Chronic Sphincteric and Sexual Symptoms Leading to the Diagnosis of a Tarlov Cyst: A Case Report of Effective Surgical Treatment.

Tarlov cysts, also known as perineural cysts, are cerebrospinal fluid-filled sacs that typically form near the dorsal root ganglion, most commonly at the sacral levels S2 and S3. While most are incidentally identified on imaging, symptomatic cysts, particularly in the lower lumbar and sacral regions, can produce neurological symptoms similar to those of a herniated disc and may have a clinically significant impact on urogenital function. We present the case of a 38-year-old woman with a long-standing history of chronic pelvic dysfunction characterized by recurrent urinary tract infections, urinary incontinence, and perineal hypoesthesia, all of which significantly impacted her quality of life. Imaging studies revealed a Tarlov cyst involving the right S2 nerve root. Surgical intervention, consisting of cyst decompression and nerve root repair, resulted in substantial symptom improvement. Although most Tarlov cysts are incidental findings, they can cause debilitating symptoms in select cases. The decision to pursue surgical intervention is complex, yet it can yield remarkable improvements, as demonstrated by our patient's outcome. However, the literature also highlights the potential for recurrence. This case underscores the importance of considering Tarlov cysts in patients presenting with unexplained chronic pelvic, urinary, or sexual dysfunction. While surgical intervention may provide significant relief in carefully selected cases, it also emphasizes the necessity for early recognition and timely management.