Surgical Treatment

Tarlov Cyst Treatment

What to Expect

Our goal is to make your surgical stay as stress-free and comfortable as possible. To achieve that goal, preparation is key. We take great care to prepare our patients, and, ask that you review the following information prior to your arrival.

When you arrive at the facility for surgery, a receptionist will greet you at the main entrance. Here, your receptionist will coordinate your check-in and ensure that any required paperwork is completed. After check-in, a preoperative nurse will escort you back to the preoperative department to begin surgery preparations. Please note that your family member(s) will be asked to remain in the waiting room until this preoperative process has been completed. In the preoperative department, after changing into a gown, you will be asked to find a comfortable position on one of our stretchers so that our staff can cover you with warm blankets. During this time, a nurse will also review your medical history, including medications and allergies, as well as obtain your vital signs (blood pressure, temperature, etc.). Our nurses will also start an Intravenous (IV). At this stage, your preoperative process will be concluded and family members are welcome to visit with you (we ask only that visits are limited to one family member at a time). As your surgery time nears, your anesthesiologist and operating room nurse will greet you. Also during this time, Dr. Feigenbaum will be available to answer any last minute questions that you may have. When it is time for surgery, your anesthesiologist and operating room nurse will carefully usher you to the operating room on your stretcher.

After your surgery has concluded, you will be transferred to a recovery room. After waking, you will notice that our recovery room nurses are tending to you. You are to remain flat in bed until the morning following your surgery. As such, the head of your bed will be flat. During your stay in the recovery room, your nurse will periodically measure your vital signs, including every five minutes during the first hour after your surgery. Similarly, you will remain on an oxygen mask for at least the first 30 minutes following your surgery, and will adjust your oxygen as tolerated. A continuous cardiac monitor will also track your vitals during this time, and a catheter will have been placed in your bladder during surgery, and if needed, drain tubes at your incision site. The recovery room nurse will treat your postoperative symptoms, including pain and nausea, to your comfort. After your recovery room nurse has stabilized your postoperative symptoms, one family member at a time may come back for visitation. You will remain in the recovery room for one hour following your surgery, or until you are stable for transportation to your inpatient room.

After transport to your inpatient room and meeting your inpatient nurse, your family is welcome to join you. While you will be on bed rest and must lie flat, you may position yourself on your side for comfort. Pain will be managed through IV medications, and other post-surgery symptoms will be treated. Your post-surgery diet starts with clear liquids, but your caregivers will advance your diet throughout the day, as tolerated. One of the Rounding Nurses will also greet you at this time and provide a contact number for our staff should you need further assistance with anything. Our Rounding Nurse will periodically check on you throughout your hospital stay. If you wish, a family member can stay with you overnight.

What to expect the first day after your cyst surgery

The morning after your surgery, your nurse will raise the head of your bed to 15 degrees. If you do not develop a headache, the head of your bed will be raised to 30 degrees at approximately 12:00pm, and again to 45 degrees at approximately 3:00pm that afternoon. As tolerated, you will be allowed to get out of bed and go for a short walk with the assistance of a physical therapist. After a walk with a physical therapist, your urinary catheter will be removed, as well as the drain tube if present. A six hour window is allotted after your urinary catheter is removed for you to pass urine. If you have trouble passing urine after the six-hour window, the catheter will be replaced. If replaced, another urinary trial will resume the following day. It is important to note that most patients do not have trouble passing their urine. If your bowels are slow you may be given a laxative or instructed to use a fleet enema. Expect to take over the counter medications to keep your bowels moving regularly for a period of time following surgery. Also on this day, your nurse will begin weaning you off of your IV pain medications and transition you to oral pain medications, as tolerated. It is common, and expected, that you will feel tired and weak during these early days of recovery. Please take it slow and easy.

What to expect the second day after your cyst surgery

Having rested through the night, on the second day after your surgery, we expect that you will begin feeling better. This includes improved energy levels and increased mobility (for example, short walks). Your pain may be different, and some symptoms may improve. That being said, please note that temporary post-surgical numbness in the buttock and/or private areas is common. Most patients are discharged from the hospital on this day. Should this be the case, you will be given discharge instructions prior to your departure.

We promise to follow your progress closely, and look forward to seeing you at your post-operative appointment in our office. Please do not hesitate to contact our office with any questions or concerns at any time!

