Intramedullary Cyst Research Articles

Type II diastematomyelia with intramedullary epidermoid cyst : An expected but rare association.

Diastematomyelia is rare congenital anomaly most often seen in lumbar region .Epidermoid tumors in spinal canal are rarer, more so in the intramedullary location. While the pathogenesis of diastematomyelia has been explained in classical papers and can explain the cooccurrence of epidermoid tumors in these cases, the actual reported cases as such are quite rare. The author reports clinical, radiological and operative findings of such a case.

Neurological Improvement after Omental Transplantation on the Upper Cervical Cord

Background: Since 1986 by the work of Goldsmith, we know that placing omental tissue on the injured spinal cord, we can provoke neurological improvement. Case report: A 4-year-old girl received a gunshot wound on August 2010., at the upper cervical cord, which was followed immediately by tetraplegia. Lose of respiratory ahttps://www.omicsonline.org/utomatism and she was connected to a fan. Preoperative MRI scans revealed a severe ischemic infarct at C2-C3. On July 2011, she received an omental transplantation. During surgery we found abundant scar tissue on the cervical cord between C2 and C3, small intramedullary cyst in the left side, reduction of blood vessels, and 70 percent of cervical cord hypotrophied. On this residual cervical cord a segment of omentum was placed. Two days after surgery, she began with respiratory automatism and voluntary movement of shoulders and right limbs. She could stand up and to walk with aid of orthopedic devices since 4 months after surgery. At present, 4 years after surgery, she(a 9-year-old girl) present partial control of sphincters and motor improvement by 40 percent. During the postoperative evolution she receive rehabilitation and electrical stimulation in the cervical cord. Conclusions: These results indicate that ischemic neurons and axons in the traumatized cervical cord can improve if is revascularized with omental tissue.

Clinical characteristics and surgical outcomes of spinal intramedullary ependymal cysts

Intramedullary ependymal cysts are exceedingly rare lesions, and have been previously reported in the literature as case reports. The aim of this study was to discuss the clinical presentation and the outcomes of microsurgery for these benign lesions. The authors retrospectively reviewed the records of ten patients who underwent microsurgery for intramedullary ependymal cysts. All patients had preoperative and postoperative magnetic resonance imaging. The surgical treatment included gross total resection and biopsy plus a cyst-subarachnoid shunt. The diagnosis of intramedullary ependymal cysts was based on radiological and pathological criteria. All patients were followed up, with a mean duration of 47.6 months. Intramedullary ependymal cysts were hypointense on T1-weighted images and hyperintense on T2-weighted images. Contrast-enhanced T1-weighted images showed no enhancement. Gross total resection was achieved in one case. Biopsy of the cyst wall plus cyst-subarachnoid shunt placement was achieved in nine cases. Long-term neurological function was improved in eight patients. No recurrence was observed on magnetic resonance imaging. Ependymal cysts should be considered in the differential diagnosis of intramedullary cysts. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate. Complete decompression and cyst-subarachnoid shunt placement is the optimal treatment and the outcome may be favorable.

A review on five cases of intramedullary dermoid cyst

Intramedullary dermoid cyst is a type of rare congenital intraspinal lesions. Its proximity and its strong adherence to the surrounding spinal cord tissue often make a complete resection of the cyst wall problematic. We retrospectively studied five cases of intramedullary dermoid cyst, focusing the recurrence of intramedullary dermoid cyst after surgery and the probable method to prevent the recurrence. Five cases of intramedullary dermoid cyst with or without other concomitant deformities were retrospectively reviewed. Subjects consisted of three males and two females, aged 2–24 years. Diagnosis was confirmed by spinal MRI and pathology studies. Surgical outcomes were analyzed. In case 2, an Ommaya reservoir was implanted in the cystic cavity, and the cystic content was sucked though the Ommaya reservoir. An 18–113 months of follow-up was conducted. The contents of intramedullary dermoid cyst were loose and easy to be cleared in the operations. The cyst wall was closely adhered to the spinal cord, and complete resection was difficult. During the follow-up of 18–113 months, the lesion reoccurred in three cases. Intramedullary dermoid cyst is prone to recurrence. The presence of residual cyst wall might be the cause of dermoid cyst recurrence. When a complete resection of cyst wall becomes infeasible, placement of an intraspinal Ommaya reservoir may help to delay and minimize clinical symptoms by aspiration of cystic contents in case of recurrence.

