Neurenteric Cyst Research Articles

Transcranial extraventricular endoscopic surgeries: Expanding the role of endoscope in neurosurgery.

Background and Aim: Transcranial endoscopic surgeries are mainly limited to intraventricular lesions. This study aims to elaborate on the various benefits of transcranial endoscopic surgeries in extraventricular regions of the brain. Methods and Materials/Patients: It is a retrospective study of transcranial extraventricular endoscopic surgeries (TEESs) operated between June 2022 to May 2023. The authors described the surgeries done for brain lesions other than intraventricular lesions as extraventricular surgeries. Access to the intracranial region was obtained through the transcranial approach. The transnasal rigid endoscope was used for the surgeries. The surgery was performed as either pure endoscopic surgery or endoscopic-assisted microscopic surgery. Results: The authors have performed 6 microvascular decompressions using an endoscope. Three pineal tumors, 3 craniopharyngiomas, 1 cerebellopontine angle epidermoid cyst, and 1 petrous neurenteric cyst were excised using an endoscope by transcranial approach. One internal carotid artery bifurcation aneurysm was clipped using an endoscope. All patients improved in the postoperative period. Surgeries were done using the 0-degree and 30-degree endoscopes. The endoscopic eye was able to reach the deep-seated area of surgical interest and authors were able to visualize the structures in a wide panoramic view with good illumination and magnification. There was no misinterpretation of structures. Conclusion: Endoscope can reach the deep-seated extraventricular areas of the brain with a narrow corridor, giving good illumination and magnification at the site of surgery. An endoscope can reach beyond the obstructing anatomical structure and visualize the area behind it. It is used as a complimentary to microscope to access the microscopic invisible areas. It has increased the ease of doing surgery, decreased tissue dissection, decreased complications, and improved surgical results. TEES improves the hand-eye coordination of surgeons in transcranial surgeries and it will help in adapting to exoscope easily

Surgical treatment of spinal neurenteric cysts

Background. Spinal neurenteric cysts are very rare benign space-occupying lesions in the vertebral canal emerging due to anomalies of neural tube development during prenatal development of the fetus. Clinically, neurenteric cysts can manifest both in childhood and adulthood.Aim. To evaluate the results of surgical treatment of adult patients with spinal neurenteric cysts who were operated on at the Neurosurgery Division of the Clinic of Nervous System Diseases of the I.M. Sechenov First Moscow State Medical University.Materials and methods. The study group included 3 patients (2 women and 1 man) with mean age of 33 years. The main diagnosis method was magnetic resonance imaging. In all cases, radical cyst resection was performed with subsequent histological examination of cyst walls.Results. In all observations, cyst walls had local areas of increased density and thickness: a distinctive solid component accumulating the contrast agent in magnetic resonance images. This type of structure is considered extremely rare per descriptions presented in literature, but in our case series it was detected in all patients. Cyst resection led to pain syndrome regression and almost full regression of clinical manifestations of spinal cord compression which justifies active surgical tactics in this pathology.Conclusion. Neurenteric cyst of the vertebral canal can cause spinal cord compression. The main diagnostic method of this pathology is magnetic resonance imaging, however magnetic resonance semiotics of these cyst has not been standardized. The presence of constant pain syndrome without marked clinical signs of compression myelopathy is sufficient reason for cyst resection surgery. Cyst resection allowsto achieve regression of pain syndrome and neurological abnormalities caused by spinal cord compression.

Spontaneous Rupture of Prenatally Detected Thoracic Neurenteric Cyst: Case Report and Review of Literature

AbstractNeurenteric cysts are usually associated with vertebral anomalies of the same segments of vertebrae. Rarely, they can be detected antenatally. The prognosis depends upon the size and site of the lesion. In cases of small cysts with minimal mass effect, the prognosis is good. Larger cysts, however, can cause hydrops fetalis and, if untreated, can lead to intrauterine fetal demise. The present case report describes the successful conservative management of the neurenteric cyst detected prenatally and is accompanied by a summary from literature.

