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Pop MM, Bouros D, Klimko A, Pop LA, Topal P, Topal A, Florian IS. Tumor-Like Lesions in the Craniovertebral Junction: A Case Series, Systematic Review, and Meta-Analysis. Cancers (Basel) 2024; 16:2788. [PMID: 39199561 PMCID: PMC11352424 DOI: 10.3390/cancers16162788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 09/01/2024] Open
Abstract
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.
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Affiliation(s)
- Maria Mihaela Pop
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400347 Cluj-Napoca, Romania;
| | - Dragos Bouros
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400347 Cluj-Napoca, Romania;
| | - Artsiom Klimko
- Laboratory of Molecular Neuro-Oncology, Department of Neurology, University Hospital Zurich, 8091 Zürich, Switzerland;
| | - Laura Ancuta Pop
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Paula Topal
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400347 Cluj-Napoca, Romania;
| | - Anil Topal
- Faculty of Medicine, Inonu University, 44000 Malatya, Turkey;
| | - Ioan Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400347 Cluj-Napoca, Romania;
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Yagnik KJ, Vakharia K, Vaubel RA, Vizcaino MA, Benson JC, Daniels DJ, Link MJ, Van Gompel JJ. Surgical Experience and Management of Intracranial Neurenteric Cysts: Single-Center Experience and Review of the Literature. J Neurol Surg B Skull Base 2023; 84:272-280. [PMID: 37180870 PMCID: PMC10171931 DOI: 10.1055/a-1775-0865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022] Open
Abstract
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.
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Affiliation(s)
- Karan J. Yagnik
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kunal Vakharia
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Rachael A. Vaubel
- Department of Pathology, Mayo Clinic, Rochester, Minnesota, United States
| | | | - John C. Benson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - David J. Daniels
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael J. Link
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
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Nosov IO, Kislyakov AN, Livshits MI, Lobankin PV, Chmutin GE, Musa G. Pineal region neuroenteric cyst in a 13-year-old girl: A rare localization with postoperative recurrence and local dissemination. Surg Neurol Int 2022; 13:287. [PMID: 35855119 PMCID: PMC9282732 DOI: 10.25259/sni_312_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/18/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Neuroenteric cysts are rare cystic benign neoplasms of the central nervous system most often located in the spinal cord and rarely, intracranially. The nonspecific neuroimaging features make management planning potentially challenging. We present a case of a radiologically misdiagnosed neurenteric cyst with a complicated course.
Case Description:
A 13-year-old girl presented with a 6-month history of headache, tinnitus, and dizziness. Initial magnetic resonance images (MRIs) were indistinguishable from a pineal arachnoid cyst with aqueductal stenosis and hydrocephalus. Cyst fenestration was performed through an infratentorial supracerebellar approach. Histology revealed a neurenteric cyst. On day 10 postoperatively, she deteriorated with acute hydrocephalus and cyst enlargement. An external ventricular drain was inserted. She remained asymptomatic thereafter. At 1-year postoperative, the patient remains asymptomatic despite the MRI showing cyst enlargement and local dissemination in the form of multiple cystic lesions in the cerebellum along the operative corridor. The patient was managed conservatively considering adhesion noted intraoperatively.
Conclusion:
Neuroimaging features of brain cystic lesions may be nonspecific. Special attention should be awarded to posterior fossa and paramedian cystic lesions. Rarer lesions like neurenteric cysts should also be considered. When in doubt, we recommend using the following methods to prevent the free outflow of the cyst contents into the subarachnoid space: lining the cyst and operative corridor with cotton wool and puncture opening and suctioning of fluid. However, the “gold standard” remains surgical treatment with radical excision of the endodermal cyst capsule. It is necessary to preassess the possibility of total or subtotal resection.
