Understanding the problem
A Tarlov cyst is a dilation of a spinal nerve root sheath, in other words, the outer covering of a spinal nerve. The progressive accumulation of cerebral spinal fluid inside the nerve causes it to expand and form a cyst. The expanded or dilated spinal nerve can then compress other nearby nerves around it and cause debilitating symptoms.
Understanding who suffers
Although the cause of Tarlov cysts is generally not well understood, data shows that they occur more commonly in women than men. They can be develop anywhere in the spine where spinal nerve roots are present, but the majority of symptomatic Tarlov cysts are found in the sacrum or base of the spine.
Potential Signs and Symptoms
Symptoms can vary depending on the location of the cysts. Some typical symptoms of sacral cysts can include:
- Sacral or tail bone pain or pressure
- Pain with sitting. May feel like you are sitting on a rock or an object
- Avoidance of sitting type activity
- Pain with standing
- Pain in the legs and feet especially in the back of the thighs
- Leg weakness or numbness
- Bowel or bladder or sexual dysfunction
- Pain or numbness in the perineum, or private areas
Examinations Usually Required
A diagnosis is made by reviewing the patient’s MRI, history, and symptoms. It is not uncommon for an event such as a fall, child birth, vehicle accident, or lifting something very heavy to bring about the onset of symptoms. MRI is currently the best study to identify Tarlov cysts, and also frequently reveals erosion or thinning of the bone around larger Tarlov cysts. Unfortunately, many patients suffer with their symptoms and are told to live with their pain due to the incorrect belief that Tarlov cysts never cause problems.
Proposing Treatment and Why AIMIS
The surgical treatment of symptomatic Tarlov cysts is designed to permanently restore the cystic nerves to their normal size and relieve the pressure off the nerves that are being compressed. The surgery is done with continuous nerve monitoring and with the aid of an operating microscope. AIMIS performs a large number of procedures under this specialty area including:
- Sacral Laminectomy and Treatment of Sacral Meningeal Cysts and Laminar Reconstruction with Absorbable
- Tarlov Cyst Surgery
- Minimally Invasive Nerve Decompression Surgery
- Minimally Invasive Reconstruction Surgery
- Meningeal Cyst Surgery
- Meningeal Diverticulum Resection
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Reputable and Prestigious Surgeon - The number one in the world!
Dr. Frank Feigenbaum is an innovative pioneer in the field of treating spinal meningeal cysts such as Tarlov cysts. He has been treating thousands of patients affected by the problems of all types of Tarlov and Meningeal cysts within the US and at the AIMIS Center in Cyprus. By providing a presence in the European Union, Dr. Feigenbaum, became more accessible to patients that would have trouble traveling long distances to the United States or were seeking the concierge style of surgical experience such as is provided at AIMIS. Since this collaboration began, patients have come for treatment from all across the world with superior outcomes.
The MRI and patient history is reviewed by Dr. Feigenbaum and a discussion with the patient of their case and proposed surgery happens well before a planned surgery date. Throughout the process patients have the opportunity to ask questions and have their concerns addressed. Patients generally meet Dr. Feigenbaum the day before their surgery and again the day of the surgery as well as during a pre-online consultation before accepting to proceed.
Getting More Information Before Moving Forward
You may have questions like:
- Can I get more information before I commit to this?
- Can I get a second opinion from you before I commit to this?
- How can I find out the cost before I have any obligation?
What AIMIS Can do:
AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.
AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.
AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.
Further information on the problem:
Symptoms of expanding/enlarging cysts occur due to compression of nerve roots.
Symptoms may include the following, dependent on the location of the cysts and the section of the spine where they occur:
- Pain in lower back (particularly below the waist) and in buttocks, legs, and feet
- Pain in the chest, upper back, neck, arms and hands
- Weakness and/or cramping in legs and feet / arms and hands
- Paraesthesia’s (abnormal sensations) in legs and feet or arms and hands, dependent on cyst locations
- Pain sitting or standing for even short periods of time
- Pain when sneezing or coughing
- Inability to empty the bladder or in extreme cases to urinate at all requiring catheterization
- Bowel or bladder changes, including incontinence
- Swelling over the sacral (or cervical, thoracic, or lumbar) area of the spine
- Soreness, a feeling of pressure and tenderness over the sacrum and coccyx (tailbone), extending across the hip and into the thigh with cysts in the sacrum. Same feelings in upper sections of the spine dependent on cyst locations
- The feeling of sitting on a rock
- Vaginal, rectal, pelvic and/or abdominal pain
- Restless leg Syndrome
- PGAD (Persistent Genital Arousal Disorder)
- Sexual dysfunction and painful intercourse
How are cysts removed:
Each Tarlov cyst is a spinal nerve root and therefore cannot simply be removed. The goal of surgery is to eliminate the cystic part of the nerve, but to preserve the nerve. This is accomplished under an operating microscope while the nerves are continuously monitored. For other types of cysts such as a meningeal diverticulum it is possible to resect the cyst.
Further Information on Increased Risk Groups
Those who have progressive and prolonged symptoms run a risk of neurological damage, if the cysts continue to compress nerve structures. If the nerve damage is progressive and affects bladder and bowel function and other body systems, it is important to have a good primary physician to coordinate referrals to specialists. Many patients become disabled and unable to continue to work, due to the pain and multi-systems affected issues. It is a highly specialized problem for a highly specialized surgeon.
Further examination that maybe required or requested
Most Tarlov cysts are discovered on MRI, CT or Myelogram. The best imaging study to image the Tarlov/perineural cyst is a "spine MRI", and since the vast majority (95%) of the perineural cysts are on the sacral spine, then the order should be for a "full sacral spine MRI (S1-S5) all the way to the coccyx/tailbone". Additionally, the ordering physician should request the radiologist to "look for the presence of Tarlov/perineural cysts, and if any are imaged, to report the cysts and their specific locations, sizes and numbers.
If the patient’s symptoms are related to the upper sections of the spine (although the cysts occur much less frequently in these areas (3-6%), then the appropriate cervical, thoracic or Lumbar MRI should be ordered. Some patients have the cysts in more than one section of the spine. It is sometimes confusing to make an accurate diagnosis as to the cause of the symptoms, if there are multiple diagnoses found, such as herniated discs, ruptured disc, DDD (degenerative disc disease). It is sometimes diagnostically conclusive that the cysts are the cause of symptoms, when pain is improved by aspirating the fluid from the cysts.
Why AIMIS for this Surgery
Since 2011 Dr. Frank Feigenbaum has been treating patients affected by the problems of all types of meningeal cysts, including Tarlov cysts, at the AIMIS Spine Center. AIMIS strives for excellence in delivering the best surgical outcomes, via the extensive expertise of its prestige surgeons, its technologies, its highly trained staff and superior facilities to provide an individualized and compassionate experience in a comfortable environment. All patients are treated with the individual care they deserve in an effort to provide the best chance of successful treatment.
Other Services Provided by AIMIS
In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you’ll know the best flights to take, where you’ll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your post-surgical care. Our Patients have said that they feel they have become “part of our family” and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.