Abstract
Background
Intradural cysts of the spine are arachnoid cysts, neuroenteric cysts, and ependymal cysts. The usual finding in case of a neurenteric cyst is a ventrally located non-contrast-enhancing lesion that is isointense on T1-weighted sequence and hyperintense on T2-weighted imaging. An arachnoid cyst is hypointense in T1-weighted image and hyperintense in T2-weighted image, mimicking cerebrospinal fluid(CSF), and the location is dorsal to the cord. But a neurenteric cyst can mimic an arachnoid cyst in appearance.
Case
A 48-yr old autorikshaw driver presented with weakness of fingers and lower limbs. All sensations were decreased below xiphisternum(T6). The gait was spastic. Magnetic Resonance Imaging(MRI) showed an extramedullary intradural cyst at C7-T1 level. It was hypointense on T1-weighted image and hyperintense on T2-weighted image. There was no enhancement with contrast. C7/T1 Laminectomy was done. On gentle retraction of the cord, a whitish cyst was seen. Some clear fluid was aspirated and cyst was excised en toto. Myelopathy improved over two weeks. Histopathological examination showed a cyst wall composed of fibrocollagenous tissue, and lined by pseudostratified epithelium containing many goblet cells and having focal ciliation. The findings were consistent with neurenteric cyst. Follow-up MRI after five years showed no recurrence.
Conclusion
To our knowledge, the peculiarities of the case are that the radiological features mimicked arachnoid cyst in having the intensity of CSF. But the ventral location was suggestive of a neurenteric cyst. Total excision could be done through the posterior approach after decompressing the cyst by aspiration.
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References
Sun, J. Classification, mechanism and surgical treatments for spinal canal cysts. Chin NeurosurgJl. 2, 7 (2016). https://doi.org/10.1186/s41016-016-0022-y.
Savardekar A, Singla N, Mohindra S, Ahuja CK, Gupta SK. Cystic spinal schwannomas: a short series of six cases. Can we predict them preoperatively? SurgNeurol Int. 2014;5:S349–53. https://doi.org/10.4103/2152-7806.139666.
Osenbach RK, Godersky JC, Traynelis VC, Schelper RD. Intraduralextramedullary cysts of the spinal canal: clinical presentation, radiographic diagnosis, and surgical management. Neurosurgery 1992;30:35–42.
Savage JJ, Casey JN, McNeill IT, Sherman JH. Neurenteric cysts of the spine. JCraniovertebr Junction Spine. 2010;1:58–63. https://doi.org/10.4103/0974-8237.65484.
Menezes AH, Traynelis VC. Spinal neurenteric cysts in the magnetic resonance imaging era. Neurosurgery. 2006;58:97–105. https://doi.org/10.1227/01.neu.0000192160.
Holcomb GW,Jr, Matson DD. Thoracic neurenteric cyst. Surgery. 1954;35:115–21.
Baek WK, Lachkar S, Iwanaga J, Oskouian RJ, Loukas M, Oakes WJ, et al. Comprehensive review of spinal neurenteric cysts with a focus on histopathological findings. Cureus. 2018;10:e3379 https://doi.org/10.7759/cureus.3379.
Kida K, Tani T, Kawazoe T, Hiroi M. A recurrent cervical neurenteric cyst treated anteriorly: safe, gross-total excision facilitated by prophylactic unilateral vertebral artery exposure, microdissection, and spinal cord monitoring-a case report and technical note. Case Rep Orthop. 2018;2018:7620182 https://doi.org/10.1155/2018/7620182.
Oyama H, Ikeda A, Inoue S, Nakamura S, Nishimura Y, Shibuya M. et al. Multiple neurenteric cysts in the posterior fossa and cervical spinal canal-case report. Neurol Med Chir (Tokyo). 2004;44:146–9.
de Oliveira RS, Cinalli G, Roujeau T, Sainte-Rose C, Pierre-Kahn A, Zerah M, et al. Neurenteric cysts in children: 16 consecutive cases and review of the literature. J Neurosurg. 2005;103:512–23. https://doi.org/10.3171/ped.2005.103.6.0512.