Treatment of ventral neurenteric cyst at the cervicothoracic junction with the anterior approach in a pediatric patient: illustrative case.

Neurenteric cysts are rare congenital lesions from heterotopic endodermal tissue, often presenting with radiculopathy or myelopathy in young adults. Gross-total resection is curative; however, the surgical approach remains widely debated for cervicothoracic cases. While the posterior approach is common, the anterior approach has had success in adults. The authors present the first pediatric case of anterior corpectomy with gross-total resection of a cervicothoracic neurenteric cyst alongside an extensive literature review. A 10-year-old male, who had undergone a previous cyst resection via a posterior approach at an outside institution, presented with back pain, paraplegia, and urinary incontinence. Magnetic resonance imaging of the spine revealed a ventral hyperintense cyst at C7-T1 consistent with a neurenteric cyst. An anterior approach involving C7 and T1 corpectomies was performed, including intradural exploration leading to complete cyst resection. This was followed by the placement of an expandable cage and anterior and posterior fixation with arthrodesis for stabilization. The patient's symptoms completely resolved after surgery, and there has been no recurrence. The anterior approach is a viable option for cervicothoracic neurenteric cyst resection in the pediatric population and can aid in gross-total resection by providing better lesion visualization. More studies are needed on long-term outcomes of the anterior approach in pediatric populations. https://thejns.org/doi/10.3171/CASE24120.

Tumor-Like Lesions in the Craniovertebral Junction: A Case Series, Systematic Review, and Meta-Analysis.

Background: Tumor-like lesions at the craniovertebral junction mimic tumors in clinical presentation and imaging. Our study focuses on three common developmental pathologies-epidermoids, dermoids and neurenteric cysts. Methods: We conducted a retrospective analysis of a case series and a meta-analysis of 170 patients from 119 reports. Results: Neurenteric cysts predominated (81.2%). Anterior cysts were linked to neurenteric cysts, while posterior ones correlated with dermoid/epidermoid cysts (p < 0.001). Complications occurred in 27.2% of cases, with cranial nerve paresis being the most common. Most patients had excellent outcomes (75.2%) with low recurrence rates (12%). Dermoid cysts were more associated with anomalies (p < 0.001). Among 138 neurenteric cyst cases, 15 experienced recurrence, with predictors including ages 51-60 and over 70, subtotal resection, complications, and poor outcomes (p < 0.001). Cysts with total resection were significantly less likely to adhere to surrounding brain tissue (p < 0.001). CSF diversion was correlated with older age (p = 0.010) and various complications (p < 0.001). Age affected outcomes, and the hydrocephalus was linked to poor outcomes (p = 0.002). Conclusions: This meta-analysis underscores the importance of total resection in minimizing recurrence rates and emphasizes meticulous preoperative planning and imaging. Our results indicate that rim enhancement (p = 0.047) and poor outcome (p = 0.007) are significant factors associated with recurrence. Additionally, associated anomalies, as well as the patient's age and overall health, significantly influence the surgical outcomes and the likelihood of recurrence.

Enlarging neurenteric cyst at the craniocervical junction with a fluid-fluid level on magnetic resonance imaging: illustrative case.

Neurenteric cysts are relatively rare benign congenital intracranial cystic lesions that enlarge rarely and very slowly. The authors present a case of an enlarging neurenteric cyst at the craniocervical junction with a fluid-fluid level on magnetic resonance imaging (MRI). A 34-year-old man with no significant medical history underwent head MRI to investigate mild headaches. An incidental cystic lesion, approximately 8 mm in diameter, was revealed at the craniocervical junction. Serial follow-up MRI showed cyst enlargement with a fluid-fluid level. Four years later, the cyst reached a size of 15 mm and was surgically removed. The cyst contained cloudy fluid with a high protein concentration, without any bleeding or tissue fragments. Pathological examination confirmed the diagnosis of a neurenteric cyst. The patient recovered well, was discharged home, and has remained recurrence free for 2 years. The growth dynamics of the relatively rapidly expanding neurenteric cyst at the craniocervical junction were monitored over time using MRI. This cyst exhibited the distinctive feature of a fluid-fluid level as it enlarged. Investigating the mechanisms underlying fluid-fluid level formation may offer novel insights into the pathogenesis of cyst enlargement. https://thejns.org/doi/10.3171/CASE24180.