Isolated intramedullary cervical dermoid cyst

A 65-year-old male was admitted because of 2-month history of left arm weakness. Spinal MRI showed a cervical intramedullary lesion whose features suggested a dermoid cyst (Fig. 1 a, b). No spinal dysraphisms were evident. At operation (under neurophysiological monitoring), after a C2–C5 laminotomy, dural opening and myelotomy, the lesion appeared composed of two components: cranially the cyst was filled with caseous yellowish and pearly material which was removed; caudally the lesion presented calcified material which was only partially removed because it was very adherent to the surrounding neural tissue (Fig. 1 c, d). Post-operative course was characterized by worsening of left arm weakness and onset of moderate weakness of legs. Histological examination confirmed the presence of keratin debris and bone suggesting a diagnosis of dermoid cyst. Intramedullary dermoid cysts are extremely rare, accounting for less than 1 % of intramedullary spinal cord tumors [1]. They arise from cell remnants due to a failure of embryological process involved in the neural tube closure [1]. This process begins in the area of the neural tube destined to become the lower cervical cord and proceeds rostrally and caudally [1]. Hence these cysts are more often located in the lumbosacral spine. As the result of an embryological defect, they are usually associated with spinal dysraphism or dermal sinus tracts and thus are commonly seen during the first decade of life [1, 2]. Although some cases of isolated cervical dermoid cyst have previously been reported, most of them were published in pre-MRI era [1]. Dermoid cysts can be differentiated from intrinsic glial tumors of the cord on the basis of heterogeneity of the T1or T2-weighted signal, lack of contrast enhancement, and signal characteristics consistent with lipid content [1]. To our knowledge only two papers reported detailed description of MRI and intraoperative features of isolated cervical dermoid cysts [1, 2]. Both cases came to surgery because patients were symptomatic. Odgen et al. [1] report on a case of a 23-year-old man with a 3-month history of symptoms consistent with myelopathy, including hand weakness and paresthesias and an unsteady gait. Patankar et al. [2] describe the case of an 18-year-old female with a gradual appearance of spastic tetraparesis. In these two cases, at operation, the cyst wall was found to be very adherent to the adjacent neural tissue and only a subtotal resection was performed to avoid spinal cord damage [1, 2], as in our case. Nonetheless the morbidity remains high even with subtotal resection, with two patients (Pantakar et al. [2], and present case) worsened after the operation. Considering the benign nature of these congenital lesions and the significant risks related with the operation a conservative management should be considered for asymptomatic patients. F. Signorelli (&) N. Montano A. Scerrati B. Cioni F. Papacci Institute of Neurosurgery, Catholic University, Largo Agostino Gemelli 8, 00168 Rome, Italy e-mail: francesco.signorelli1984@gmail.com

Intramedullary dermoid cyst with relatively atypical symptoms: a case report and review of the literature

BackgroundIntraspinal dermoid cysts are rare and benign tumors that occur primarily due to the defective closure of the neural tube, an ectodermal derivative, during the process of development. They are slow-growing tumors manifesting in the second and third decades of life.Case presentationWe present here a case of a 14-year-old Sindhi boy with a six-month history of paraparesis of the lower limbs and a progressive loss of power of grade 3/5, and hypoesthesia in the L4/L5 dermatomes of his right lower limb. A plain magnetic resonance imaging scan revealed a well-demarcated intraspinal intramedullary cyst containing an abscess at the level of T12 and L1 causing localized cord compression, which was producing the symptoms. Near total excision of the cyst was successfully performed and was sent for biopsy, which revealed keratinocytes and keratin flakes. With one month of follow-up, along with physiotherapeutic management, the patient gradually improved and was able to walk without support.ConclusionsCritical evaluation of every case with aggravating symptoms should be carried out, and neurological and radiological examinations should be conducted to ensure the well-being of patients.

