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(A) Cyst view after laminectomy. (B) Roots in the anterior wall (arrow). (C) Cyst opening. (D) Closure of the communication with the dural sac with a small piece of Tachosil®. (E) Final view of the nerve root. (F) Titanium mesh over the laminectomy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Angel Horcajadas Almansa, Ana M. Jorques Infante, Ana M. Román Cutillas, Luis Guzmán Álvarez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Angel Horcajadas" "apellidos" => "Almansa" ] 1 => array:2 [ "nombre" => "Ana M. Jorques" "apellidos" => "Infante" ] 2 => array:2 [ "nombre" => "Ana M. Román" "apellidos" => "Cutillas" ] 3 => array:2 [ "nombre" => "Luis Guzmán" "apellidos" => "Álvarez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1130147322000598" "doi" => "10.1016/j.neucir.2022.05.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147322000598?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S252984962200096X?idApp=UINPBA00004B" "url" => "/25298496/0000003400000002/v1_202303021421/S252984962200096X/v1_202303021421/en/main.assets" ] ] "itemAnterior" => array:18 [ "pii" => "S1130147322000586" "issn" => "11301473" "doi" => "10.1016/j.neucir.2022.04.003" "estado" => "S300" "fechaPublicacion" => "2023-03-01" "aid" => "553" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Neurocirugia. 2023;34:97-100" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Covered stent delivery in tortuous internal carotid artery for treatment of direct carotid cavernous fistula" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "97" "paginaFinal" => "100" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colocación de un stent cubierto en una arteria carótida interna tortuosa para el tratamiento de la fístula carótida cavernosa directa" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 773 "Ancho" => 1607 "Tamanyo" => 177474 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Follow up DSA AP (A) and lateral (B) views 3 months postoperatively shows no residual dCCF of the left cavernous ICA and no residual filling of the left ophthalmic artery pseudoaneurysm.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mehrnoush Gorjian, Scott Raymond, Matthew Koch, Aman Patel" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Mehrnoush" "apellidos" => "Gorjian" ] 1 => array:2 [ "nombre" => "Scott" "apellidos" => "Raymond" ] 2 => array:2 [ "nombre" => "Matthew" "apellidos" => "Koch" ] 3 => array:2 [ "nombre" => "Aman" "apellidos" => "Patel" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147322000586?idApp=UINPBA00004B" "url" => "/11301473/0000003400000002/v1_202303021130/S1130147322000586/v1_202303021130/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Symptomatic sacral Tarlov cyst: Case report and review of literature" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "101" "paginaFinal" => "104" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Angel Horcajadas Almansa, Ana M. Jorques Infante, Ana M. Román Cutillas, Luis Guzmán Álvarez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Angel Horcajadas" "apellidos" => "Almansa" "email" => array:1 [ 0 => "angel.horcajadas@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana M. Jorques" "apellidos" => "Infante" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Ana M. Román" "apellidos" => "Cutillas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Luis Guzmán" "apellidos" => "Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Neurocirugía, Hospital Vithas Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Radiología, Hospital Vithas Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Quiste de Tarlov sacro sintomatico: presentacion de un caso y revision de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 674 "Ancho" => 1340 "Tamanyo" => 110293 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Preoperative MRI. (A) Sagital view showing a sacral Tarlov cyst. (B) Axial view where it is possible to identify the nerve roots in the anterior wall of the cyst (arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tarlov cysts (TC) are cystic formations located between the perineurium and the endoneurium of the dorsal branch of a sacral root at the level of the dorsal root ganglion. Prevalence ranges from 1 to 9% of the general population,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1–3</span></a> being more frequent in women.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,4</span></a> Most of them are asymptomatic but, due to their relationship with the sacral roots, they have also been related to a variety of symptoms ranging from radicular pain and paresthesias, to sacrococcygeal pain, radicular, perineal, urogenital pain or bladder or ejaculation disorders.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis and treatment of TC is controversial and different techniques has been proposed for the management.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A case of a patient with urogenital and radicular pain secondary to a sacral Tarlov cyst who underwent surgery is presented.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a 21-year-old female patient with a 6-year history of groin pain radiating to the genital region and anus, on the right side, with neuralgic discharges related to Valsalva maneuvers. He also reported more diffuse pain referred to the sacral and coccygeal region as well as in the right leg on the posterior side up to the knee. The pain improved with rest and worsened with sitting and exercise.