Regardless of the underlying proposed causes, the mechanism by which these cysts naturally develop is attributed to hydrostatic and pulsating forces of the cerebrospinal fluid along with a phenomenon of a valve valve mechanism, leading to continuous dilation of the cyst, as mentioned in the study “Growth of Lumbosacral Perineural (Tarlov) Cysts: A Natural History Analysis”. In this study, the natural course of the Tarlov cysts was followed and symptoms can worsen, as with e.g. spinal stenosis without discernible changes during imaging. Macroscopic cyst growth is easily detected with MRI, however, growth is not a prerequisite for progression or onset of symptoms.
In a number of original reports and reviews of Tarlov cysts, a mechanism is described with valve mechanism. This valve mechanism ensures that when cerebrospinal (brain) fluid comes under increased hydrostatic pressure, it enters the cyst but no longer leaves the cyst. This allows pressure to build up in the cyst.
However, the theory of the valve mechanism does not cover all cases, as several studies have shown and reported evidence that non-valve ventilated cysts and even very small dilations of nerveroots are capable of causing severe symptoms.