Congenital dermal sinus in mid-dorsal spine with large intramedullary dermoid cyst in an 18-months-old child

Intramedullary dermoid cyst is a rare entity. It is usually associated with spinal dysraphism and dermal sinus. Our case is an 18-months-old female child who presented with history of fever and mild difficulty in moving left leg. She had a sinus in mid dorsal spine since birth with history of intermittent discharge from it. On magnetic resonance imaging of spine she was diagnosed to have large intramedullary epidermoid/dermoid cyst in the D2-7 vertebral level with a sinus tract. A dermoid cyst along with the sinus tract was excised. Post-operative follow up period was uneventful with full recovery.

Thoracic intramedullary spinal epidermoid tumor: A rare entity

Epidermoid cyst in the spinal cord is a rare condition. It constitutes of only 0.6-1.1% of all spinal tumors. We are reporting a case of a 22-year-old female who presented with complaints of tingling and numbness in both lower limbs since past 3 years and weakness in both lower limbs since past 1 year, which gradually progressed. Since last 3 months she was unable to walk and get up from their squatting position. Magnetic resonance imaging of spine revealed a mid-thoracic intramedullary mass with obliteration of anterior and posterior subarachnoid space, which was confirmed as an intramedullary epidermoid cyst at surgery. Total excision of intramedullary epidermoid tumor was performed. Histopathological examination of resected specimen confirmed the diagnosis of epidermoid cyst. The patient recovered progressively after initial deterioration in neurological status.

Diffusion-Weighted Magnetic Resonance Imaging of an Intramedullary Epidermoid Cyst with Dorsal Dermal Sinus Tract in a Toddler

We report the use of diffusion-weighted magnetic resonance imaging to diagnose and manage a rare case of a symptomatic thoracic intramedullary congenital epidermoid cyst with associated dermal sinus in a girl. Congenital intramedullary epidermoid cysts with associated dermal sinuses are very rare occurrences and seldom present symptomatically in very young children. We present a case of a 32-month old with a draining dimpled skin lesion. Magnetic resonance images demonstrated an intramedullary epidermoid with a dorsal dermal sinus tract opening to the skin surface which was confirmed surgically. The patient was treated with debulking to prevent recurrent infection and progression of neurological symptoms. This case demonstrates the use of diffuse-weighted MRI to assist in the diagnosis and surgical management of an atypical presentation of a rare developmental abnormality, which is not well documented in the pediatric radiological literature. Failure to diagnosis may have significant neurological permanent debilitating consequences.

Posterior spinal cord herniation: a novel occurrence following surgery for an intramedullary cyst at the thoracolumbar junction

Dorsal herniation of the spinal cord through the dura is an uncommon phenomenon and this is only the fifth reported case in the thoracolumbar spine, the first following surgery at the thoracolumbar junction. A 57-year-old male underwent marsupialisation of a benign intramedullary cyst at the T12-L1 level and subsequently returned with symptoms of dorsal column compromise. He was found to have a posterior herniation of the cord into a pseudomeningocele at the level of the previous surgery. The hernia was reduced surgically and the defect closed directly without the need for a dural patch leading to a full recovery. Posterior cord herniation, its possible aetiologies and management strategies are discussed.

An Extensive Intramedullary Epidermoid Cyst with a Longstanding History of Paraplegia: A Case Report

Spinal cord tumors still challenge clinicians because of their neurological deterioration before and after surgery. Epidermoid cyst is one of the rare intramedullary lesions producing neurological deterioration in cervical spine and it has been reported four times in the literature. We report the case of an intramedullary epidermoid cyst showing a longstanding history of paraplegia as well as recent slowly progressive tingling paresthesia extending from C4 to T10 and weakness in both hands.

