TARLOV AND MENINGEAL CYSTS
UNDERSTANDING THE PROBLEM
A Tarlov cyst is a dilation of a spinal nerve root sheath, in other words, the outer covering of a spinal nerve. The progressive accumulation of cerebral spinal fluid inside the nerve causes it to expand and form a cyst. The expanded or dilated spinal nerve can then compress other nearby nerves around it and cause debilitating symptoms.
UNDERSTANDING WHO SUFFERS
Although the cause of Tarlov cysts is generally not well understood, data shows that they occur more commonly in women than men. They can be develop anywhere in the spine where spinal nerve roots are present, but the majority of symptomatic Tarlov cysts are found in the sacrum or base of the spine.
POTENTIAL SIGNS AND SYMPTOMS
Symptoms can vary depending on the location of the cysts. Some typical symptoms of sacral cysts can include:
- Sacral or tail bone pain or pressure
- Pain with sitting. May feel like you are sitting on a rock or an object
- Avoidance of sitting type activity
- Pain with standing
- Pain in the legs and feet especially in the back of the thighs
- Leg weakness or numbness
- Bowel or bladder or sexual dysfunction
- Pain or numbness in the perineum, or private areas
EXAMINATIONS USUALLY REQUIRED
A diagnosis is made by reviewing the patient’s MRI, history, and symptoms. It is not uncommon for an event such as a fall, child birth, vehicle accident, or lifting something very heavy to bring about the onset of symptoms. MRI is currently the best study to identify Tarlov cysts, and also frequently reveals erosion or thinning of the bone around larger Tarlov cysts. Unfortunately, many patients suffer with their symptoms and are told to live with their pain due to the incorrect belief that Tarlov cysts never cause problems.
PROPOSING TREATMENT AND WHY AIMIS
The surgical treatment of symptomatic Tarlov cysts is designed to permanently restore the cystic nerves to their normal size and relieve the pressure off the nerves that are being compressed. The surgery is done with continuous nerve monitoring and with the aid of an operating microscope. AIMIS performs a large number of procedures under this specialty area including:
- Sacral Laminectomy and Treatment of Sacral Meningeal Cysts and Laminar Reconstruction with Absorbable Plating
- Meningeal Diverticulum Resection
- Cervical or Thoracic or Lumbar Laminectomy and treatment of Tarlov/meningeal cyst
REPUTABLE AND PRESTIGIOUS SURGEON - THE NUMBER ONE IN THE WORLD!
Dr. Frank Feigenbaum is an innovative pioneer in the field of treating spinal meningeal cysts such as Tarlov cysts. He has been treating thousands of patients affected by the problems of all types of Tarlov and Meningeal cysts within the US and at the AIMIS Center in Cyprus. By providing a presence in the European Union, Dr. Feigenbaum, became more accessible to patients that would have trouble traveling long distances to the United States or were seeking the concierge style of surgical experience such as is provided at AIMIS. Since this collaboration began, patients have come for treatment from all across the world with superior outcomes.
The MRI and patient history is reviewed by Dr. Feigenbaum and a discussion with the patient of their case and proposed surgery happens well before a planned surgery date. Throughout the process patients have the opportunity to ask questions and have their concerns addressed. Patients generally meet Dr. Feigenbaum the day before their surgery and again the day of the surgery as well as during a pre-online consultation before accepting to proceed.
TARLOV CYST SURGICAL OUTCOMES
Dr. Feigenbaum has extensive, world-renowned experience treating over 1800 Tarlov and meningeal cyst patients. His specialized techniques and outcomes research starting in 2007, singles him out as one of a few neurosurgeons worldwide to show statistical improvements in his patients.
Under the supervision of Sarah Cannon Research Institute and North Texas IRB, Dr. Feigenbaum has been gathering and analyzing Tarlov Cyst surgical outcomes since 2007. To date, over 1500 Tarlov cyst patients have been involved in Dr. Feigenbaum's study which measures and reports patient outcomes for two years post-surgery. Patient outcomes are captured using four standardized self-assessment questionnaires: Visual Analog Scale, SF-36, Oswestry and Feigenbaum questionnaires. Study patients send in their completed self-assessments at specific intervals: Pre-op, 3 months, 6 months, 12 months and 24 months following surgery.