Vinters HV, Gilbert JJ. Neurenteric cysts of the spinal cord mimicking multiple sclerosis. Can J Neurol Sci. 1981;8:159–61. https://doi.org/10.1017/s0317167100043092. MayPMID: 7296425
Garg N, Sampath S, Yasha TC, Chandramouli BA, Devi BI, Kovoor JM, et al. Is total excision of spinal neurenteric cysts possible? Br J Neurosurg. 2008;22:241–51. https://doi.org/10.1080/02688690701818919.
Rauzzino MJ, Tubbs RS, Alexander E 3rd, Grabb PA, Oakes WJ. Spinalneurenteric cysts and their relation to more common aspects of occult spinal dysraphism. Neurosurg Focus. 2001;10:e2 https://doi.org/10.3171/foc.2001.10.1.3.
Miyagi K, Mukawa J, Mekaru S, Ishikawa Y, Kinjo T, Nakasone S. Enterogenous cyst in the cervical spinal canal. Case report JNeurosurg. 1988;68:292–6. https://doi.org/10.3171/jns.1988.68.2.0292.
Sasani M, Ozer AF, Oktenoglu BT, Peker K, Bozkus MH, Sarioglu AC, et al. Excision of an asymptomatic cervical intraduralneurenteric cyst through the anterior approach: a study of two cases and a review of the literature. Spine J. 2007;7:720–7. https://doi.org/10.1016/j.spinee.2006.12.010.
Muzumdar D, Bhatt Y, Sheth J. Intramedullary cervical neurenteric cyst mimicking an abscess. PediatrNeurosurg. 2008;44:55–61. https://doi.org/10.1159/000110664.
Paolini S, Ciappetta P, Domenicucci M, Guiducci A. Intramedullary neurenteric cyst with a false mural nodule: case report. Neurosurgery. 2003;52:243–5. https://doi.org/10.1097/00006123-200301000-00033.
Devkota UP, Lam JM, Ng H, Poon WS. An anterior intraduralneurenteric cyst of the cervical spine: complete excision through central corpectomy approach-case report. Neurosurgery. 1994;35:1150–3. https://doi.org/10.1227/00006123-199412000-00021.
Takase T, Ishikawa M, Nishi S, Aoki T, Wada E, Owaki H, et al. A recurrent intradural cervical neurenteric cyst operated on using an anterior approach: a case report. Surgical Neurol. 2003;59:34–9. https://doi.org/10.1016/s0090-3019(02)01001-7.
Abhishek A, Anushree A, Patir R, Sehgal AD. Extreme lateral approach in a case of acute-onset quadriplegia due to high cervical neurenteric cyst. PediatrNeurosurg. 2007;43:134–6. https://doi.org/10.1159/000098388.
Song JK, Burkey BB, Konrad PE. Lateral approach to a neurenteric cyst of the cervical spine: case presentation and review of surgical technique. Spine (Philos Pa 1976). 2003;28:E81–5. https://doi.org/10.1097/01.BRS.0000049225.46912.BA.
Chen CT, Lai HY, Jung SM, Lee CY, Wu CT, Lee ST. Neurenteric cyst or neuroendodermal cyst? immunohistochemical study and pathogenesis. World Neurosurg. 2016;96:85–90. https://doi.org/10.1016/j.wneu.2016.08.089.
Pant I, Chaturvedi S. Spectrum of histopathology in spinal lesions. Astrocyte. 2016;2:187–99.
Acknowledgements
We acknowledge Dr.Jayalakshmi Panicker Balakrishna for her pathology opinion in this work.
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Unnithan, A.K.A. A case of neurenteric cyst of spine mimicking an arachnoid cyst. Spinal Cord Ser Cases 8, 31 (2022). https://doi.org/10.1038/s41394-022-00500-2
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DOI: https://doi.org/10.1038/s41394-022-00500-2
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