Spinal neurenteric cysts: experience with 9 cases via an anterior cervical approach

OBJECTIVE Intraspinal cysts are uncommon, and the success rate of complete resection is still low for spinal neurenteric cysts (NCs). The aim of this study was to evaluate the efficacies of an anterior microscopic surgical approach in the treatment of ventral and ventrolateral subaxial cervical NCs (SCNCs). METHODS Between 2019 and 2022, 9 patients with NCs of the subaxial spine underwent an anterior microsurgical approach. Their clinical presentations, radiological features, operative findings, and follow-up data were retrospectively reviewed and analyzed. RESULTS All spinal cysts were intradural and extramedullary in origin. Five patients were first-time cases while 4 patients with recurrence underwent revision surgery. The most common clinical manifestation was pain (77.78%). One patient was found to have a concomitant disorder of Klippel-Feil syndrome. Microscopically confirmed gross-total resection was achieved in 8 patients (88.89%) based on clinical comparisons between pre- and postoperative MRI and intraoperative video. One patient had symptom recurrence 1 year after subtotal resection, while there was no evidence of recurrence during follow-up for the other patients. Dense adhesions within the spinal cord were observed in 8 patients (88.89%) intraoperatively. Most importantly, the surgical outcome was significantly improved in all patients, and the mean (± SE) Japanese Orthopaedic Association score increased from 11.33 ± 0.91 preoperatively to 16.22 ± 0.32 postoperatively (p = 0.008). CONCLUSIONS An anterior surgical approach was proven to be both safe and effective in treating the ventral or ventrolateral SCNCs. The authors believe that an anterior microsurgical approach should be considered as a useful approach especially in patients with ventral recurrent SCNCs. Its clinical efficacy compared with a posterior approach in ventral spinal cyst may be better as most of the neurenteric cysts are ventrally or ventrolaterally located.

Enigmatic echoes: Exploring brainstem neurenteric cysts - A case series and literature review

Introduction and importanceNeurenteric cysts (NCs) are rare congenital anomalies within the central nervous system, originating from the endodermal layer due to inappropriate embryonic notochordal plate and endoderm separation. Despite constituting a minute fraction of CNS tumors, their diverse clinical presentations and brainstem occurrence pose diagnostic challenges. Case presentationThis study presents a series of three brainstem NCs, detailing demographics, clinical presentations, radiological features, and operative findings. Patients aged 2–40 years exhibited varied symptoms including headaches, vomiting, cranial nerve deficits, and motor/sensory deficits. Literature review of 27 cases showed a mean age of 26.8 years, predominantly in females, with diverse cystic characteristics on MRI. Surgical intervention achieved mostly complete resection, with varying outcomes including recurrence and malignant transformation. Clinical discussionThis study sheds light on the rare entity of brainstem NCs, emphasizing their diagnostic complexity. NCs, though constituting a minute fraction of CNS tumors, present a diagnostic challenge due to their diverse clinical presentations and rarity in the brainstem. ConclusionThis study provides insights into brainstem NCs, emphasizing diagnostic complexity and the importance of MRI in accurate diagnosis and surgical intervention. Enhanced collaboration is needed to refine management strategies for these intriguing lesions.

