Neurenteric Cyst Research Articles

Uncommon Intradural–Extramedullary Lesions Removed by Uniportal Minimally Invasive Technique. Clinical and Radiological Results: A Study with 12 Months of Follow-Up

Introduction Intradural extramedullary cervical lesions usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes standard fashion cut incision, open laminectomy, and some cases fusion. Patients and Methods We present four patients (one woman and three men) with symptoms including radicular pain and/or neurological deficit, due intradural extramedullary cervical lesion. All the patients underwent total resection with minimally invasive uniportal technique using a tree blade MAXCESS retractor system (Nuvasive, Inc.). We measured a VAS, Nurick scales pre-op, and with follow-up of 6 weeks, 3.6 and 12 months post-op. Surgical time, blood loss and time to discharge. All the patients underwent control MRI postoperatively. Results One patient neurenteric cyst, two patients: underwent neurocysticercosis, and the last epidermoid cyst. The VAS and Nurick scales were decreased over the time line. The surgical time was 140 minutes (mean), blood loss 30 mL (mean). All the patients were discharged at 47 hours mean, and return to daily activities 10 days (mean). Conclusion Intradural–extramedullary lesions can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization, disruption to local tissues, and return to daily activities suggest that this technique may present an alternative to traditional open resection.

Clinical presentation and surgical outcomes of intramedullary neurenteric cysts

Intramedullary neurenteric cysts (NECs) are exceedingly rare lesions and have been previously reported in case reports. The aim of this study was to determine the clinical manifestations, radiological features, and long-term prognosis of patients with such lesions. The authors retrospectively reviewed the records of 13 patients with an intramedullary NEC. Each patient underwent MRI, laminotomy, and microsurgery. The accurate diagnosis was based on imaging and pathology findings. Each patient's follow-up status was determined through individual office visits and a structured telephone interview. The series included 7 male and 6 female patients. Progressive or intermittent motor deficit was the main symptom associated with or without pain or sensory disturbance. Five cysts were located in the cervical cord, 1 in the cervicothoracic cord, 3 in the thoracic cord, and 4 in the conus medullaris. Concurrent malformations included scoliosis (3 cases), fusion of rib (1 case), enlarged spinal canal (1 case), tethered spinal cord (1 case), and ectocardia (1 case). Gross-total resection of the cyst was achieved in 8 cases, and subtotal resection (STR) was achieved in 5 cases. All patients were followed up, with a mean duration of 66.5 months. Cyst recurrence was observed in 4 cases after STR. In 2 cases the patients underwent reoperation; the other 2 patients remained clinically stable and did not undergo reoperation. At the last evaluation, neurological function was improved in 11 patients and remained stable in 2 patients. Intramedullary NECs should be considered in the differential diagnosis of a middle-aged patient with intermittent neurological symptoms and concurrent malformations. Early surgery is advocated to prevent permanent neurological deficits. When gross-total resection cannot be achieved, maximally safe removal under the protection of intraoperative neuromonitoring is advised. Because of the high risk of cyst recurrence, routine follow-up MRI is needed. If a residual cyst shows obvious regrowth and results in neurological deficits, timely reoperation with a goal of STR should be performed.

Spinal neurenteric cyst presented with lower extremity weakness

Spinal neurenteric cyst presented with lower extremity weakness

A dorsally located giant posterior fossa neurenteric cyst in a Chinese woman

Neurenteric cysts (NC) are rare, endodermal-derived intracranial lesions, commonly located anteriorly in the posterior cranial fossa. We describe a rare case of a giant posterior fossa NC (6.5×5.9×4.3cm) located dorsal to the brain stem in a Chinese woman with a 1week history of cerebellar symptoms. To our knowledge, this is the largest documented cyst of this type and the third dorsally located NC in the posterior fossa.

Surgical Outcomes in Intracranial Neurenteric Cysts—Retrospective Review of a 15-Year Institutional Experience

Surgical Outcomes in Intracranial Neurenteric Cysts—Retrospective Review of a 15-Year Institutional Experience

Rare Neural Tube Defect: Type I Split Cord Malformation and Spinal Neurenteric Cyst in an Adult