We look forward to being a part of your journey and care.

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Nerve Monitoring During Tarlov or Meningeal Cyst Surgery

In order to assist in identifying and protecting your nervous system during the surgery special nerve monitoring will be done. This monitoring procedure is referred to as Intraoperative Neurophysiologic Monitoring (IOM).

The technologist may meet you in the pre-operative holding area to discuss the monitoring procedure, perform a brief neurologic exam, discuss your symptoms, and apply non-invasive electrodes to your arms and legs. Some of the electrodes come in the form of small needles attached to a wire. The needle electrodes will only be placed after you are asleep in the operating room and removed before you wake up, so you will not feel any discomfort from the monitoring.

Once the electrodes are placed, they are connected to specialized monitoring equipment which is used to run tests on your nervous system, which includes your brain, spinal cord, and the nerves that run from your spinal cord to your arms and legs. Our technologist will run a set of baseline responses prior to the incision, and then continuously run tests throughout your procedure – "monitoring" the results of the tests and comparing them to the baseline responses. If there are any changes in the way your nerves behave during your surgery, the technologist will inform your surgeon.

The services of a neurologist will also be utilized. The neurologist observes the monitoring response in real-time via remote monitoring technology. The neurologist will interpret the tests being performed by the technologist and ensure that the tests are adequately monitoring your nervous system. The neurologist is also available for consultation during the procedure should the technologist or surgeon need clarification about the status of your nervous system's responses to the testing. All of the members of the monitoring team, including the surgeon, Dr. Frank Feigenbaum, the technologist, and the neurologist, work together to make sure that your nervous system is fully protected.

All of the electrodes will be removed from your body prior to waking up from anesthesia. You may notice some small spots of blood on your arms, legs, or scalp from where the electrodes were placed. The technologist will do everything possible to prevent bleeding from where the electrodes were removed and ensure that the bleeding has been controlled prior to you leaving the Operating Room suite.

Expect the nerve monitoring company, which includes the technologist and neurologist, to bill the hospital and insurance provider on your behalf. You may receive a bill. In the interim, you may receive a notice from your insurer about the monitoring performed on you during your procedure. Procedure terms such as "Evoked Potential Testing", "EMG/Electromyography", "Nerve Conduction Testing", "EEG/Electroencephalography", and "Intraoperative Monitoring" may be used in reference to our services. In addition, you may see the name of the neurologist who performed the interpretation of the monitoring signals during your procedure.

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Pre-Surgery Body Cleansing With Hibiclens

Getting your skin ready for surgery is extremely important to decrease your risk of infection. To do this, you should cleanse your skin with Hibiclens. Hibiclens can be purchased over the counter at any pharmacy (Walmart, Walgreens, CVS, etc.). There is no prescription needed. The frequency for bathing should be once a day, for 3 days prior to surgery, & the morning of surgery for the best results. Clean, freshly-laundered washcloths, towels and clothes should be used for each shower.

Before using, read all instructions.

Note: If allergic reactions occur, stop using and contact our office.

  1. Wash and rinse your hair, face, and body using your normal shampoo and soap.
  2. Make sure you completely rinse off in a very thorough manner.
  3. Turn off the shower, or step out of the bathwater.
  4. Pour a quarter size amount of Hibiclens soap onto a wet, clean washcloth, and apply to your entire body FROM THE NECK DOWN. Do NOT use on your face, hair, or genital areas.
  5. Rub the soap filled washcloth over your entire body for 3 minutes; apply more soap as needed (1/4 of bottle should be used with each of the 4 showers/cleansing). Avoid scrubbing your skin too hard.
  6. Turn on the shower/return to the bath, & rinse the soap off your body completely with warm water.
  7. Do NOT use regular soap after washing with the Hibiclens.
  8. Pat your skin dry with a freshly-laundered, clean towel after each shower/bath cleansing.
  9. Dress with freshly-laundered clothes after each shower/bath cleansing.
  10. It is important the night before surgery, upon the 3rd day of bathing, sleep with clean bed linens.
  11. Do NOT apply any lotions, deodorants, powders, or perfumes to your body.
  12. Do NOT shave your legs the night before or the day of surgery. Nor remove any body hair below the neck only. Facial shaving is permitted before surgery.

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