Post-Operative Low Cerebrospinal Fluid Pressure Headache in Giant Tarlov Cysts

Abstract

Giant Tarlov cysts are described as fluid-filled sacs located in the spine. They are mostly found in the sacral region, but are usually asymptomatic. The symptomatic Tarlov cysts are planned for surgical treatment in the form of laminectomy and marsupilisation of cysts. These surgical procedures can have complications like cerebrospinal fluid (CSF) leak, bacterial meningitis, and radiculopathic pain. We report a case of a 30-year-old male who presented with complaints of pain in his left leg for one and half years, urinary incontinence off and on for six months, and scrotal pain for two months. He was diagnosed with two giant Tarlov cysts on contrast-enhanced magnetic resonance imaging and planned for surgery. Intraoperatively, approximately 1000 ml of CSF was drained. The patient complained of severe headache in the immediate postoperative period, which was confirmed to be a low-CSF pressure headache. Prompt diagnosis and management with collaborative teamwork of neuroanesthetists and neurosurgeons helped treat the patient and prevent long-term morbidity.