Surgery

What happens during surgical treatment of Tarlov cysts?

First the surgeon performs a sacral laminectomy in which they remove the bone covering the cyst area. A single sacral laminectomy procedure is not enough to address the symptomatic Tarlov cysts. The cysts must be treated.Then, the surgeon removes the cerebral spinal fluid from the cysts, preserving the nerve and decreasing the pressure on the nerves by the cysts.

The surgery is performed with the high magnification of a microscope or similar exoscope (high-definition, 3D camera system to project magnified, high resolution, real-time images onto large monitors for the surgical team) and continuous intraoperative nerve monitoring to give the surgeon feedback on the tolerance of the nerves to manipulation.

Do I need surgery right away, or can I wait and watch?

This is a discussion for you and your healthcare professionals. You may choose to monitor your symptoms if they are tolerable and your quality of life is still high. Generally, surgery is offered when more conservative treatments have failed.

Surgery may be the only option when other treatments have not worked, neurological symptoms become severe, or bone is wearing away.

Symptoms like extreme pain and severe bladder or bowel or sexual dysfunction are signs that nerve injury is occurring. If you are offered surgery and decide not to proceed, your symptoms may worsen and the untreated compressed nerves could become damaged.

What are the risks of surgery?

In general the risks for this type of surgery include infection, bleeding, anesthesia reactions, nerve injury, cerebral spinal fluid leak, bowel, bladder, or sexual dysfunction, and worsening of symptoms or minimal symptom improvement.

What are the outcomes of surgery?

We are beginning to see data with longer-term outcomes of two years that reflect sustained improvement of symptoms with surgical treatment. The most current literature reflects improvements with surgical treatment and a high rate of success. The specific success rates and risks should be discussed with your neurosurgeon.