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Affiliation(s)
- Ilya O. Nosov
- Department of Neurological diseases and Neurosurgery, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Alexei N. Kislyakov
- Department of Pathological Anatomy, Morozov Children’s City Clinical Hospital, Moscow, Russia
| | - Matvey I. Livshits
- Department of Neurosurgery, Morozov Children’s City Clinical Hospital, Moscow, Russia
| | - Pavel V. Lobankin
- Department of Neurosurgery, Morozov Children’s City Clinical Hospital, Moscow, Russia
| | - Gennady E. Chmutin
- Department of Neurological diseases and Neurosurgery, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
| | - Gerald Musa
- Department of Neurological diseases and Neurosurgery, Peoples Friendship University of Russia (RUDN University), Moscow, Russia
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Pettersson SD, Ali S, Burmaka P, Fercho J, Szmuda T, Abuhaimed A, Alotaibi Y, Słoniewski P, Krakowiak M. Predictors for complete surgical resection of posterior fossa neurenteric cysts: A case report and meta-analysis. Surg Neurol Int 2021; 12:530. [PMID: 34754580 PMCID: PMC8571428 DOI: 10.25259/sni_723_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/16/2021] [Indexed: 11/04/2022] Open
Abstract
Background Incomplete resection of neurenteric cysts (NCs) has been associated with increased recurrence rates in patients compared to complete resection (CR) and information on intracranial NCs appearance on diagnostic imaging is scarce. We sought to identify factors associated with CR and provide the largest up-to-date review of NCs appearances on various diagnostic images. Methods Data from Medline, EMBASE, and Web of Science were extracted. Univariate and multivariate logistic regression models were used to analyze factors associated with CR. Results A total of 120 publications reporting 162 original cases on posterior fossa NCs met the inclusion criteria for analysis. Eighty-nine (55.6%) of the patients were female, the mean (SD) age of the patients' during operation was 34.3 (16.9) years, and CR was achieved in 98 (60%) of patients. Univariate analysis identified male sex as a statistically significant predictor for complete reaction (OR 2.13, 95% Cl 1.10-4.11, P = 0.02). The retrosigmoid approach (OR 1.89, 95% Cl 0.98-3.63, P = 0.06), far lateral approach (OR 0.46, 95% Cl 0.21-1.02, P = 0.06), and pediatric patient (OR 2.45, 95% Cl 0.94-6.56, P = 0.07) may be possible predictors for CR, however, they were not statistically significant. NCs are mainly hypodense on CT (32 [61.5%]), varied greatly in intensity on T1WI, hyperintense on T2WI magnetic resonance imaging (98 [67.1%]), and hyperintense on fluid-attenuated inversion recovery (17 [63.0%]). Conclusion We recommend utilizing various diagnostic imaging tests to help reduce misdiagnoses when identifying intracranial NCs. For patient safety, CR should be achieved when possible, to reduce risk of additional operations due to recurrence.
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Affiliation(s)
- Samuel D Pettersson
- Department of Neurosurgery, Scientific Circle of Neurology and Neurosurgery, Pomeranian Voivodeship, Poland
| | - Shan Ali
- Department of Neurosurgery, Scientific Circle of Neurology and Neurosurgery, Pomeranian Voivodeship, Poland
| | - Pavlo Burmaka
- Department of Neurosurgery, Scientific Circle of Neurology and Neurosurgery, Pomeranian Voivodeship, Poland
| | - Justyna Fercho
- Department of Neurosurgery, Scientific Circle of Neurology and Neurosurgery, Pomeranian Voivodeship, Poland
| | - Tomasz Szmuda
- Department of Neurosurgery, Medical University of Gdansk, Gdansk, Pomeranian Voivodeship, Poland
| | - Ahmed Abuhaimed
- Department of Neurosurgery, Scientific Circle of Neurology and Neurosurgery, Pomeranian Voivodeship, Poland
| | - Yazeed Alotaibi
- Department of Neurosurgery, Scientific Circle of Neurology and Neurosurgery, Pomeranian Voivodeship, Poland
| | - Paweł Słoniewski
- Department of Neurosurgery, Medical University of Gdansk, Gdansk, Pomeranian Voivodeship, Poland
| | - Michał Krakowiak
- Department of Neurosurgery, Medical University of Gdansk, Gdansk, Pomeranian Voivodeship, Poland
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Krivoshapkin A, Sergeev G, Gaytan A, Salim N, Krotenkova I, Savitskiy I, Bulanov D, Yasieva M, Abdullaev O. A case report: Malignant transformation of a neurenteric cyst with intracranial metastases mimicking neurocysticercosis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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[Nonneoplastic lesions of the spinal canal]. Radiologe 2021; 61:283-290. [PMID: 33566131 DOI: 10.1007/s00117-021-00829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
Numerous vascular, inflammatory, degenerative and tumorous lesions of the spinal canal can cause paraplegic symptoms. In addition to the neurological examination and the leading symptoms, the first topographical classification of the (suspected) disease is essential for further diagnostics. Hence, high-resolution magnet resonance imaging (MRI) is the gold standard for the majority of questions. To avoid diagnostic and therapeutic mistakes, differentiation of intraspinal tumors from tumor-like (nonneoplastic) lesions is indispensable, which is often only possible after follow-up imaging or surgical exploration.