Rare Neural Tube Defect: Type I Split Cord Malformation and Spinal Neurenteric Cyst in an Adult Objective: Split cord malformation (SCM) is a rare form of closed neural tube defect characterized by a sagittal splitting of the spinal cord. Pang’s classification distinguishes a type I SCM (diastematomyelia with septum) and a type II SCM (true diplomyelia). SCM typically presents in childhood and, rarely, in aduls. Neurenteric cysts are composed of heterotopic endodermal tissue. They usually have an intradural extramedullary location, ventrally or ventrolaterally to the spinal cord. Less frequently, the cyst may be located posteriorly to the spinal cord, within the cord, or within the cleft of a diastematomyelia. Methods: We reported a 56-year-old woman with a 4-month history of severe back pain and paresthesia on the right flank. MRI revealed, at T9-T11 level, the coexistence of a type 1 SCM and an intradural extramedullary neurenteric cyst. The patient underwent surgery. Results: Following a T9-T11 laminectomy, a posterior median incision of the dura was performed to expose the cystic thin-walled translucent membrane. The wall was opened with drainage of a whitish fluid and the cyst membrane was totally removed “en-bloc”. After the operation, the patient referred complete disappearance of the dorsolumbar pain. There was no deterioration of neurological status. The patient was discharged on 7th day post-operatively. Conclusion: The association between diastematomyelia and neurenteric cyst represents a very rare condition, especially in adulthood, in spite of their possible common embryological origin. The symptoms are usually related to the spinal cord compression caused by the cyst; therefore, the surgical excision of the cyst is effective.

Intracranial neurenteric cyst traversing the brainstem

Neurenteric cysts (NECs), also called enterogenous cysts, are rare benign endodermal lesions of the central nervous system that probably result from separation failure of the notochord and upper gastrointestinal tract. Most frequently they are found in the lower cervical spine or the upper thoracic spine. Intracranial occurrence is rare and mostly confined to infratentorial compartment, in prepontine region [51%]. Other common locations are fourth ventricle and cerebellopontine angle. There are few reports of NEC in medulla or the cerebellum. Because of the rarity of the disease and common radiological findings, they are misinterpreted as arachnoid or simple cysts until the histopathological confirmation, unless suspected preoperatively. We herein report a rare yet interesting case of intracranial NEC traversing across the brainstem.

Interesting Case Reports of Neurenteric Cyst with Type 1 Spilt Cord Malformation at Conus Medullaris

Two rare cases of split cord malformation with neurenteric cyst are presented. The clinical, radiological and surgical findings are presented with brief review of literature. Co-existent neurenteric cysts along with SCM type 1 have been described very rarely in the literature.

Acute Tetraplegia after Trivial Neck Injury Revealed a Cervical Intraspinal Neurenteric Cyst in a Child

Neurenteric cysts (NC) are rare anomalies of the central nervous system (CNS). They result from abnormal separation of the neural tube and the endodermis during the 3rd week of gestation, which leads to the persistence of endodermal elements in the spinal cord. They usually present insidiously with local spinal pain, radiculopathy, and myelopathy. We report the case of an 8-year-old boy with a high cervical neurenteric cyst who developed a progressive myelopathy after a minor neck trauma. He recovered completely after cyst removal.

An Unusual Presacral Cyst in An Infant

The neurenteric cyst is a rare developmental lesion arising as a result of persistence of the neurenteric canal. It usually presents in the second and third decade. Lesions occurring in children are rare. Majority of the cases presented with signs of spinal cord involvement. This is a rare case of neurenteric cyst in an infant who presented with a presacral mass. A nine-month-old female had an antenatally diagnosed sacrococcygeal lesion. Radiology suggested a diagnosis of sacrococcygeal teratoma. Histology was typical of a neurenteric cyst. We report this case to create awareness about this rare cystic lesion and inclusion of this entity in the differential diagnosis of cystic masses in children at this location.

Malignant Transformation of a Neurenteric Cyst in the Posterior Fossa Presenting with Intracranial Metastasis: A Case Report and Literature Review

Malignant Transformation of a Neurenteric Cyst in the Posterior Fossa Presenting with Intracranial Metastasis: A Case Report and Literature Review

PO-0739 An Unusual Case Of Neonatal Respiratory Distress : Case Report

Background Neurenteric cysts are the association of an endodermal cyst with a vertebral dysplasia. This congenital malformation can be asymptomatic or manifest itself through respiratory signs due to airway compression. Case report A male newborn, from normal vaginal delivery at 40 weeks of gestation, weighing 4000 g with Apgar score of 8 and 9 at 1 and 5 min was referred to the neonate intensive care unit. The clinical findings showed tachypnea, mild intercostals retraction and there was diminished air-entry on the right side. The chest X-ray showed vertebral anomalies in the midthoracic region, there was an hydric opacity occupying the 2:3 of the right side with deviation of the mediastinum to the left side. The CT scan of the chest revealed butterfly and hemi-vertebrae of the upper thorax. There was a large posterior mediastinal cystic mass partitioned by multiple septa on the inferior right side. On fifth day, the patient underwent a right thoracotomy. A large cystic mass attached to the oesophagus wall was exised, Histopathology favours the diagnosis of neurenteric cyst. Postoperatively outcomes were poor, the operation was complicated by bilateral chylothorax diagnosed on 10 th post-operative day and increasing oxygen needs. The newborn died on the 16 th postoperative day in a severe sepsis. Conlusion Antenatal diagnosis of this malformation is not easy but possible. In post-natal, the radiological approach based on chest x-ray and CT scan, is helpful for establishing the diagnosis and lead to a prompt curative surgery.

