What are the best treatments for Tarlov Cyst?

I have tried multiple treatments, but the best before surgery was a nerve block done in the sacral area. I don't suggest this necessarily as it can cause more cysts and other health problems, but it gave me relief for the month before surgery. It did become less and less effective however.

Surgery was the only thing that made a difference, and the effects were pretty immediate for the worst of my symptoms.

I have opted not to have surgery because it is so risky and many people end up no better or even worse than prior to surgery. What works best for me is modification of my activities, ice, diet, reducing inflammation.

Cyst draining and refilling

My personal experience is handling the pain with medication so i am physically able to handle physical therapy with slow stretches and balanced lifting to keep the body aligned.

I'm currently taking a blend of Chinese herbs to replace the tramadol as that wasn't very helpful. I'm doing acupuncture therapy, massage therapy and physical therapy currently to ease the pain.

Surgery was best for me and now pain management

Pain Medicine
Nerve Medicine
Fibrin Glue
Surgery

Ct drainages are most common, i have had 3 done & the tarlov cyst has came back for the 4th time, my next option is surgery

Most doctors throw drugs at you and require physical therapy. Physical therapy, personally made my symptoms worse, but water therapy kept me active. There are several surgeons who will attempt to ease the symptoms with several different methods. Each have their pros and cons. Nothing will be 100%. I just hoped for 50% with my surgery. Research all possibilities.

Surgical procedures

Surgery was my best option

surgery

This is a highly debated subject. Surgery works for some and worsens others. Mainly pain management.

The best treatment for a Tarlov cyst, is for a qualified neurosurgeon, specifically Dr. Frank Fiegenbaum of the Tarlov Cyst Institute in Dallas Texas, do his patented procedure. Where he mixes fatty tissue from your body with medical grade super glue, then goes in and injects that mixture into the sheath of the affected nerve, above the cyst, which seals off the sheath, and doesn't allow CSF to reach the area of the cyst. He then drains the cyst of the CSF that has filled/formed it, and wraps the excess tissue of the sheath, which has been created as a result of being stretched as the cyst has grown over time, around the nerve, and then wraps the area where the cyst was, basically in medical grade duck tape so that the cyst can't reform in the same place.

There are options, but no cures. I chose surgery with one of the few doctors nation wide.

Tarlov Cyst Disease is classified as a rare disease. The majority of people have the cysts and symptoms located in their lumbar spine, coccyx and pelvis. Only 3-6% have them in their cervical spine and are symptomatic. The only two neurosurgeons I know are Dr. Feigenbaum in Dallas, Texas and Dr. Schrot in Sacramento, California. Going on an AIP (Anti-Inflammatory Protocol) Diet helps, as long with Tumeric, Lidocaine patches and narcotics. There is no cure.

Tratamiento para el Dolor
Ejercicio físico suave (tai chi, yoga suave)

Nerve pain treatment- Gabapentin
Pain - Oramorph

Draining and wrapped

Лечението е единствено оперативно.
Консервативното лечение с медикаменти е само за облекчаване на част от симптомие.

There is stil no consensus on the best treatment.
It all depends on how many cysts there are, age, and how long symptoms are there already (nerve damage).

Interventional therapies have been performed to relieve pain and symptoms of symptomatic Tarlov cysts, such as aspiration of the cyst followed by injection of fibrin glue. However, recurrence of symptoms occurs and intra procedural bleeding or nerve injury makes any subsequent surgery more difficult. Arachnoiditis can occur due to fibrin glue getting into the thecal sac. The fibrin bonding technique is falling out of favor both in the United States and abroad, with only a few centers with significant experience continuing its use. Strict patient selection is necessary because this technique cannot be injected into a non-valve-ventilated cyst or a wide-necked cyst.

In general, microsurgery would be the treatment of choice to treat nerve root compression. However, the surgery is delicate due to the high hydrostatic pressure, fragility of tissues, and the presence of the nerve root fibers in the cyst or cyst wall leading to high incidence of complications such as a dural leak or nerve damage. However, the quality of the evidence is poor due to methodological problems. In addition, with the underlying cause, the hydrostatic pressure is not resolved, allowing cysts to recur or new cysts to form.