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Salehani A, Howell S, Harmon D. Management of a cervical spine neurenteric cyst via an anterior surgical approach: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE20119. [PMID: 35854698 PMCID: PMC9241353 DOI: 10.3171/case20119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022]
Abstract
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. 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. OBSERVATIONS A 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. LESSONS A 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.
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Affiliation(s)
- Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Sasha Howell
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Daniel Harmon
- Department of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, Alabama
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Intracranial neurenteric cyst: A case report and differential diagnosis of intracranial cystic lesions. Radiol Case Rep 2020; 15:2649-2654. [PMID: 33093931 PMCID: PMC7568188 DOI: 10.1016/j.radcr.2020.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022] Open
Abstract
Neurenteric cysts are uncommon, benign lesions that are rarely located intracranially. These cysts are likely due to aberrant embryologic development of the notochord. Clinically, neurenteric cysts may present with symptoms of mass effect, or they can be asymptomatic and incidentally discovered. Imaging features of neurenteric cysts have significant overlap with other intracranial cystic lesions, which can make diagnosis difficult. We present a case of a 35-year-old female with a histopathologically confirmed neurenteric cyst in the premedullary and left cerebellomedullary cistern, with associated symptoms of headache, dizziness, tinnitus, and dysphagia. The patient underwent surgical resection, with improvement in symptoms. We present a review of literature, and a discussion of typical features of multiple intracranial cystic lesions. We hope to promote accurate preoperative diagnosis, to allow for appropriate surgical technique to reduce the risk of recurrence.
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9
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Neurenteric cysts at foramen magnum in children: presentation, imaging characteristics, and surgical management-case series and literature review. Childs Nerv Syst 2020; 36:1379-1384. [PMID: 32322975 DOI: 10.1007/s00381-020-04604-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Neurenteric cysts (NEC) are rare benign tumors of the central nervous system. Even more rare are the NEC at the ventral foramen magnum in children that are misdiagnosed. They cause distortion of the vertebrobasilar vascular system and cervicomedullary neural structures and are adherent to the latter. The inferior portion lies ventral to the upper most dentate ligament. This has implications in the surgical approach for complete excision. METHODS AND CASE SERIES We reviewed our series of five children with ventral foramen magnum NEC in the MRI era and analyzed presentation, radiological findings and surgical management. A literature review is also presented. RESULTS There were two females and five males. Headache and neurological deficit was present in all five; one child presented with recurrent meningitis. The NEC was present ventral to the cervicomedullary junction in all cases. The posterolateral transcondylar approach was used for complete excision with no recurrences. CONCLUSIONS Neurenteric cysts at the ventral foramen magnum can be confused with other cystic lesions. Headaches are the most common presentation. The posterolateral transcondylar approach to the ventral cervicomedullary junction provides the most reliable avenue for entire resection.
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Agresta G, Sokol D, Kaliaperumal C, Kandasamy J, Gallo P. A novel management proposal for intrinsic brainstem neurenteric cysts: case report. J Neurosurg Pediatr 2020; 25:83-87. [PMID: 31628284 DOI: 10.3171/2019.8.peds19336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022]
Abstract
Neurenteric cysts (NCs) are rare congenital lesions with epithelial mucin-secreting walls. They can occur anywhere along the neural axis, and an intrinsic midbrain cyst is extraordinary. Surgical management may pose a challenge due to the location of the lesion and adhesion of the cyst wall to the surrounding brainstem. The authors describe the first case of pediatric NC that was treated successfully with intracystic interferon-α (IFN-α).A 16-month-old baby girl presented with a 2-week history of progressive croup, vomiting, and swallowing difficulty. MRI revealed a 1.8-cm cystic intrinsic lesion in the pontomedullary region. She initially underwent posterior fossa craniotomy and drainage of the cyst under intraoperative neurophysiology monitoring. Three weeks following the procedure, her symptoms recurred, and follow-up MRI demonstrated cystic recurrence. She underwent repeat aspiration of the cyst and biopsy of the cyst wall, and INF-α-2b was injected into the cystic cavity. Her symptoms improved and completely resolved after 5 months. A 9-month follow-up brain MRI study showed complete resolution of the NC. Intracystic IFN-α injection after cystic content aspiration may be a safe treatment option for the management of intrinsic brainstem NCs. Long-term clinical and radiological follow-up is recommended.
