Tarlov Cyst Aspiration and Sealing
Percutaneous treatment of symptomatic Tarlov cysts, guided by computed tomography — a technique Dr. Miguel Cordeiro introduced in Europe.
What it is
Symptomatic Tarlov cysts are cerebrospinal-fluid-filled dilations of the nerve root sheaths in the sacrum that compress the roots and cause sciatic pain, sacral pain and, in some cases, neurological changes. The fine double-needle technique consists of positioning two fine needles inside the cyst under continuous CT guidance: the deeper needle first allows controlled aspiration of the fluid and is subsequently used to inject the fibrin sealant, while the second needle, positioned more superficially, acts as a venting needle during the procedure. This combination prevents the cyst from repressurising and refilling — the main limitation of simple aspiration — without open surgery. Dr. Miguel Cordeiro learned this technique at Johns Hopkins Hospital (Baltimore, USA) with Kieran Murphy, who published the double-needle technique, and introduced it in Europe.
Who it is for
- Tarlov cyst with a confirmed relationship to symptoms
- Persistent sciatic, sacral or perineal pain
- Symptoms unresponsive to medication and conservative measures
- Sensory or sphincter changes associated with the cyst
- Patients seeking a percutaneous alternative to open surgery
How it works, step by step
- 1
Specialist neuroradiology assessment to confirm the cyst is the source of symptoms
- 2
Outpatient procedure, under local anesthesia
- 3
Positioning of the two fine needles inside the cyst, CT-guided with millimetric precision
- 4
Controlled aspiration of cerebrospinal fluid through the deep needle, followed by injection of the fibrin sealant through the same needle, with the second needle acting as a vent
- 5
Discharge after a short observation period, with scheduled clinical and imaging follow-up
Scientific evidence
The literature on percutaneous treatment of Tarlov cysts is based on published case series and observational studies, describing significant pain relief in carefully selected patients — including work on CT-guided aspiration with sealing material injection. The double-needle technique is a refinement of this approach. As symptomatic disease is rare, the evidence is more limited than for other techniques — which is why careful patient selection and rigorous follow-up are decisive.
Recovery
Same-day discharge or after a short observation period. Symptom improvement is assessed at follow-up, with control MRI to confirm reduction or sealing of the cyst.