Studies comparing medical, interventional and surgical treatments are scarce and questionable and have been derived from relatively small case series of small trial size. Postoperative complications were significant in the surgical group and included CSF leakage, transient sciatica, sexual dysfunction, wound infections and others (venous hemorrhage, transient intracranial hypotension, seroma, cerebral hemorrhage and prostatitis). Within the non-surgical group, among others, CSF leaks, transient sciatica and other complications were seen as aseptic meningitis, allergic reaction to the sealant. It is also unclear which possible indications predict a response to treatment. It was shown that advanced age, the number of perineural cysts observed preoperatively and the duration of symptoms gave a poor postoperative outcome. Nevertheless, treatment methods are recommended as the preferred method and it should be determined whether the benefits outweigh the risks of aggressive treatment, as it can lead to significant morbidity with a significant risk of recurrence of symptoms.

It is believed that when the cyst is "removed", the nerve compression will be relieved and the patient's problems should be resolved. In cases of large valved cysts, which are quite uncommon, microsurgical treatment may help, but will not resolve the underlying cause of the pressure. During follow-up of 36 symptomatic patients, 93% of patients showed improvement at some point, however 50% developed recurrent pain, despite cyst size reduction.

https://www.researchgate.net/publication/297663732_Electromyographic_Abnormalities_Associated_with_Symptomatic_Sacral_Tarlov_Cysts

https://www.researchgate.net/publication/333025384_Symptomatic_Tarlov_cysts_are_often_overlooked_ten_reasons_why-a_narrative_review

“Growth of Lumbosacral Perineural (Tarlov) Cysts: A Natural History Analysis”
https://pubmed.ncbi.nlm.nih.gov/30535342/

Chapter 115 (Feigenbaum - Henderson - Voyadzis)
https://clinicalgate.com/tarlov-cysts/

* Medicatie tegen zenuwpijn: Gabapentine (Neurontin) of Pregabaline (Lyrica) is de eerste keuze. Cymbalta. Redomex. Deanxit. Soms zijn morfine-afgeleide producten nodig.
* Er wordt ten stelligste aangeraden om zo weinig mogelijk te zitten, te staan of zware inspanningen te doen. Dat doet immers de druk in de cyste oplopen en lokt de symptomen uit. Bovendien wordt ook aangeraden (bij geringe pijn) om overdag minstens een uur te gaan liggen om de druk te laten afnemen.
* Aangewezen activiteiten zijn rustig wandelen, zwemmen (in warm water), fietsen (elektrische fiets) op een eigen tempo en binnen de pijngrens.
* Geleidelijke opbouw van de fysieke conditie binnen de pijngrens. Maar de belastbaarheid is erg laag. Daar moet rekening mee worden gehouden. Stabilisatieoefeningen kunnen de pijn doen toenemen en de patiënt haakt af, niet omdat hij/zij niet wil, maar omdat het niet kan.
* Warmte, manuele therapie, osteopathie, ...
* Alcohol, koffie en blootstelling aan de zon vermijden. Dat verhoogt de cerebrospinale druk.

Laminectomy surgery is the only way to stop progression of Tarlov Cyst Disease. Short term relief may be attained with draining and filling with fibrin glue but this procedure may also make surgery more difficult.

Medication for nerve pain: Gabapentin (Neurontin) or Pregabalin (Lyrica) is the first choice. Cymbalta. redomex. Deanxit. Sometimes morphine-derived products are needed. (Targin act)
* It is strongly recommended to sit, stand or do strenuous exercise as little as possible. After all, this increases the pressure in the cyst and provokes the symptoms. In addition, it is also recommended (in case of minor pain) to lie down for at least an hour during the day to let the pressure decrease.
* Suggested activities are gentle walking, swimming (in warm water), cycling (electric bike) at your own pace and within the pain threshold.
* Gradual build-up of physical condition within the pain threshold. But the load capacity is very low. This must be taken into account. Stabilization exercises can increase the pain and the patient drops out, not because he/she does not want to, but because he/she cannot.
* Heat, manual therapy, osteopathy, ...
* Avoid alcohol, coffee and sun exposure. That increases cerebrospinal pressure.
Suctioning and injecting tissue glue is only possible for the rare large cysts with a valve system in some Dutch hospitals. Surgery which is only performed by a few doctors worldwide. . These are less obvious treatment options.

Medicine sacral cranial therapy, surgery and neuroestimulador