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Agrawal M, Dharanipathy S, Nakra T, Garg K, Gurjar H, Mishra S, Singh M, Chandra PS. Supratentorial Neurenteric Cyst: A Rare Differential for a Frontal Cyst. World Neurosurg 2019; 129:140-142. [PMID: 31426248 DOI: 10.1016/j.wneu.2019.05.246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Abstract
Supratentorial neurenteric cyst is a rare entity. They are usually isointense to slightly hyperintense on T1W images and hyperintense on T2-weighted/fluid attenuated inversion recovery images. There was a diagnostic dilemma in this case due to the cerebrospinal fluid intensity of the cyst on magnetic resonance imaging. Postoperative residual lesion predisposes to hemorrhage and seizures.
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Affiliation(s)
- Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Tripti Nakra
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Hitesh Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Uno T, Hayashi Y, Sasagawa Y, Miyamori T, Oishi M, Nakada M. A suprasellar colloid cyst over an 11-year follow-up: case report and literature review. World Neurosurg 2019; 124:261-266. [PMID: 30664960 DOI: 10.1016/j.wneu.2018.11.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Colloid cysts (CCs) are rare cystic lesions derived from the endoderm of the central nervous system. Although they appear most commonly in the anterior roof of the third ventricle, there are only a few reports of CCs located in the suprasellar region. Although CCs are considered to be slow-growing benign tumors, their developmental process remains unclear. CASE DESCRIPTION A 6-year-old boy was referred to our hospital for a mild head injury. Head computed tomography scan revealed a round, hyperdense suprasellar lesion, while magnetic resonance (MR) imaging depicted the mass as an isointense lesion with multiple highly hypointense spots on T2-weighted imaging. Although this lesion had been managed conservatively with annual MR imaging follow up, its size gradually increased, resulting in an increase in diameter by a factor of 1.5 over an 11-year period. The doubling time of this tumor was estimated to be approximately a 7 years. Despite its asymptomatic nature, the cystic lesion was totally resected when the patient was 17 years of age using an endoscopic endonasal approach to make a definitive histological diagnosis and prevent the occurrence of neurological symptoms. The postoperative course was uneventful, and the histological diagnosis of the surgical specimen was consistent with CC. CONCLUSIONS This case suggests that CC may be one of several possible diagnoses in patients who present with suprasellar cystic lesions. Even if CCs in the suprasellar region remain asymptomatic, radiological follow-up is required due to possible progressive enlargement of the cyst.
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Affiliation(s)
- Takehiro Uno
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
| | - Yasuo Sasagawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Tadao Miyamori
- Department of Neurosurgery, Toyama Municipal Hospital, Toyama, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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13
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Giant Craniospinal Intramedullary Neurenteric Cyst in Infant—Case Report and Review of Literature. World Neurosurg 2018; 118:126-131. [DOI: 10.1016/j.wneu.2018.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 11/23/2022]
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14
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Weng JC, Ma JP, Hao SY, Wang L, Xu YL, Yang J, Jia WQ, Wu Z, Zhang LW, Li D, Zhang JT. Intradural Extramedullary Bronchogenic Cyst: Clinical and Radiologic Characteristics, Surgical Outcomes, and Literature Review. World Neurosurg 2018; 109:e571-e580. [DOI: 10.1016/j.wneu.2017.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/16/2022]
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15
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Reddy R, Kumar M, Bhattacharjee S. Atypical location of unusual supratentorial neurenteric cyst: a case report. Br J Neurosurg 2017; 33:696-698. [PMID: 29228813 DOI: 10.1080/02688697.2017.1409880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a case of a right anterior clinoid process (ACP) neurenteric cyst which presented with gradual impairment of vision in the right eye. Imaging suggested an infective cystic lesion. In view of rapid visual loss urgent surgery was conducted. Erosion of the ACP was found from where white mucus like material was aspirated. The cyst wall was completely excised. Immunohistochemistry indicated an endodermal origin of the cyst.