Ventral Foramen Magnum Neurenteric Cysts: Case Series and Review of Literature

Introduction: Neurenteric cysts are uncommon, benign, and congenital lesions. Foramen magnum location is very rare. Authors report four cases of neurenteric cyst at the foramen magnum situated ventral to the cervicomedullary junction, all managed surgically. The difficulties in diagnosis and management are discussed along with review of the pertinent literature. Material and Methods: Retrospective chart review of patients diagnosed and operated from 2010 to 2013 with a diagnosis of ventral foramen magnum neurenteric cyst. Results: Mean age group was 27.5 years (range, 14-55 years). Male:female ratio was 3:1. Mean duration of presentation was 7 months (range, 4-12 months). Presenting symptoms were: suboccipital pain (n = 3), LCN paresis (n = 2), long tract signs (n = 1), and gait ataxia (n= 1). Mean size of the cyst was 2.8 cm (1.7-4.8 cm). Lesions were hypointense and hyperintense on T1WI in one and three cases, respectively. The surgical approaches utilized were: lateral suboccipital (n = 1), far lateral (n = 2), and retromastoid (n = 1). Thick milky and gelatinous contents were seen in two cases each. Near-total excision was performed in three cases while marsupialization was done in a single case. Mean follow-up was 16.5 months (3-36 months). Conclusions: Foramen magnum neurenteric cysts are rare, benign tumors of central nervous system. Exact preoperative diagnosis can usually be established with MRI. Surgical removal is the treatment of choice. Complete excision can rarely be achieved and must not be attempted aggressively. Near-total removal leads to good long-term control. Long-term follow-up with radiological studies is necessary as delayed recurrences can occur.

Kystes neurentériques de l’orbite. À propos d’un cas et revue de la littérature

IntroductionNeurenteric cysts defined as a cyst lined by endodermal-type epithelium are extremely rare. We report a rare case of an orbital neurenteric cyst. Case reportA 19-year-old female presented with an orbital cyst tumor that had cosmetic consequences. The signal of the cyst was not enhanced after administration of gadolinium on MRI examination. The patient underwent surgery due to the increase in size of the tumor. A complete cyst removal including the cyst wall through the inferior palpebral fold was performed. The histological examination confirmed the diagnostic of neurenteric cyst. The patient was discharged home in excellent condition. ConclusionThis report discusses the clinical presentation, neuroradiological aspect, pathological findings and therapeutic consideration of the neurenteric cyst. We described a rare case of orbital neurenteric cyst. Due to the local recurrence rate observed after partial resection, the goal of the surgery should be a total resection of the cyst with the cyst wall.

Scoliosis-Associated Cervical Spine Pathologies

Study DesignA total of 126 scoliosis patients admitted to the hospital were screened for concomitant cervical pathologies. ObjectivesTo investigate the prevalence of cervical spine pathologies and the clinical relevance of magnetic resonance imaging (MRI) in the evaluation of patients with neuromuscular, congenital, syndromic, and idiopathic scoliosis. Background SummaryWith the development of MRI, upper neural axis abnormalities such as syringomyelia and Chiari malformation are increasingly being found in patients with scoliosis, but no report in the literature describes other pathologies in the cervical area seen concomitant with different scoliosis types. MethodsA total of 126 consecutive patients who were classified as having neuromuscular, congenital, syndromic, and idiopathic scoliosis were retrospectively evaluated. Data regarding cervical neural axis abnormalities obtained from the MRI studies were analyzed and classified into each type of scoliosis group. ResultsA total of 126 patients with scoliosis were evaluated for hindbrain and cervical spine anomalies. Patients were divided into 4 groups regarding the type of scoliosis. The cervical spine of all patients was evaluated with MRI and other radiologic methods when needed. The most frequently seen pathology was syringomyelia. Other pathologies found included congenital vertebral anomalies, Chiari malformation, arachnoid cyst, atlanto-axial dissociation, split cord, posterior vertebral fusion, vertebral hypoplasia, neurenteric cyst, myelomalacia, dermoid cyst, and decrease in craniovertebral angle. Cervical pathologies were most frequently seen in neuromuscular scoliosis, followed by congenital and syndromic groups. ConclusionsCervical spinal pathologies vary according to the type of scoliosis. The number of cervical spinal pathologies diagnosed in idiopathic scoliosis patients was least compared with neuromuscular and syndromic groups. The most common pathology was syringomyelia, followed by congenital vertebral anomalies and cerebral tonsillar hernia. Preoperative MRI scan provides vital information regarding cervical spinal pathologies encountered in scoliosis patients.