Disseminated Intracranial and Spinal Neurenteric Cysts: A Case Report and Literature Review

Neurenteric cysts (NECs) are rare congenital, benign lesions of the central nervous system (CNS), predominantly located within the spinal cord. However, they may also occur less frequently within the brainstem, fourth ventricle, or cerebellopontine angle (CPA). Originating from anomalous interactions between embryonic layers, NECs are recognized for their potential to compress adjacent structures. We report a unique case of disseminated NECs exhibiting few to absent symptoms, which represents an unusual presentation of this disease, with only six similar reports in the literature. A 22‐year‐old female presented to our institute with chronic headaches resistant to nonsteroidal anti‐inflammatory drugs (NSAIDs). Initially treated for intracranial hypertension (ICH) secondary to a cyst in the quadrigeminal cistern at the age of 17 via neuroendoscopic surgery and subsequent ventriculoperitoneal shunting, she experienced transient relief. However, follow‐up at 22 years of age revealed multiple cysts in the basal and spinal cisterns, with MRI findings suggestive of neurocysticercosis. Despite treatment with albendazole and corticosteroids, subsequent MRIs showed no change in the size or number of the cysts. Six years later, symptoms had worsened, previously identified cysts had grown, and the detection of new cysts prompted surgical intervention. Histopathological examination confirmed the presence of NECs. This case highlights the diagnostic challenges posed by NECs, especially in regions endemic for neurocysticercosis, where clinical and radiological findings may initially suggest this condition. It underscores the importance of considering NECs in the differential diagnosis of cystic lesions in the CNS, even in the absence of typical symptoms of spinal cord compression. The recurrence and spread of NECs post‐treatment demand a comprehensive management approach, encompassing surgical intervention and close monitoring.

A Purely Lumbar Spinal Neurenteric Cyst with Vertebral Destruction: An Unusual Presentation with Review of Literature

Abstract Neurenteric cysts are one of the uncommon differentials for cystic lesions of the spine. Occurring most commonly in the cervical and cervicothoracic regions, purely lumbar neurenteric cysts are extremely rare entities. Here, we describe a case of a 25-year-old female patient who presented with complaints of chronic low back aches and difficulty in walking and underwent surgery. Histopathological examination revealed a neurenteric cyst. We also discuss relevant literature on the embryological, radiological, and clinicopathological aspects of purely lumbar neurenteric cysts.

Bilateral Vertebral Artery Fenestration in a Case of Craniovertebral Junction Neurenteric Cyst: Implications for Surgical Planning

Abstract Vertebral artery fenestration (VAF) is a type of anomaly of the vertebral artery in which a segment of the vessel divides into two separate channels that join together later in the course. Neurenteric cysts are rare, congenital lesions arising within the spinal canal usually in the cervical region. Vertebral artery anomalies if not considered during operative planning can lead to iatrogenic injury. We report a case of a 5-year-old boy who presented with a history of acute onset, non-traumatic spastic quadriparesis. Examination revealed the presence of cervical neurenteric cyst present ventrally at C1–C3 level. Further workup revealed the presence of bilateral VAF with the fenestrated part going along the inferior aspect of the arch of atlas bilaterally. Surgical excision of the lesion was done taking into consideration the anomalous course of vertebral artery. VAFs are classified according to their location as intracranial or extracranial and according to the segment of the vertebral artery from which they arise (V1–V4). Iatrogenic injury to the vertebral artery has been reported during both anterior and posterior approaches to the cervical spine. Due consideration should be given to anomalous course of vertebral artery while planning the surgical approach in craniovertebral junction.

An Unusual Case of Neurenteric Cyst in a Patient with Split Cord Malformation

Neurenteric cyst in a split cord malformation is a rare finding. We report an adult female becoming acutely symptomatic secondary to an expanding neurenteric cyst, though previous imaging had demonstrated stability. We discuss our workup and management with surgical resection and possible etiologies of her acute decline.

