Submited on: 03 Feb 2014 06:09:08 PM GMT
Published on: 04 Feb 2014 04:59:38 AM GMT
 
Critical Appraisal of a Case of Sacral Nerve Root Sheath Cyst
Posted by Dr. Sanjoy Sanyal on 17 Mar 2014 04:43:47 AM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    1. Tarlov Cysts are rare sacral nerve root meningeal sheath dilatations (Important claim)
    2. They are rare causes of back pain (Important claim)
    3. Asymptomatic Tarlov cysts should be left alone (Important claim)
    4. Significantly symptomatic Tarlov cysts should be operated (Important claim)
    5. Exact surgical procedure is debatable, but nerve roots should be preserved (Important claim)
    6. Tarlov cysts should be considered in the Differential diagnosis of back pain (Not important, because of rarity)
    7. Medical fraternity should be made aware of this condition (Not important clinically because of rarity, but may be an interesting academic exercise)


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    No, these claims are not novel. They are generally accepted by most authorities in the field.


  • Are the claims properly placed in the context of the previous literature?

    Yes, mostly. However there are certain caveats.

     

    1. The authors have given 3 references to Tarlov in their bibliography (References 1, 6, 8). "Tarlov cysts were first described in 1938 as an incidental finding at autopsy1 Tarlov described a case of symptomatic perineural cyst and recommended its removal." They have not given the reference for the second statement.

     

    2. First line of Case Report: "1-year history of progressive, intractable sacrococcygeal pain..."; Fifth line: "it used to get relieved by non steroidal antiinflammatory drugs..." This contradicts the word 'intractable' in the first line.


  • Do the results support the claims? If not, what other evidence is required?

    Yes, mostly. Anecdotally the authors claim that the patient became asymptomatic after surgery and at 3-month follow up, and he joined work. However, a post-operative MRI would have added weight to the claim. But the patient's socio-economic status precluded a repeat MRI because these images are expensive propositions.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No protocol is explicitly provided, but the authors have not deviated significantly from the accepted norms of managing these types of cases.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes, to both questions


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    The following additional information would have improved the quality of the paper considerably

     

    1. The pre-operative MRI: Authors have not specified what type of MRI and whether contrast was used or not. However, they have mentioned in a later "The cyst did not fill with contrast material" So one would assume that contrast was used. However, on examining the MRI image, this reviewer feels it is Non-contrast T2 MRI, showing Hyperintensity of the CSF and the cyst content, as would be expected. This point requires clarification

     

    2. A post-operative MRI would have been ideal. But the patient's socio-economic status precluded a repeat MRI because MRIs are expensive

     

    3. Higher resolution Intra-operative pictures, zooming on the pathology, with proper references to patient's orientation and anatomy would have been even better


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    While not exactly OUTSTANDING, it is a GOOD paper. This reviewer may wish to present it in his University seminar as an interesting academic curiosity. However, it would not be included in the next general lecture because of its relative rarity.


  • Other Comments:

    Well done, authors!! Quite a good paper, especially after the revision 

     

    The following points were noted

     

    1. Typos: "Ganeral Surgery"

    2. Punctuation Errors: No space between comma and the next word in numerous places; Space before a comma in several places - Both sets of errors should be rectified

    3. Grammatical Errors: "These cyst communicate..."; "These cyst can enlarge..."; "Knee jerks was normal" (Plurality Errors)

    4. Sentence Construction: "We report a case of symptomatic Tarlov cyst, its clinical presentation, treatment, and results of surgical cyst wall resection in a case of a symptomatic sacral Tarlov cyst" (Repetition of phrase)

    5. Word Usage: "The pain had progressed to the lower back and bilateral upper thigh up to the ankle"

    6. Illustrations: Appropriate areas should be labeled and arrows should be inserted, pointing to the object of interest.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    1. This reviewer has operated on cystic spinal lesions on patients in the past
    2. This reviewer is a Professor and Course Director of Neuroscience and FCM-III Clinical Neurology
    3. This reviewer takes regular lectures and gives practical demonstrations to Med 3 Neuroscience Medical Students in a medical university in the Caribbean

  • How to cite:  Sanyal S .Critical Appraisal of a Case of Sacral Nerve Root Sheath Cyst[Review of the article 'Symptomatic Tarlov Cyst: A Rare Case Report and Its Management ' by Kania H].WebmedCentral 2014;5(3):WMCRW003018
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Symptomatic Tarlov cyst: case report and management
Posted by Prof. Angelo Lavano on 19 Feb 2014 07:19:50 PM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    This is a case report presenting with back pain: the claim is to increase the knowledge of it in surgical comunity 


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes, the results support the claim


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No protocol is provided


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes, the metodology is valid


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    This work is a case report but its results can be incorporated in next general lecture on this subject


  • Other Comments:

    For completeness it would be good to mention in the bibliography the article of Giampaolo Cantore  Sacral Tarlov Cyst: surgical treatment by clipping pubblished in World Neurosurgery 79 (2): 381-389, Febrary 2013. This article reports the largest series in the literature of Sacral Tarlov Cyst.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    Professor of Neurosurgery

  • How to cite:  Lavano A .Symptomatic Tarlov cyst: case report and management[Review of the article 'Symptomatic Tarlov Cyst: A Rare Case Report and Its Management ' by Kania H].WebmedCentral 2014;5(2):WMCRW003007
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Tarlov Cyst
Posted by Dr. William J Maloney on 13 Feb 2014 05:22:05 PM GMT Reviewed by Interested Peers

  • What are the main claims of the paper and how important are they?

    The aim of the authors is to present a case report of a Tarlov Cyst.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    No


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Yes- it would be a great lecture in a medical school.


  • Other Comments:

    Tarlov cysts are meningeal dilatations of the posterior spinal nerve root sheath that most often affect sacral roots.  The authors present the case of a 47 year-old man with a Tarlov cyst.  After surgery the patient experienced an immediate relief of pain.

  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Clinical associate professor

  • How to cite:  Maloney W J.Tarlov Cyst[Review of the article 'Symptomatic Tarlov Cyst: A Rare Case Report and Its Management ' by Kania H].WebmedCentral 2014;5(2):WMCRW002976
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