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Affiliation(s)
- Ramanadha Reddy
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Telangana, India
| | - Mahesh Kumar
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Telangana, India
| | - Suchanda Bhattacharjee
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Telangana, India
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16
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Kent M, Glass EN, Miller AD, de Lahunta A. Neuroendodermal cyst in the fourth ventricle of a dog. Aust Vet J 2017; 95:294-298. [PMID: 28749028 DOI: 10.1111/avj.12613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/24/2016] [Accepted: 11/29/2016] [Indexed: 01/28/2023]
Abstract
CASE REPORT We describe the MRI appearance and surgical outcome of a rare neuroendodermal cyst in the fourth ventricle of a German Shorthaired Pointer. The dog presented with uncoordinated gait and occasional falling that increased when she became excited. The MRI appearance is shown and the surgical treatment described. Recurrence occurred on two occasions and the dog was euthanased. CONCLUSION Recurrence of these cysts is highly likely unless there is complete surgical resection.
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Affiliation(s)
- M Kent
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 2200 College Station Road, Athens, GA 30605, USA
| | - E N Glass
- Section of Neurology and Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, NJ, USA
| | - A D Miller
- Section of Anatomic Pathology, Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - A de Lahunta
- Section of Anatomic Pathology, Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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Bao XJ, Li XY, Wang QP, Ren XY, Liang ZY, Ma WB, Wang RZ, Wei JJ. Intraparenchymal endodermal cyst with spontaneous intracystic hemorrhage in the temporal lobe of an adult. Medicine (Baltimore) 2016; 95:e4968. [PMID: 27861331 PMCID: PMC5120888 DOI: 10.1097/md.0000000000004968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Endodermal cysts (EC) are rare but well-known congenial lesions of the central nervous system mainly located in the spinal subdural space. Intracranial ECs are rare and commonly encountered in the posterior cranial fossa as extra-axial lesions; an intraparenchymal location is exceedingly rare. A complete removal is the best surgical strategy and any residue can cause recurrence. It is necessary to exclude EC in patients with intracranial cystic lesions. We present a case of intraparenchymal EC with spontaneous intracystic hemorrhage in the temporal lobe of an adult. METHODS A 43-year-old man presented with headache and memory deterioration. Brain computed tomography and magnetic resonance imaging showed a slightly enhanced temporal lobe cystic lesion, which was homogenously hyperintense on T1-and T2-weighted images. There was a suspicion of brain abscess at admission. The lesion was totally removed with a left subtemporal craniotomy. Histological examination revealed an EC with intracystic hemorrhage. RESULTS The preoperative symptoms were relieved after surgery and 3-month follow-up magnetic resonance imaging found no cystic signs. CONCLUSION This case suggests that EC should be considered in the differential diagnosis of intracranial cystic lesions and a complete removal is the best strategy of choice.
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Affiliation(s)
| | | | | | - Xin-Yu Ren
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Yang Y, Fang J, Li DA, Wang L, Ji N, Zhang J. Recurrent intracranial neurenteric cyst with malignant transformation: A case report and literature review. Oncol Lett 2016; 11:3395-3402. [PMID: 27123123 DOI: 10.3892/ol.2016.4386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 01/06/2016] [Indexed: 11/06/2022] Open
Abstract
Neurenteric cysts (NCs) are uncommon congenital cystic lesions. Malignantly transformed NCs are extremely rare. The present study reports the case of a recurrent foramen magnum NC with a malignant transformation and reviews 8 previously reported cases. A 58-year-old woman with a 5-month history of occasional headaches, dizziness and vomiting presented to the Beijing Tiantan Hospital (Beijing, China) with palsy of the left cranial IX and X nerves, decreased sensation in the limbs on the right side and an ataxic gait. Magnetic resonance imaging (MRI) scans revealed a cystic mass in the left side of the foramen magnum, positioned anteriolaterally to the medulla oblongata. Surgery using a left suboccipital retrosigmoid approach was performed. The lesion was partially resected and was histopathologically diagnosed as an NC with focal hyperplasia of the epithelial cells. Additional MRI scans that were performed 25 months later revealed a solid lesion posterior to the medullar oblongata. Therefore, surgery using a suboccipital midline approach was performed. The solid lesion was sub-totally removed and was histopathologically diagnosed as a well-differentiated papillary adenocarcinoma. At 1 month post-surgery, the patient's condition worsened, eventually resulting in mortality due to respiratory failure. Based on the findings of the present case and previous literature, strict criteria for malignant-transformed NCs were created. The location distribution of malignant-transformed NCs does not coincide with the location distribution of all NCs, and malignantly transformed NCs usually occur in adult patients and present as atypical radiological features. Surgery is the optimal treatment for malignantly transformed NCs, and the effectiveness of adjuvant therapy requires additional studies.
