Giant symptomatic Tarlov cysts: A case report and literature review

•Surgical Procedure for Repairing the Dural Defect:•We addressed the dural defect by customizing the repair material to ensure complete coverage of the defect. We then utilized interrupted sutures to meticulously close the wound. Our belief in the sufficiency of this surgical procedure for repairing the defect was based on the direct application of the patch to the defect.•Management of Large Pseudomeningocele and Follow-Up Imaging:•Following the identification of a large pseudomeningocele during the patient's 3-month postoperative follow-up, our recommended course of action involved advising the patient to rest in bed and prescribing oral anti-inflammatory and analgesic medications, along with dehydrating agents to alleviate swelling. Subsequent monthly telephone follow-ups revealed that the patient had reported nearly complete resolution of symptoms. Symptomatic Tarlov cysts are extremely rare, and there is no consensus on the optimal treatment for this condition. Here, we encountered a patient with a symptomatic giant sacral Tarlov cyst and reviewed the relevant literature. Case description A 55-year-old male patient was diagnosed with a large sacral canal cyst based on an MRI examination four years ago. Due to mild symptoms, the patient received conservative treatment. In 2023, the patient's symptoms worsened, significantly affecting daily activities. It was suspected that the symptoms were related to the cyst. Subsequently, the patient underwent laminectomy and microsurgical excision of the cyst. Postoperatively, the patient experienced an improvement in symptoms. We conducted a review of the surgical approach used for this patient and explored alternative treatment methods proposed in the literature for similar conditions. We achieved favorable outcomes by performing microsurgical excision of symptomatic giant Tarlov cysts in a 55-year-old patient. Additionally, we reviewed relevant literature regarding Tarlov cysts. The treatment approaches for this condition vary, and conservative, interventional, or surgical treatments have all shown efficacy. Therefore, it is crucial to choose an appropriate treatment plan based on the patient's specific circumstances.