• Sho Akahori, Yusuke Nishimura, Kaoru Eguchi, Yoshitaka Nagashima, Ryo Ando, Takayuki Awaya, Masahito Hara, and Atsushi Natsume.
• Department of Neurosurgery, Nagoya University, Nagoya, Japan.
• World Neurosurg. 2021 Jan 1; 145: 306-310.

BackgroundThis manuscript discusses the case of huge presacral Tarlov cysts (TCs) and the substantial neurologic recovery noted in the patient following spontaneous rupture of the most prominent cyst. Perineural or TCs are nerve root cysts, which are usually incidental findings on magnetic resonance imaging (MRI) and are most frequently observed in the sacral spine. Symptomatic lesions are rarely encountered.Case DescriptionIn this case, a 44-year-old woman presented with anal and vulva pain on the right side, and bladder and bowel dysfunction. MRI of the lumbosacral spine showed multiple huge bilateral TCs located within the presacral space from S1-3. There was a substantially large right-sided S3 cyst that was presumed to be responsible for her symptoms. Surgical intervention was considered; however, her symptoms improved significantly during the waiting period for surgery because of spontaneous rupture of the right-sided S3 cyst, as confirmed on follow-up MRI. On follow-up over a 1-year period, the patient had been very well with no recurrent symptoms.ConclusionsTo our knowledge, this is the first report of spontaneous cyst rupture and resultant neurologic improvement in a case of symptomatic presacral TCs.Copyright © 2020 Elsevier Inc. All rights reserved.

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