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Om examination there were not loss of strength or sensivity in lower limbs or perineal region, and reflexes were normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">MRI showed a TC of around 18 mms at the level of right S2. Nerve roots were located in the anterior margin of the cyst and apparently displaced (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A neurophysiological study was conducted, showing an active sacral radiculopathy with spontaneous activity of denervation at the right anal hemisphincter.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient underwent surgery through a right sacral hemilaminectomy with intraoperative neurophysiological control, exposing the cyst, which did not have a completely free communication with the thecal sac. The sacral roots were located on the anteromedial side of the cyst. The cyst was opened and the communication with the thecal sac was sealed with a small piece of Tachosil®. Another layer of Tachosil® was placed covering the laminectomy and a titanium mesh was placed over the laminectomy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) to reinforce closure and to restore the anatomy.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The postoperative course was uneventful and urogenital symptoms disappeared after surgery.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Control MRI 6 months after surgery showed the resolution of the cyst (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">After surgery she improved from the urogenital pain, and the neuralgic discharges dissappeared. Improvement continued one year after surgery.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">TC were described in 1938 after an anatomic study about cauda equina in 30 cadavers. In his description, the cysts were located in the perineural space, at the junction of the posterior root and the ganglion and contain roots either on their wall or inside. They communicated with the subarachnoid space but not freely, so that they had late filling on a myelogram. Tarlov differentiated them from meningeal diverticula, which originate distal to the ganglion, did not contain roots, and had extensive communication with the subarachnoid space.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A recent meta-analysis of 13,266 patients estimates the prevalence of TC in 4.27%, being more frequent in women and being symptomatic in around 16%.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> 22% of TC will become symptomatic over time<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> and it is thought that the cause of the onset of symptoms is due to a valvular mechanism in the neck of the cyst that would lead to a pressure increase in the cyst and growth.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">3,5,7,8</span></a> This would explain that the prevalence of TC increases with age.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The most frequent location is sacral, especially S2,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> and it usually affects S2–S4 roots. Due to its location, sensitive roots use to be more affected than motor roots. The symptoms that have been related to TC are lumbosacral, radicular, perineal and urogenital pain, coccydynia, urinary dysfunction (voiding urgency and increased urinary frequency) and intestinal dysfunction.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1–4,7–11</span></a> Urodynamic disorders are frequent,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,3,7,8,11</span></a> being the sensation of early bladder filling the most common.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">2,11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The diagnosis is mainly clinical, but a well-directed anamnesis is necessary to establish it.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> In MRI it is sometimes possible to identify the roots in the cyst wall, as in the case presented. Contrast-enhanced myelography or myelo-CT can identify late cyst filling that would point to a valvular mechanism.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Neurophysiological studies should be aimed at studying the sacral roots<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> and usually show alterations in the Hoffmann reflex, the anus-anal reflex and a delay in F waves.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">11,12</span></a> They should include a study of the sural nerve as well as the gastrocnemius and the intrinsic foot muscles innervated by tibialis.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Symptoms are frequently related to posture (up to 74%<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a>), improving in the supine position, and worsening when sitting as well as with Valsalva maneuvers.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1,4,7,13</span></a> These phenomena are present in the reported case</p><p id="par0090" class="elsevierStylePara elsevierViewall">Some authors propose CSF drainage as a diagnostic test, being positive if symptoms relief is achieved.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Once the diagnosis is established, different treatments have been proposed. Some authors have published good results with a simple caudal epidural injection of steroids.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Percutaneous therapies have been proposed and are based on aspiration of the cyst and injection of fibrin in order to seal the communication with the subarachnoid space.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9,14</span></a> A comparative meta-analysis of surgical versus percutaneous treatment on 750 patients showed an overall improvement in 83.5% of patients regardless of the technique. Comparing with surgical treatment, percutaneous techniques showed fewer complications (12.47% versus 21%) but greater radiological recurrence of the cyst (20% versus 8%) although clinical recurrence was similar (21% versus 20%). The limitation of this study is that the surgical techniques were not homogeneous.