Kyste neuroglial intramédullaire : à propos d’un cas

Background and purposeNeuroglial cysts are uncommon congenital lesion with own wall, which can be confined into or outside the central nervous system. In the central nervous system the cyst is located commonly in the brain. Spinal intramedullary neuroglial cyst are exceptional. Our objective is to present a case of intramedullary neuroglial cyst, to discuss the differentiels diagnosis and to show difficulties of its medical taking care. Case reportA 60 year-old man, without past history, was admitted to the hospital with a compression of conus medullaris since one year. The clinical examination revealed paraparesis and genito-sphincterian disorders. MRI of the spine revealed intramedullary cyst at T12-L1 level. The patient underwent cystic evacuation, a large marsupialization of the cavity and a wall biopsy. Histopathological examination confirmed the diagnosis of neuroglial cyst. The postoperative outcome was favourable with a partial improvement of motor weakness. Postoperative MRI showed a persistent residual cavity. ConclusionNeuroglial intramedullary cyst is uncommon. It is a benign lesion. Complete surgical resection is very difficult seen the absence of defined plan cleavage.

Intramedullary gangliocytoma with calcification and multiple intramedullary cysts

Intramedullary gangliocytoma with calcification and multiple intramedullary cysts

Spinal arachnoid cysts in the pediatric population: report of 31 cases and a review of the literature

The goal of this study was to review all cases of pediatric spinal arachnoid cysts (SACs) surgically treated at the authors' institution between 1992 and 2008 and to compare these cases to the published literature for the general population. The charts of all pediatric patients with SACs were reviewed for demographics, medical history, presenting symptoms, imaging findings, operative procedure(s), complications, and outcomes. Following a complete literature review, the pediatric data were compared with data from the general population and unique findings associated with pediatric patients were identified. Thirty-one pediatric patients (median age 6.9 years) underwent operative intervention for SACs between 1992 and 2008 (median duration of follow-up 4.2 years). There were 17 female patients (55%) and 14 male patients (45%). Twenty-one patients (68%) presented with symptoms of radiculopathy or myelopathy. The most common presenting symptoms were pain (42%), lower-extremity weakness (39%), gait instability (32%), spasticity (19%), sensory loss (10%), and bladder dysfunction (7%). In 3 patients (10%) SACs were incidental findings. Intradural SACs were more common (18 patients, 58%) than extradural SACs (11 patients, 36%). One patient (3%) had extradural and intradural components. One patient (3%) had a purely intramedullary cyst, and 1 patient (3%) had both an intradural and intramedullary component. Of the 18 intradural SACs, 9 (50%) were located ventral to the spinal cord and 9 (50%) were dorsally situated. One dorsal intradural SAC had an intramedullary component. All extradural SACs were located dorsal to the spinal cord. Intradural SACs were primarily concentrated in the cervical and thoracic regions (67%), whereas extradural cysts were more evenly distributed between the thoracic, lumbar, and sacral regions. Of the 18 patients with intradural SACs, 13 (72%) had significant previous CNS abnormalities, compared with 3 (27%) of 11 patients with extradural SACs. There were 2 operative complications. One patient had a CSF leak treated with a lumbar drain, and the second patient had a pseudomeningocele. No patients had neurological deterioration as a result of surgical intervention. Twenty-one patients (68%) had complete remission of symptoms, 6 (19%) had improvement, 3 (10%) were stable, and 1 (3%) has worsening of symptoms with recurrence that ultimately required cystoperitoneal shunting, despite multiple failed attempts at fenestration. Spinal arachnoid cysts are rare lesions in the pediatric population. Affected patients present with back pain, weakness, and/or gait instability. In children, SACs predominantly develop in the thoracic region and are more likely to occur intradurally, compared with SACs in the general population. Overall outcomes following surgical fenestration or excision of SACs are excellent, with complete remission or improvement of symptoms achieved in 87% of cases.

