• Baichuan Wang, Feifei Pu, Qiang Wu, Zhicai Zhang, and Zengwu Shao.
• Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: wangbaichuan-112@163.com.
• World Neurosurg. 2018 Feb 1; 110: 79-84.

BackgroundA presacral Tarlov cyst is an unusual cause of abdominal pain. The unusual location of a presacral Tarlov cyst can lead to misdiagnosis and inappropriate treatment. To guide appropriate diagnosis and treatment, we reviewed causes, clinical presentations, radiologic features, and management options of this extremely rare lesion.MethodsWe performed an English-language literature search using PubMed to identify reports of patients with presacral Tarlov cysts. The diagnosis was based on classic radiologic signs. Seven patients described in 7 publications met the inclusion criteria and were analyzed in conjunction with 3 new patients described by our team.ResultsA congenital arachnoidal defect may be the primary causative factor of a presacral Tarlov cyst. Lumbosacral pain, leg pain, and bowel and bladder dysfunction are common clinical complaints, while abdominal pain is uncommon. Myelography and magnetic resonance imaging are considered useful diagnostic techniques. Myelography provided the definitive diagnosis for 33% of the patients, and magnetic resonance imaging was diagnostic for 67%. Surgical interventions may be appropriate for symptomatic presacral lesions. Two patients who received conservative treatment continued to experience their presenting symptoms, whereas 7 patients who underwent surgical treatment experienced favorable outcomes.ConclusionsAlthough extremely rare, presacral Tarlov cysts should be suspected in patients with abdominal pain, especially when pain occurs along with other neurologic symptoms. This review provides a systematic description of this rare disease, which may be helpful in guiding the appropriate diagnosis and treatment.Copyright © 2017 Elsevier Inc. All rights reserved.

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