Patients with Marfan syndrome used to succumb early in life from cardiovascular 
complications. With the current rapid advance in medical and surgical care, such 
patients may now have near-normal longevities. Consequently, rare late-life 
complications are emerging in these patients and represent challenges to 
clinicians for their diagnoses and treatments. The authors report a rare case of 
pelvic pain and genital prolapse from a giant presacral Tarlov cyst in a 
67-year-old patient with Marfan syndrome. This 67-year-old Caucasian female 
presented with progressively severe pelvic pain, intermittent explosive 
diarrhea, and dysuria. Physical and bimanual examination demonstrated genital 
prolapse and a nontender, cyst-like mass fixed in the midline. She underwent 
ultrasound, CT, and eventually MRI evaluations that led to the diagnosis of a 
giant (6.7 × 6.4 × 6.6 cm) Tarlov cyst originating from the right S-2 nerve root 
sleeve/sacral foramen with intrapelvic extension. She underwent S1-S2 and S2-S3 
laminectomy with obliteration of the Tarlov cyst using aneurysm clips. 
Postoperatively, her pelvic pain and bowel symptoms resolved and the bladder 
symptoms improved. The 3-month follow-up CT of abdomen/pelvis demonstrated 
resolution of the cyst. The present case illustrates that clinicians caring for 
elderly patients with Marfan syndrome need to increasingly recognize such 
unusual late-life complications. Also, these large Tarlov cysts can be simply 
and effectively obliterated with aneurysm clips.