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Evaluating the discordant relationship between Tarlov cysts and symptoms of pudendal neuralgia.
评价Tarlov囊肿与阴部神经痛症状的不和谐关系。
- 影响因子:4.22
- DOI:10.1016/j.ajog.2019.07.021
- 作者列表:"Lim VM","Khanna R","Kalinkin O","Castellanos ME","Hibner M
- 发表时间:2020-01-01
Abstract
BACKGROUND:Pudendal neuralgia is a painful neuropathic condition involving the pudendal nerve dermatome. Tarlov cysts have been reported in the literature as another potential cause of chronic lumbosacral and pelvic pain. Notably, they are often located in the distribution of the pudendal nerve origin at the S2, S3, and S4 sacral nerve roots and it has been postulated that they may cause similar symptoms to pudendal neuralgia. Literature has been inconsistent on the clinical relevance of the cysts and if they are responsible for symptoms. OBJECTIVE:To evaluate the prevalence of S2-S4 Tarlov cysts at the pudendal nerve origin (S2-S4 sacral nerve roots) in patients specifically diagnosed with pudendal neuralgia, and establish association of patient symptoms with location of Tarlov cyst. STUDY DESIGN:A retrospective study was performed on 242 patients with pudendal neuralgia referred for pelvic magnetic resonance imaging from January 2010 to November 2012. Dedicated magnetic resonance imaging review evaluated for presence, level, site, and size of Tarlov cysts. Among those with demonstrable cysts, subsequent imaging data were collected and correlated with the patients' clinical site of symptoms. Statistical analysis was performed using χ2, Pearson χ2, and Fisher exact tests to assess significance. RESULTS:Thirty-nine (16.1%) patients demonstrated at least 1 sacral Tarlov cyst; and of the 38 patients with complete pain records, 31 (81.6%) had a mismatch in findings. A total of 50 Tarlov cysts were identified in the entire patient cohort. The majority of the Tarlov cysts were found at the S2-S3 level (32/50; 64%). Seventeen patients (44.7%) revealed unilateral discordant findings: unilateral symptoms on the opposite side as the Tarlov cyst. In addition, 14 (36.8%) patients were detected with bilateral discordant findings: 11 (28.9%) had bilateral symptoms with a unilateral Tarlov cyst, and 3 (7.9%) had unilateral symptoms with bilateral cysts. Concordant findings were only demonstrated in 7 patients (18.4%). No significant association was found between cyst size and pain laterality (P = .161), cyst volume and pain location (P = .546), or cyst size and unilateral vs bilateral pain (P = .997). CONCLUSION:The increased prevalence of Tarlov cysts is likely not the etiology of pudendal neuralgia, yet both could be due to similar pathogenesis from part of a focal or generalized condition.
摘要
背景: 阴部神经痛是一种累及阴部神经皮节的疼痛性神经病。Tarlov囊肿已被文献报道为慢性腰骶部和盆腔疼痛的另一个潜在原因。值得注意的是,它们通常位于阴部神经起源的S2 、S3 和S4 骶神经根的分布中,据推测它们可能会引起与阴部神经痛相似的症状。关于囊肿的临床相关性以及它们是否与症状有关的文献不一致。 目的: 评估阴部神经痛患者中阴部神经来源 (S2-S4 骶神经根) S2-S4 Tarlov囊肿的发生率。并建立患者症状与Tarlov囊肿位置的相关性。 研究设计: 对 2010 年 1 月至 2012 年 11 月就诊于盆腔磁共振成像的 242 例阴部神经痛患者进行回顾性研究。专用磁共振成像审查评估Tarlov囊肿的存在、水平、部位和大小。在那些有明显囊肿的患者中,收集随后的影像学数据,并与患者的临床症状部位相关。使用 χ 2 、Pearson χ 2 和Fisher精确检验进行统计学分析以评估显著性。 结果: 39 例 (16.1%) 患者显示至少 1 例骶骨Tarlov囊肿; 38 例有完整疼痛记录的患者中,31 例 (81.6%) 发现不匹配。在整个患者队列中总共确定了 50 个Tarlov囊肿。大多数Tarlov囊肿位于S2-S3 水平 (32/50; 64%)。17 例患者 (44.7%) 发现单侧不一致的表现: 对侧单侧症状为Tarlov囊肿。此外,14 例 (36.8%) 患者检测到双侧不一致的结果: 11 例 (28.9%) 有单侧Tarlov囊肿的双侧症状,3 例 (7.9%) 有双侧囊肿的单侧症状。仅 7 例患者 (18.4%) 显示了一致的结果。未发现囊肿大小与疼痛偏侧 (P = .161) 、囊肿体积和疼痛位置 (P = .546) 之间存在显著关联,或囊肿大小和单侧vs双侧疼痛 (P = .997)。 结论: Tarlov囊肿的患病率增加可能不是阴部神经痛的病因,但两者都可能是由于部分局灶性或全身性病症的相似发病机制。
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囊肿是一种良性疾病,它可以长在人体表面,也可以长在内脏里;囊肿就是长在体内某一脏器、囊状的良性包块,其内容物的性质是液态的。