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‘A Curious Case of a Tarlov Cyst’
Abstract Number: SUN-40
Abstract Type: Case Report/Case Series
Spinal anaesthesia, whilst reliable, has a failure rate of 1-4%.¹ Multiple factors are implicated. One factor described in the literature, but not reported, relates to tarlov cysts. These meningeal cysts are fluid sacs containing cerebrospinal fluid (CSF), predominately affecting the lumbosacral region with a reported incidence of 5-9%².
In this case, a 38 year old patient presented for Caesarean section. With appropriate monitoring and access, the patient was seated for spinal anaesthesia. Following standard asepsis precautions, a 25 gauge whittaker needle was inserted between the third and fourth lumbar vertebrae by a Consultant. A good flow of CSF was obtained and standard anaesthetic dose injected containing heavy bupivacaine, fentanyl and morphine. CSF was freely aspirated twice during the injection of anaesthetic confirming needle placement.
Ten minutes later there was a complete absence of sensory or motor block. The same spinal dose was repeated at a space higher with good effect and surgery proceeded uneventfully.
Postoperatively the patient informed us of the presence of tarlov cysts reported on a previous MRI.
This being the cause of the failed spinal is supported by the ability to freely aspirate CSF but complete absence of block despite this. This suggests the anaesthetic mixture never entered the CSF circulation. The solutions injected were checked and cross referenced as standard.
The patient is to have a further MRI due to the potential for failed spinal again in the future.
¹ Failed Spinal Anaesthesia: Mechanism, management, and prevention. P.D.W Fettes et al.
BJA 102 (6): 739-48 (2009)
²American Association of Neurological Surgeons (November 2006)
Conflict of interest: None
Disclosures: Consent was given by the patient with regards to this case report