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Surgical treatment is based on the fenestration of the cyst and its imbrication, closing the communication with the subarachnoid space. It shows very favorable results in more than 80% of cases.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">8,9</span></a> The main disadvantage are complications, among which CSF leak stands out. To avoid them, an exquisite surgical technique is essential. In a systematic review of 283 patients, 16.9% of complications were described with clinical improvement in 81% of cases and radiological resolution in 79%. Improvement was achieved in motor deficits(17.8–5.4%), sensory deficits (47–14.5%) and urinary/bowel dysfunction (40–14.3%). The results were better in younger patients and if the symptoms had a shorter evolution time.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> A systematic review of the surgical treatment on 646 patients yielded better data with improvement in 83% of the cases and 5.4% of complications, being the fistula CSF the most frequent (1.7%).<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">There are different surgical techniques reported. Some authors recommend performing a laminoplasty to reconstruct the bone wall<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> and even endoscopic approaches has been used in a case of a sacral TC with radiculopathy.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The case presented is a clear example of a symptomatic Tarlov cyst with resolution of symptoms after surgical treatment. We chose surgical treatment instead of percutaneous techniques due to the lack of experience with these techniques and the good results showed by surgery in literature. It is important to know the symptoms associated with Tarlov cysts since neurosurgeons often disregard this pathology or do not identify it<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a>, depriving patients of a possible solution to their problem.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">TC are a quite common finding in MRI and some of them can be symptomatic. It is important to know the symptoms related to them in order to set a correct diagnosis. Neurophysiological studies can help in the management. Surgical and percutaneous techniques are effective in the treatment of symptomatic TC.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1856371" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1614206" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1856372" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1614207" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-03-11" "fechaAceptado" => "2022-05-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1614206" "palabras" => array:2 [ 0 => "Tarlov cyst" 1 => "Urogenital pain" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1614207" "palabras" => array:2 [ 0 => "Quiste de Tarlov" 1 => "Dolor urogenital" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tarlov cysts are a common finding in MRI. Most of them are asymptomatic but in some cases can cause pain in urogenital region. Diagnosis and treatment are controversial and most of the symptomatic cases are not well diagnosed and treated because of unawareness of neurosurgeons about them. Treatment of symptomatic TC is effective and good results have been published with percutaneous and surgical techniques. A case of a young woman with a symptomatic sacral cyst treated surgically successfully is presented and literature about it is reviewed.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los quistes de Talov son un hallazgo frecuente en resonancia magnética. La mayoría de ellos son asintomáticos, pero en algunos casos pueden producir síntomas dolorosos urogenitales. El diagnóstico y el tratamiento de los quistes de Tarlov es controvertido y la mayoría de los casos sintomáticos no son diagnosticados adecuadamente debido a que el neurocirujano no es capaz de identificar el cuadro clínico. El tratamiento de los quistes de Tarlov sintomáticos es efectivo y se han publicado buenos resultados tanto con técnicas percutáneas como quirúrgicas. Se presenta el caso de una mujer joven con quiste de Tarlov sintomático intervenida quirúrgicamente con resolución de la clínica y se revisa la literatura publicada al respecto.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 674 "Ancho" => 1340 "Tamanyo" => 110293 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Preoperative MRI. (A) Sagital view showing a sacral Tarlov cyst. (B) Axial view where it is possible to identify the nerve roots in the anterior wall of the cyst (arrows).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1166 "Ancho" => 2007 "Tamanyo" => 417405 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Surgical steps. (A) Cyst view after laminectomy. (B) Roots in the anterior wall (arrow). (C) Cyst opening. (D) Closure of the communication with the dural sac with a small piece of Tachosil®. (E) Final view of the nerve root. (F) Titanium mesh over the laminectomy.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 614 "Ancho" => 1340 "Tamanyo" => 90344 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Postperative MRI showing the resolution of the sacral Tarlov cyst. Titanium mesh is visible (arrows), restoring the sacral anatomy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of sacral Tarlov cysts. 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Symptomatic sacral Tarlov cyst: Case report and review of literature
Quiste de Tarlov sacro sintomatico: presentacion de un caso y revision de la literatura