magnetic Resonance Imaging Scan ◽  
Cystic Dilatation ◽  
Nerve Roots ◽  
Tarlov Cyst ◽  
Tarlov Cysts ◽  
Lumbar Area ◽  
First Time

Introduction: The spinal perineurial cyst is a rare anomaly of the nervous system. It is also known as Tarlov cyst, since it was described for the first time by Isadore M. Tarlov. The pathology is defined as a cystic dilatation between the perineurium and endoneurium of spinal nerve roots, located at the level of the spinal ganglion and filled with cerebrospinal fluid but without communication with the perineurial subarachnoid space. Case report: We present the case of a 56-year-old female who reported sudden onset of symptoms of a depressive symptomatology accompanied with acute pain in the lumbar area. Lumbosacral magnetic resonance imaging scan revealed Tarlov cysts. Discussion: Radiological investigations in patients with depressive symptomatology may be substantial.

Surgical Treatment of Cardiovascular Complications in Patients with Marfan Syndrome: a Report of two Cases and Literature Review

2012 ◽  
Vol 112 (3) ◽  
pp. 213-218
Author(s):  
S. Bruis ◽  
M.A. Radermecker ◽  
E. Creemers ◽  
P. Bonnet ◽  
E. Nellessen ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Marfan Syndrome ◽  
Cardiovascular Complications

Interstitial Cystitis/Bladder Pain Syndrome

2018 ◽  
Vol 36 (02) ◽  
pp. 123-135 ◽  
Author(s):  
Ioana Marcu ◽  
E. Campian ◽  
Frank Tu
Keyword(s):  
Interstitial Cystitis ◽  
Pelvic Pain ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Bladder Pain ◽  
Painful Bladder ◽  
Bladder Symptoms ◽  
The Many ◽  
American Urological Association ◽  
Underlying Pathophysiology

AbstractInterstitial cystitis/bladder pain syndrome is an uncommon but potentially devastating pelvic pain disorder affecting both women and men. This condition is often confusable and comorbid with other pelvic pain disorders. Although our understanding of the underlying pathophysiology is growing, the exact longitudinal course by which peripheral and central aberrations involving the bladder mucosa, peripheral inflammation, and central dysregulation of bladder sensitivity create painful bladder symptoms remains an area in need of further study. Only a limited number of drugs have been approved for treatment by the Food and Drug Administration, and overall durable efficacy of the many treatments reviewed in recent American Urological Association guidelines remains suboptimal, making awareness, early diagnosis, and use of effective treatments early in the disease course, where neural changes may still be reversible, imperative.

scholarly journals Spinal cord stimulation for the treatment of chronic pelvic pain after Tarlov cyst surgery in a 66-year-old woman: A case report

2020 ◽  
Vol 25 ◽  
pp. e00171 ◽  
Author(s):  
Jamal Hasoon ◽  
Amnon A. Berger ◽  
Ivan Urits ◽  
Vwaire Orhurhu ◽  
Omar Viswanath ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Pelvic Pain ◽  
Spinal Cord Stimulation ◽  
Chronic Pelvic Pain ◽  
Tarlov Cyst

scholarly journals A Rare Reason for Pelvic Pain in Pregnancy: Infectious Sacroiliitis

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Yasemin Cekmez ◽  
Ahmet Göçmen ◽  
Oğuz Arslan ◽  
Fatih Şanlıkan ◽  
Simge Bağcı Türkmen
Keyword(s):  
Pelvic Pain ◽  
C Reactive Protein ◽  
Mri Scan ◽  
Pelvic Magnetic Resonance Imaging ◽  
Reactive Protein ◽  
Magnetic Resonance Imaging Mri ◽  
Wbc Count ◽  
The Right ◽  
Low Risk Women ◽  
In Pregnancy

Introduction. Although the incidence of pregnancy-associated sacroiliitis is low, it is associated with significant morbidity and mortality. Timely diagnosis of the disease is confusing due to its nonspecific clinical features.Case. A 28-year-old woman at 34 weeks of gestation with severe pain in her right buttock radiating down the backside of the right thigh was admitted to our hospital. White blood cell (WBC) count and C-reactive protein (CRP) were elevated. The pelvic magnetic resonance imaging (MRI) scan revealed right sacroiliitis.Conclusion. Infectious sacroiliitis should be considered as a differential diagnosis even in low-risk women who present with debilitating pelvic pain in pregnancy and medical treatment should not be delayed.

scholarly journals Isadore Max Tarlov (1905–1977) and the controversial Tarlov cyst: historical perspective

2016 ◽  
Vol 24 (3) ◽  
pp. 510-513 ◽  
Author(s):  
Subhas K. Konar ◽  
Shyamal C. Bir ◽  
Tanmoy K. Maiti ◽  
Papireddy Bollam ◽  
Anil Nanda
Keyword(s):  
Fibrin Glue ◽  
Spine Surgery ◽  
Medical Practice ◽  
Historical Perspective ◽  
Nerve Repair ◽  
Lumbar Surgery ◽  
Tarlov Cyst ◽  
Patient Position ◽  
Tarlov Cysts ◽  
Spinal Compression

Isadore Max Tarlov, an early neurosurgeon, made several important contributions to the field of spine surgery. He described sacral perineural cysts, now known as Tarlov cysts. Dr. Tarlov also introduced the knee-chest patient position to facilitate exposure and hemostasis in lumbar surgery. In addition, he developed the use of fibrin glue in nerve repair. His book on mechanisms of spinal compression was published in 1957. He published a book of essays titled Principles of Parsimony in Medical Practice that remains highly relevant in today's medical world.

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