Surgical Management of Meningeal Cysts, Including Perineural (Tarlov) Cysts and Meningeal Diverticula

The two most prevalent forms of nerve root cyst are perineural (Tarlov) cysts and meningeal diverticula. They occur most commonly in the lumbosacral region, where cyst expansion can produce local pain, radiculopathy, and bowel or bladder dysfunction. These lesions are best diagnosed with MRI, which also yields useful information on related neural and osseous anatomy. Techniques such as simple decompression and percutaneous needle aspiration have proven ineffective as treatments since they do not prevent continued cyst expansion or refilling. Our experiences lead us to concur with recent trends in the literature, which have favored more definitive surgical treatments aimed at the fundamental cause of meningeal cyst formation. Surgery for Tarlov cysts involves exposure, identification of neural structures, and cyst wall resection. Treatment of meningeal diverticula is similar, but also involves osteum identification and ligation.