1. 2012;15;141-146Minimally Invasive Interventional Therapy for Tarlov Cysts Causing Symptoms of Interstitial Cystitis
   Case Report
   James Freidenstein, MD, J. Antonio Aldrete, MD, and Timothy Ness, MD, PhD.

BACKGROUND: Tarlov cysts (TC) are present in 4.6% of the population and represent a potential source of chronic pain. When present at lumbosacral levels, symptoms are classically described as perineal pain/pressure, radiculopathy, and headache. Treatment outlined to date primarily includes cyst drainage with fibrin glue sealant and surgical interventions.

OBJECTIVES: We present 2 cases in which TC presented with signs and symptomatology consistent with interstitial cystitis who were treated with caudal epidural steroid injections.

METHODS: Patients with urinary bladder pain and urgency received urological workups demonstrating hallmark features of interstitial cystitis including cystoscopic evidence of glomerulations. Radiographic imaging identified TC to be present on sacral nerve roots. Since pelvic pains could represent compressive radiculopathy of sacral roots, a cautious trial of minimally invasive caudal epidural steroid injections was performed.

RESULTS: Both patients attained nearly 100% relief of pain for a period ranging from 6 months to 2 years following low volume, targeted caudal epidural steroid injection. They continue to be followed clinically and continue to report benefit with this treatment.

LIMITATIONS: This limited case series is retrospective in nature and potential complications have been noted by others in association with TC.

CONCLUSIONS: Use of caudal epidural steroid injections proved beneficial in the treatment of pelvic pain symptomatology and so may be considered as an option in patients with identified sacral TC.