Hemifacial Spasm Secondary to a Neurenteric Cyst: case report and literature review

Hemifacial Spasm Secondary to a Neurenteric Cyst: case report and literature review

Intramedullary Spinal Cord Tumors (IMSCTs): Outcome after surgical resection in 35 cases and review of literature

BACKGROUND Intramedullary Spinal Cord Tumors (IMSCTs) are rare and they represent only 5% of all spinal tumors. Ependymoma and astrocytoma are two most common IMSCTs. Due to recent advances in micro instruments, imaging and technology, aggressive surgical excision has become a safer possibility with better outcome. Aim of this study is to analyze functional outcome of patients after surgical resection of IMSCTs and review of literature.&#x0D; METHODOLOGY Over a period of 4 years, between May 2017 and January 2021, 35 patients were operated for IMSCTs under general anesthesia. Neurophysiological monitoring (NPM) was recently available and used only in last few cases. CUSA was used whenever required in these microsurgical procedures. This retrospective study was carried out after retrieving data from OT registers, inpatient files, OPD records, and statistical analysis was executed using SPSS software (version 18). Functional outcome was assessed by McCormick grading scale and mean follow up period was 2.5 years.&#x0D; RESULTS Out of 35 patients, 17 were male and 18 female. Mean age distribution was 27.57(+/-17.68). On admission, 30 patients had motor deficits, 18 had neck or back pain, 10 had sphincter dysfunction, 7 had kyphoscoliosis and 2 patients had normal neurology. MRI with IV contrast of these 35 patients revealed intramedullary lesions at cervical (11), cervicomedullary (4), thoracic (8), cervicothoracic (2), thoracolumbar (3), conus (6) and lumbar (1) regions. 22 patients had gross total and 13 had subtotal resection. Histological examination confirmed 30 glial tumors (ependymoma &amp; astrocytoma), 2 dermoid/epidermoid, 2 neurenteric cysts and 1 secondary. Postoperative complication was 17% and there was no surgery related 30 days’ mortality. Functional outcome was measured by McCormick grade before and after microsurgical resection. Preoperatively 3(8.5%) patients had low grade or independent and 32 (91.4%) had high grade or dependent. Postoperatively and at the time of discharge 14 (40%) of patients had low grade or independent and 21 (60%) were dependent or high grade. On last followed up (4 years) 15 (48.3%) had low grade and 16 (51.6%) had high grade or dependent. In our series, on followed up of 4 years, recurrence rate was 5(14.2%), They were 2 astrocytoma, 1 secondary, and 2 myxopapillary ependymomas. Two patients with myxopapillary ependymoma were operated twice and no radiotherapy was advocated. 8 (22.6%) patients received local radiation and recurrence rate was 17.2%.&#x0D; CONCLUSION Safe resection of intramedullary lesion is possible with the aid of modern neurosurgical tools, however, functional outcome relies on preoperative neurological status of the patients, extent of excision and histology of tumor. Risk factors for recurrence of IMSCTS are extent of resection and histological behavior of tumor.

Meningeal carcinomatosis secondary to neurenteric cysts with malignant transformation: a case report

BackgroundMeningeal carcinomatosis is mainly associated with breast cancer, lung cancer, and melanoma. However, meningeal carcinomatosis secondary to a neurenteric cyst with malignant features is extremely rare.Case presentationWe report the case of a 35-year-old woman who was admitted to the hospital with a 10-month history of headache, 6-month history of diplopia, 4-month history of hearing loss, and 1-month history of back pain, suggesting a diagnosis of chronic meningitis. Notably, enhanced brain and spinal cord magnetic resonance imaging (MRI) revealed extensive lesions with enhancement signals in the pia mater of the pons and cervical, thoracic, and lumbar spinal cord. The cerebral spinal fluid profile showed that pressure was significantly elevated, with a slight increase in leukocytes that mostly comprised mononuclear cells and decreased glucose concentration. Cytology evaluation showed a small cluster of atypical nuclei, which were suspected to be tumor cells arising from the epithelium. However, no primary tumor was found through comprehensive body and skin screening. After a histopathological biopsy of subarachnoid meninx of the thoracic spinal canal, the cause of meningeal carcinomatosis of this patient was determined as neurenteric cysts with malignant features, which is extremely rare.ConclusionThis is the first case to ever report neurenteric cysts as a cause of leptomeningeal carcinomatosis and the first ever report of neurenteric cysts presenting as leptomeningeal carcinomatosis without typical cyst visible on brain MRI. This extremely rare case provided a novel view on the pathogenesis of meningeal carcinomatosis and clinical presentation of neurenteric cysts, highlighting the value of meningeal biopsy in chronic meningitis of unknown causes.