Incidental findings on cone beam computed tomographic images: a Pandora's box?

Incidental findings on cone beam computed tomographic images: a Pandora's box?

Neurenteric cyst of the area postrema.

Neurenteric cysts are CNS lesions most frequently occurring in the spinal cord. Intracranial neurenteric cysts are rarer, typically presenting with headache, mass effect, or location-specific symptoms. The area postrema is known as the emetic center of the brain; lesions can cause nausea and vomiting. Our case, featuring a neurenteric cyst of the area postrema, illustrates the importance of considering a neurological etiology for nonspecific symptoms that otherwise elude explanation. Our patient presented with acute decompensated hydrocephalus upon exploratory abdominal laparoscopy for unresolving abdominal pain. The patient had an eight-month history of unexplained intermittent nausea, vomiting, and abdominal pain. These bouts increased in frequency during the weeks before acute presentation, prompting exploratory abdominal laparoscopy. The acute decompensation was managed by ventriculostomy, and cranial MRI revealed a cystic mass by the floor of the fourth ventricle. After the patient stabilized and returned to neurological baseline, suboccipital craniectomy and resection were performed. The mass was histologically identified as a neurenteric cyst. The patient was free from neurological complaints at one-year follow-up, indicating that the successful resection of the area postrema-associated neurenteric cyst resolved her previous symptoms. Thus, some intracranial lesions can masquerade as nonspecific symptoms, presenting a challenge to accurate diagnosis.

A case report of craniovertebral junction intradural extramedullary neurenteric cyst

A neurenteric cyst of the craniocervical (CV) junction, as a cause of bulbomedullary compression, is very rare. An abnormal communication between the endoderm and neuroectoderm during the third week of embryogenesis may be responsible for its formation. It is a rare spinal condition. The most frequent location is at the lower cervical and higher thoracic spine. Neurenteric cysts of the craniocervical junction are even rarer. We report the case of a CV junction intradural neurenteric cyst. <br>Magnetic Resonance Imaging (MRI) of our patient demonstrated an intradural extramedullary process of the craniocervical junction. A surgical posterior approach allowed gross total resection of the lesion. The histopathology of the surgical specimen showed that the cyst wall was made up of fibrocollagen walls lined with a partially ciliated columnar epithelium.

Neurenteric cyst at the craniovertebral junction: A report of two cases

Neurenteric cysts at the craniovertebral junction are extremely rare, in that most are located ventrally in the midline. We report two patients with neurenteric cysts in an unusual location – the lateral craniovertebral junction. The embryological basis, clinical features, imaging characteristics, and management options in these patients have been discussed.

Complex forms of spinal dysraphism

Spinal dysraphisms are a heterogeneous group of congenital malformations involving the bony component of vertebrae or spinal cord or both. Simple forms include the contiguous, solitary malformations such as myelomeningocele and diastematomyelia, and can be either aperta or occulta type. Complex forms include various types of spinal malformations occurring in combination, one type of malformations occurring at multiple levels in noncontiguous manner or spinal dysraphisms with other organ anomalies. Anomalous development in gastrulation, primary neurulation, and secondary neurulation stage in variable proportions give rise to these types of complex malformations. These cases can be diagnosed postnatally in early infancy by the strong clinical suspicion, supplemented by whole spinal axis and cranial magnetic resonance imaging (MRI) screening, to detect any occult spinal dysraphisms like split cord malformations, neurenteric cyst, lipoma, or cranial anomalies like Chiari malformations and hydrocephalus. Computed tomography and MRI are the gold standard to detect bony anomalies and cord malformations, respectively. Complex spinal dysraphisms, to our mind, should always be tried to be corrected in single operative stage, however, in case of ruptured defects, correction through multiple operations can be considered. Overall, prognosis of complex forms of spinal dysraphism is poor in comparison to their simple forms and depends on preoperative neurological status and the nature of complex dyraphism. We discuss the classification, embryogenesis, investigation, and treatment protocol with review of literature of such complex anomalies.