Proven Surgical Technique
At two years following surgery, Dr. Feigenbaum's patients:
- Have statistically significant improvements in leg pain, physical functioning, sitting time, energy, and emotional well-being.
- Also have significant reduction in number of locations of pain and narcotic use for pain management.
- The responses from the four unique self-assessments of pain, quality of life, and functionality indicated a trend toward improvement in all areas following surgery.
GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
- Can I get more information before I commit to this? You will have plenty of opportunities to obtain more information and have your questions addressed.
- What is the cost for the MRI review and consultation? There is no charge for a consultation. However, there may be a fee for a 2nd opinion.
WHAT AIMIS CAN DO:
AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.
AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.
AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.
FURTHER INFORMATION ON THE PROBLEM:
Symptoms of expanding/enlarging cysts occur due to compression of nerve roots.
Symptoms may include the following, dependent on the location of the cysts and the section of the spine where they occur:
- Pain in lower back (particularly below the waist) and in buttocks, legs, and feet
- Pain in the chest, upper back, neck, arms and hands
- Weakness and/or cramping in legs and feet / arms and hands
- Paraesthesia’s (abnormal sensations) in legs and feet or arms and hands, dependent on cyst locations
- Pain sitting or standing for even short periods of time
- Pain when sneezing or coughing
- Inability to empty the bladder or in extreme cases to urinate at all requiring catheterization
- Bowel or bladder changes, including incontinence
- Swelling over the sacral (or cervical, thoracic, or lumbar) area of the spine
- Soreness, a feeling of pressure and tenderness over the sacrum and coccyx (tailbone), extending across the hip and into the thigh with cysts in the sacrum. Same feelings in upper sections of the spine dependent on cyst locations
- The feeling of sitting on a rock
- Vaginal, rectal, pelvic and/or abdominal pain
- Restless leg Syndrome
- PGAD (Persistent Genital Arousal Disorder)
- Sexual dysfunction and painful intercourse
HOW ARE CYSTS REMOVED:
Each Tarlov cyst is a spinal nerve root and therefore cannot be removed. Inside the cyst are nerve fibers that provide function and feeling. The goal of the surgery is to eliminate the cystic part of the nerve, but to preserve the nerve. This is accomplished under an operating microscope while the nerves are continuously monitored. For other types of cysts such as a meningeal diverticulum it is possible to remove the cyst.
FURTHER INFORMATION ON INCREASED RISK GROUPS
Those who have progressive and prolonged symptoms run a risk of neurological damage, if the cysts continue to compress nerve structures. If the nerve damage is progressive and affects bladder and bowel function and other body systems, it is important to have a good primary physician to coordinate referrals to specialists. Many patients become disabled and unable to continue to work, due to the pain and multi-systems affected issues. It is a highly specialized problem for a highly specialized surgeon.
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED
Most Tarlov cysts are discovered on MRI, Myelogram, or CT. The best imaging study to image the Tarlov/perineural cyst is a MRI of the spine. As the majority of the perineural cysts are on the sacral spine, it is important that the imaging include all of the sacrum. Many lumbar MRI's do not completely image the sacral spine. If the patient's symptoms are related to the upper sections of the spine then the appropriate cervical, thoracic or lumbar MRI should be ordered. Some patients have the cysts in more than one section of the spine. An example of the order for the desired MRI imaging is: MRI of the entire sacrum with T2 weighted sagittal and axial views. Flexion and extension x-rays may be requested on certain cases.
WHY AIMIS FOR THIS SURGERY
Since 2011 Dr. Frank Feigenbaum has been treating patients affected by the problems of all types of meningeal cysts, including Tarlov cysts, at the AIMIS Spine Center. AIMIS strives for excellence in delivering the best surgical outcomes, via the extensive expertise of its prestige surgeons, its technologies, its highly trained staff and superior facilities to provide an individualized and compassionate experience in a comfortable environment. All patients are treated with the individual care they deserve in an effort to provide the best chance of successful treatment.
OTHER SERVICES PROVIDED BY AIMIS
In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.