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Magnetic resonance images at T9-T11 showing multiple perineural cysts. Sagittal views at the level of the left intervertebral foramina on T1-(left) and T2-weighted (middle) images show multiple cysts on the left side. In axial views acquired by fast imaging employing steady-state acquisition (FIESTA, right), a linear shadow (arrowhead) is seen in the largest cyst at left T10
Source publication
Background
Perineural cysts are sometimes found incidentally with magnetic resonance imaging, and clinical symptoms requiring treatment are rare. Perineural cysts typically exhibit delayed filling with contrast medium on myelography, which is one of the criteria used by Tarlov to distinguish perineural cysts from meningeal diverticula. We present a...
Context in source publication
Context 1
... identify the cause of the neuralgia, we performed MRI, which revealed multiple cysts at the T9-T11 nerve roots bilaterally (Fig. 1). No other causal abnormality for the chest wall pain was found other than the cysts. The interior of the cysts showed similar intensity to the CSF on imaging. The largest cyst was at the level of the left T10 vertebra and had a linear shadow that suggested the presence of nerve root fibers. Computed tomography (CT) with myelography was also performed to study CSF communication between the thecal sac and the cysts. After 10 mL of 240 mg I/mL iodinated contrast medium (Omnipaque 240, Daiichi Sankyo, Inc., Japan) was injected into the thecal sac at L4/5 in the lateral recumbent position, the first CT image was taken imme- diately (left and middle columns of Fig. 2), and revealed multiple cysts from T6-L2, including small cysts. The cysts were enhanced by the contrast medium and most showed the same intensity as that of the thecal sac at the corresponding level; however, the largest cyst at left T10 and another at left T9 showed much higher concen- trations of the contrast medium. Three hours after the injection, the intensities of the cysts and the thecal sac were equal on the second CT (right column of Fig. 2). The next day, another CT examination showed no de- tectable contrast enhancement. Based on these findings, we suggested a diagnosis of multiple perineural ...
Citations
... Thoracic perineural cysts have been rarely reported and reviewed in literature [6,[14][15][16]. Their origin is uncertain, however, evidence supports various etiologies such as inflammation within the connective tissue of peripheral nerves, traumatic hemorrhage, congenital diverticula of the dura, or hydrostatic cerebrospinal fluid (CSF) pressure [6,17,18]. ...
Background and importance
To describe the first case of a thoracic perineural cyst successfully treated using a direct thoracic transforaminal endoscopic approach.
Methods
Case report.
Clinical presentation
A 66-year-old male presented with right-sided radicular pain in a T4 distribution. MRI of the thoracic spine revealed a right T4 perineural cyst caudally displacing the root in the T4-5 foramen. He had failed attempts at nonoperative management. The patient underwent an all endoscopic transforaminal perineural cyst decompression and resection as a same-day surgical procedure. Postoperatively, the patient noted near complete resolution of the preoperative radicular pain. A thoracic MRI with and without contrast was performed 3 months after surgery and showed no evidence of the preoperative perineural cyst and no symptom recurrence was noted by the patient.
Conclusion
This case report presents the first safe and successful report of an all endoscopic transforaminal decompression and resection of a perineural cyst in the thoracic spine.
... 1---3 The literature contains very few case reports describing thoracic TCs. 1,2,5 The main entities considered in differential diagnosis are other cystic nerve root sheath tumors. The presence of a solid component and contrast enhancement of the cyst suggest cystic schwannoma and cystic neurofibroma as important considerations in differential diagnosis. ...
Background A perineural (Tarlov) cyst is a fluid-filled lesion occurring between the perineurium and the endoneurium of spinal nerve roots. The aim of the study was to evaluate the prevalence and morphology of perineural cysts, detected incidentally in patients with symptomatic degenerative disk disease.
Materials/methods The study was based on the retrospective data gathered during magnetic resonance imaging (MRI) examinations.
Results and Conclusions Out of 3,128 spinal MRI examinations, perineural cysts were detected in 286 patients (9%). The cysts were most commonly observed in the sacral region, followed by thoracic, cervical, and lumbar regions. Cysts were more common in women than in men and the average age of patients was 54.8 years. In the majority, a single cyst was found. The average longest dimension of the lesion was 11.72 mm.
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
This article has been retracted at the request of the Editor-in-Chief.
In investigating concerns brought up regarding the authenticity of the article, the editors reached out to the corresponding author for an explanation and to request the original data. Per journal policy, the editors, at their discretion, may request deposition of any or all original data files for examination by the reviewers and/or editors. As a result of the author’s unsatisfactory explanation and failure to provide these data—in violation of journal policy—the editors feel that the findings of the manuscript cannot be relied upon.
The corresponding author does not agree to this retraction.
Vorgestellt wird der Fall einer Patientin mit 6‑jähriger erfolgloser medikamentöser und invasiver Schmerztherapie bei thorakaler Radikulopathie ohne adäquate Diagnostik. Nicht erkannte Ursache war eine Tarlov-Zyste, deren Resektion zu einer anhaltenden Schmerzbefreiung führte (Follow-up 8 Monate). Thorakale Tarlov-Zysten sind sehr selten, müssen aber differenzialdiagnostisch in Erwägung gezogen werden. Der Fall unterstreicht die Notwendigkeit einer adäquaten Diagnostik vor Einleitung einer langjährigen rein symptomatischen Schmerztherapie speziell bei Radikulopathie.
