Robot-assisted ventral sacral Tarlov cystectomy; A case report

Abstract

Introduction and importance

Although asymptomatic Tarlov cysts (TCs) are reported in up to 13% of the population, symptomatic TCs are rare (less than 1%), making the management of the symptomatic cysts controversial. The most common location of symptomatic TCs is sacral nerve roots where they can cause pelvic, perineal chronic discomfort and pain, and lower extremity sensory and motor changes. Ventral (intrapelvic retroperitoneal) sacral TCs are extremely rare with no management recommendations. Available surgical options include cyst resection, and inlet-obliteration, however, these methods are often considered invasive and not definitive.

Case presentation

A 39-year-old woman presented with debilitating low back pain (LBP) radiating to her pelvis and the right lower extremity for 4 years. Magnetic Resonance Imaging (MRI) showed multiple sacral nerve root TCs including a large retroperitoneal right S3 TC. Surgical resection of the right S3 cyst was achieved utilizing a robot-assisted anterior approach which provided excellent visualization and maneuverability in the targeted retroperitoneal space. Postoperatively, the patient experienced significant pain relief, and she was able to perform activities of daily life and return to work.

Clinical discussion

Robotic-assisted pelvic surgery has gained widespread popularity in the last two decades due to its many potential benefits. Utilizing robotic systems in sacral nerve sheath lesions shows a promise to deliver effective minimally invasive surgical management without sacrificing good visualization or instrument maneuverability.

Conclusion

Robot-assisted resection of sacral nerve roots TCs represents a minimally invasive and safe surgical option to manage cysts located anterior to the sacrum in the pelvic retroperitoneal space.

Highlights

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  Tarlov cysts are incidental findings that often affect the sacral nerve roots.

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  We present a rare case of a sacral root Tarlov cyst with large pelvic extension.

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  Management of such cases can be elusive, due to the cyst location.

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  Robot-assisted cystectomy surgery achieved a successful resection and pain relief.

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  This report endorses such minimally invasive techniques to reach sacral roots.