A Rare Huge Sacral Tarlov Cyst with Progressive Neurologic Deficit: A Case Report

Background and Importance: Perineural cysts, also known as Tarlov cysts, are benign cysts of the spinal cord containing a collection of cerebrospinal fluid. They most frequently originate in the sacral spine and can be asymptomatic. Case Presentation: We presented a 30-year-old woman who was referred to our clinic with an 8-month history of perianal paresthesia, slowly progressive lower back pain, pain in back of the left and right thigh, and a one-week history of bladder incontinence. Magnetic resonance imaging (MRI) done six months ago showed a large cyst with size of 74x40x22 mm in S1 from S4 of the spinal canal. The cyst was uncovered after laminectomy of S1 to S4. The cyst was aspirated, its neck ligated, and the dismissed portion was excised. The nerve roots were reserved intact. Postoperatively, the patient reported noticeable pain relief. At month 3, the patient's bowel and bladder control recovered. Sensation and deep reflexes were also normal. Conclusion: A giant sacral Tarlov cyst and the development of associated radicular symptoms are powerfully associated with an outstanding outcome following surgery.