Management of a cervical spine neurenteric cyst via an anterior surgical approach: illustrative case.

Arsalaan Salehani,Daniel Harmon,Sasha Howell

doi:10.3171/case20119

Arsalaan Salehani, Daniel Harmon + Show 1 more

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https://doi.org/10.3171/case20119

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Abstract

BACKGROUNDCentral nervous system neurenteric cysts (NCs) represent a rare entity thought to arise from failure of the separation of endodermal and neuroectodermal elements during week 3 of embryogenesis. They account for 0.7–1.3% of all spinal cord lesions and are typically intradural extramedullary lesions located near the cervicothoracic junction. Most NCs are associated with multisystem malformation disorders, making a solitary extramedullary NC a rare entity.OBSERVATIONSA 45-year-old man presented with progressive right lower-extremity weakness and an inability to walk. Cervical spine magnetic resonance imaging demonstrated an approximately 1.6 × 1.1 × 2.7–cm, T2 hyperintense, nonenhancing, intradural, extramedullary cystic lesion at the level of C6–7 eccentric to the right with atrophy of the spinal cord. An anterior surgical approach was used for resection of the cyst in totality with C6–7 corpectomies and anterior plating and fixation from C5 to T1. Postoperatively at 1 month, the patient denied any significant neck or arm pain and demonstrated improving right lower-extremity strength, allowing some funcitonal independence.LESSONSA solitary, extramedullary cervical NC is a rare entity, with a posterior surgical approach for resection primarily described in the literature. The authors present anterior corpectomy and plating with fixation as a viable surgical approach for this rare pathology.

Highlights

Central nervous system neurenteric cysts (NCs) represent a rare entity thought to arise from failure of the separation of endodermal and neuroectodermal elements during week 3 of embryogenesis, resulting in thin-walled cysts with a lining similar to the respiratory or gastrointestinal epithelium.[1,2]
We present a rare case of a middle-aged man with solitary cervical NC without associated dysraphism or malformation disorder
Observations Isolated extramedullary NC without congenital syndromic origin remains a rare presentation of acute myelopathy in adults

Summary

BACKGROUND

Central nervous system neurenteric cysts (NCs) represent a rare entity thought to arise from failure of the separation of endodermal and neuroectodermal elements during week 3 of embryogenesis, resulting in thin-walled cysts with a lining similar to the respiratory or gastrointestinal epithelium.[1,2] They account for 0.7–1.3% of all spinal cord lesions and are typically ventral in location.[3] The vast majority of cysts are intradural, extramedullary and are typically associated with multisystem malformation disorders, including vertebral and cutaneous anomalies.[4,5] They are typically located in the lower cervical and upper thoracic spine and demonstrate hyperintensity on T2-weighted magnetic resonance imaging (MRI) sequences.[6,7] Solitary spinal NCs are rare entities, with the published literature indicating older age and cervical location to be correlated with their presence, whereas younger age and lumbosacral location are correlated with cases associated with dysraphism.[2] We present a rare case of a middle-aged man with solitary cervical NC without associated dysraphism or malformation disorder

Illustrative Case

Discussion