ODP337 Neurenteric Cyst Apoplexy with Post-Operative Diabetes Insipidus in a 14-year-old Male

Abstract Background Apoplexy of benign neurenteric cysts can present with acute onset of a severe headache. Pituitary dysfunction, such as hypothyroidism and diabetes insipidus, can occur after transsphenoidal resection of these cysts. Clinical Case A 14-year-old male presented to the ED with acute onset of a severe headache, nausea and emesis. He denied recent vision changes, weight changes, temperature intolerance, diarrhea, constipation, skin changes, polyuria, or polydipsia. He reported starting puberty by 13 years of age. He was treated with Zofran, Tylenol, and Dexamethasone which led to headache resolution. His MRI showed a trans-sellar structure measuring 12 by 16 mm and demonstrating internal intrinsic T1 hyper-intensity, deep T2 hypo-intensity, and mildly thickened peripheral enhancement. The lesion abuts the undersurface of the optic chiasm and the stalk enhances normally. The neurohypophysis is not well identified. The optic nerves are unremarkable, and the optic chasm is slightly bowed superiorly. His initial labs were significant for: Na 136 mmol/L, K 4 mmol/L, TSH 1.15 uIU/mL, FT4 0.81 ng/dL, IGF-1 286 ng/mL, cortisol &amp;lt;1 ug/dL (drawn in the PM), FSH 6.23 mIU/mL, LH 2. 01 mIU/mL, PRL 7.8 ng/mL, testosterone 187 ng/dL. He was taken to surgery where a transsphenoidal resection with a mucosal graft for sellar reconstruction was completed. Pathology results showed evidence of a neurenteric cyst with glandular elements within the cyst wall. He was noted to have an increase in water intake and urine output post-operatively with intake of 6200 mL and output of 6768 mL over 24 hours (3.5 mL/kg/hr). His Na was 141 mmol/L with urine SG of 1. 002, and urine osmolality of 75 mosm/kg. He was discharged on a DDAVP dose of 0.2 mg tid. His thyroid function was reassuring post-op with a T4 of 8.4 ug/dL. He had a normal morning cortisol of 14.6 ug/dL. One month post-op, he required treatment with a DDAVP dose of 0.1 mg bid. The rest of his pituitary function appeared intact one month post-op with labs significant for LH 2.56 mIU/mL, FSH 5 mIU/mL, testosterone 261 ng/dL, PRL 7.8 ng/mL, TSH 2. 09 uIU/mL, and FT4 1 ng/dL. Conclusion This case demonstrates that neurenteric cyst apoplexy can occur in teenagers who present with the acute onset of a severe headache with associated nausea and emesis. This case demonstrates the importance of thoroughly investigating the patient's pituitary function at baseline and post-operatively since pituitary deficiencies, such as DI, can occur. Presentation: No date and time listed

Nonneoplastic and noninfective cysts of the central nervous system: A histopathological study.

Nonneoplastic epithelial cysts involving the central nervous system are diverse and are predominantly developmental in origin. This study represents a surgical series describing the histopathological features of 507 such epithelial cysts with clinical and imaging correlation. Age at surgery ranged from 7 months to 72 years (mean: 33 years) affecting 246 male and 261 female patients. Colloid cyst was the most frequently resected cyst, followed by epidermoid cyst, arachnoid cyst, Rathke cleft cyst, dermoid cyst, neurenteric cyst, Tarlov cyst, and choroid plexus cyst. Diagnosis was based on the location of the cysts and the nature of the lining epithelium. Rathke cleft cyst showed the highest propensity for squamous metaplasia, significant inflammation, and xanthogranulomatous reaction. Ulceration of lining epithelium and calcification were most frequent in dermoid cyst. Radiopathological concordance was maximal for colloid cyst, followed by epidermoid and arachnoid cysts. Epidermoid and dermoid cysts exhibited the highest propensity for local tumor progression, followed by Rathke cleft cyst.