Die adulte Syringomyelie - ein Krankheitsbild mit verschiedenen Ursachen

Syringomyelia describes an intra-medullary cyst in the spinal cord. In the adult patient, the pathology mostly results from Chiari-I-malformation or from severe spinal trauma. The clinical picture varies broadly, but symptoms often include pain and progressive neurologic deficits. During the clinical course, muscular atrophy and loss of pain and temperature sensation may develop in the affected region. Today, magnet resonance imaging helps to detect syringomyelia at an early stage. The interdisciplinary therapeutic approach includes an adequate pain treatment and physiotherapy, in selected cases a surgical intervention by an experienced surgeon. If not treated surgically, most symptomatic patients experience progressive neurologic deficits that may lead to severe paragplegia and chronic neuropathic pain.

Cystic lesion of the ventriculus terminalis in an adult

We present a 40-year-old man with conus medullaris syndrome secondary to a cystic lesion of the ventriculus terminalis (CLVT) and review the relevant literature. The patient presented with 4 years of worsening right leg weakness, and examination showed bilateral fasciculations and hyporeflexia. MRI showed a cystic lesion at T11–12. He was managed with a T11–12 laminectomy and fenestration of an intramedullary cyst. A total of 32 patients, including ours, have been described since 1968: 24 were female with a mean age of 46.6 years. All patients presented symptomatically: five were managed conservatively, four using percutaneous aspiration under MRI guidance, and 22 with open surgery. We conclude that symptomatic patients are best managed surgically, although percutaneous aspiration is an emerging technique.

Pre-surgery diagnosis of unusual presentation of diastematomyelia associated with epidermoid cysts: Diagnostic value of diffusion weighted imaging

We report a case of diastematomyelia associated with epidermoid cysts. On initial 1.5 T MRI the diagnosis of multicystic tumor or cysticercosis in the cauda equina was considered. A careful examination of the initial MRI and additional 3 T MRI raised the possibility of diastematomyelia associated with epidermoid intramedullary cysts (confirmed on diffusion weighted imaging). This information was very important for the surgeon in order to avoid an unnecessary exploration of an already compromised spinal cord.

Neurenteric cysts of the spine

Neurenteric cysts account for 0.7-1.3% of spinal axis tumors. These rare lesions result from the inappropriate partitioning of the embryonic notochordal plate and presumptive endoderm during the third week of human development. Heterotopic rests of epithelium reminiscent of gastrointestinal and respiratory tissue lead to eventual formation of compressive cystic lesions of the pediatric and adult spine. Histopathological analysis of neurenteric tissue reveals a highly characteristic structure of columnar or cuboidal epithelium with or without cilia and mucus globules. Patients with symptomatic neurenteric cysts typically present in the second and third decades of life with size-dependent myelopathic and/or radicular signs. Magnetic resonance imaging and computed tomography are essential diagnostic tools for the delineation of cyst form and overlying osseous architecture. A variety of approaches have been employed in the treatment of neurenteric cysts each with a goal of total surgical resection. Although long-term outcome analyses are limited, data available indicate that surgical intervention in the case of neurenteric cysts results in a high frequency of resolution of neurological deficit with minimal morbidity. However, recurrence rates as high as 37% have been reported with incomplete resection secondary to factors such as cyst adhesion to surrounding structure and unclear dissection planes. Here we present a systematic review of English language literature from January 1966 to December 2009 utilizing MEDLINE with the following search terminology: neurenteric cyst, enterogenous cyst, spinal cord tumor, spinal dysraphism, intraspinal cyst, intramedullary cyst, and intradural cyst. In addition, the references of publications returned from the MEDLINE search criteria were surveyed in order to examine other pertinent reports.

Intramedullary spinal epidermoid cyst of the cervicodorsal region: A rare entity

Intramedullary spinal epidermoid cysts are rare, with only few cases having been reported in the literature. We are reporting a case of a 10-year-old female child who presented with symptoms of meningitis with progressive paraparesis. Magnetic resonance imaging of the spine revealed an intramedullary epidermoid cyst from C6 to D5. Near-total excision of the tumor was performed. Histopathological report confirmed the diagnosis of epidermoid cyst. The patient showed progressive recovery.

Myelocystographic and fluorescein studies to demonstrate communication between intramedullary cysts and the cerebrospinal fluid space.

Myelocystographic and fluorescein studies to demonstrate communication between intramedullary cysts and the cerebrospinal fluid space.