Neurenteric cyst in spinal canal: Four case reports and literature review

Abstract The congenital malformation known as a spinal neurenteric cyst (NEC) is a rare form of an endodermal cyst. We have reported four cases of intradural extramedullary NEC aged from five months to five years. All patients had symptoms and improved after the surgery. We conducted a literature review from a PubMed and Google Scholar search, and an analysis of the cases of NECs.

Risk Factors in a Pediatric Population for Postoperative Intracranial Infection Following Endoscopic Endonasal Skull Base Surgery and the Role of Antibiotic Prophylaxis.

Endoscopic endonasal skull base surgery (EESBS) is performed through a non-sterile corridor. Intracranial infection rates in a pediatric population have not been extensively studied and the exact effect of antibiotic prophylaxis on rates of infection after EESBS in pediatric patients remains unclear. The purpose of our study is to investigate risk factors for postoperative intracranial infection during EESBS in a pediatric population and help elucidate the role of antibiotic prophylaxis. We conducted a retrospective chart review of 99 consecutive patients under the age of 18 who underwent EESBS at our institution from 2013 to 2021. Centers for Disease Control and Prevention/National Healthcare Safety Network criteria for diagnosis of meningitis were used to identify postoperative intracranial infections. The average age was 12.3 years (range 1.6-18) with 66 male patients and 33 female patients. 49 patients had an intraoperative cerebrospinal fluid (CSF) leak, of which 4 had a postoperative CSF leak. We identified 3 postoperative intracranial infections (3%), which were all meningitis cases. The infection rate was 6% (3/49) among those with intraoperative CSF leaks. All patients with meningitis had a postoperative CSF leak. All infections were transclival approaches (2 chordoma and 1 neurenteric cyst). This investigation represents one of the largest pediatric endoscopic skull base surgery cohorts. EESBS is safe to perform in pediatric populations, but transclival approaches and postoperative CSF leaks are risk factors for postoperative meningitis.

Surgical Experience and Management of Intracranial Neurenteric Cysts: Single-Center Experience and Review of the Literature.

Introduction Neurenteric cysts (NECs) are rare, congenital lesions lined by endodermal cell-derived columnar or cuboidal epithelium. Based on previous studies, gross total removal of the capsule has been presumed to be the ideal surgical goal. Objective This series was undertaken to further understand the risk of recurrence based on the extent of capsule resection. Methods Records were retrospectively reviewed for all patients with radiographic or pathological evidence of intracranial NEC from 1996 to 2021. Results A total of eight patients were identified; four of eight (50%) presented with headache, and four had signs of one or more cranial nerve syndromes. One patient (13%) presented with third nerve palsy, one (13%) had sixth nerve palsy, and two (25%) with hemifacial spasm. One patient (13%) presented with signs of obstructive hydrocephalus. Magnetic resonance imaging demonstrated T2 hyper- or isointense lesions. Diffusion-weighted imaging was negative in all patients (100%) and T1 contrast-enhanced imaging demonstrated minimal rim enhancement in two patients (25%). In three of eight (38%), a gross total resection (GTR) was achieved, while in four (50%), a near-total resection, and in one (13%), a decompression was performed. Recurrences occurred in two (25%) patients, one with decompression and another with near-total resection, among these 1/2 required repeat surgery after a mean follow-up of 77 months. Conclusion In this series, none from GTR group demonstrated recurrence, while 40% of those receiving less than GTR recurred, underpinning the importance of maximally safe resection in these patients. Overall patients did well without major morbidity from surgery.