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Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Jingyi Fang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
| | - D A Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Prasad GL, Sharma BS, Mahapatra AK. Ventral foramen magnum neurenteric cysts: a case series and review of literature. Neurosurg Rev 2015; 39:535-44. [PMID: 26662045 DOI: 10.1007/s10143-015-0687-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 07/02/2015] [Accepted: 08/09/2015] [Indexed: 11/30/2022]
Abstract
Neurenteric cysts (NEC) are uncommon, benign, congenital lesions. Ventral foramen magnum (FM) location is very rare. The difficulties in diagnosis and management aspects are detailed with a review of the pertinent literature. We report four new cases of ventral FM NEC, all managed surgically and present a literature review of ventral FM NEC. A retrospective analysis of histopathologically confirmed cases of ventral FM NEC, operated from 2010-2013 at our institute, was performed. For review, only those cases of NEC extending from the lower clivus to the C2 level constituting the foramen magnum were included. Including our four cases, a total of 47 cases were identified. The male to female ratio was 1.2:1. Mean age was 33.5 years (range 1-60 years). Neck pain and occipital headache were the most common symptoms, followed by limb weakness and cranial nerve paresis. Recurrent meningitis was noted in three cases. Hyperintensity on both T1- and T2-weighted sequences with absent enhancement was the most common finding on MRI. Surgical approaches were as follows: suboccipital (n = 21), far/extreme lateral (n = 18), retrosigmoid (n = 6), and transoral (n = 4). The extent of resection was as follows: total, 26; near total, 6; subtotal, 9; and partial, 3 cases. Cerebrospinal fluid diversion was done in four cases for intracranial hypertension. Mean follow-up duration was 26.8 months (range 1 month-9 years). Recurrence was noted in four (8.5 %) cases. One (2 %) case had malignant transformation. Mortality rate was 4 %. Foramen magnum neurenteric cysts are rare, benign tumors of the central nervous system. Accurate preoperative diagnosis can often be established with MRI. Surgical removal is the treatment of choice. Complete excision is ideal but often not possible. Near total removal would suffice with good progression-free periods. A long-term follow-up with radiological studies is necessary as delayed recurrences can occur.
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Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Bhawani Shankar Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ashok Kumar Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Chen J, Lai R, Li Z, Gao J, Li Y, Wang T, Li Y. Case Report Series and Review of Rare Intradural Extramedullary Neoplasms-Bronchiogenic Cysts. Medicine (Baltimore) 2015; 94:e2039. [PMID: 26656329 PMCID: PMC5008474 DOI: 10.1097/md.0000000000002039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/25/2015] [Accepted: 10/20/2015] [Indexed: 02/05/2023] Open
Abstract
The congenital malformation known as an intraspinal bronchiogenic cyst is a rare form of endodermal (neurenteric, enterogenous) cyst lined with respiratory tract epithelium. We describe 3 new cases of intradural extramedullary bronchiogenic cyst in the Department of Neurosurgery between the years 2006 and 2014. Three patients were performed resection of intradural extramedullary bronchiogenic cysts and finally symptoms were relieved. Taken together with 10 previous reports identified from a PubMed search, an analysis of 13 cases of intradural bronchiogenic cysts was conducted. The aim of this literature review was to provide information on histopathology, mechanisms of pathogenesis, clinical manifestations, radiographic features, and surgical strategies.Symptoms in spinal bronchiogenic cyst patients primarily depend on the local mass effect of the cyst on the spinal cord. magnetic resonance imaging, together with myelograms and computed tomography scans, is necessary to preoperative evaluation of spinal bronchiogenic cysts. The aim of surgery is total resection, although tight adhesion, ventral and intramedullary locations, and vertebral anomalies make it more challenging.
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Affiliation(s)
- Junchen Chen
- From the Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong (JC, RL, YL); and Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peaking Union Medical College, Beijing, China (ZL, JG, YL, TW)
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21
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Liu QP, Zhang JN, Zhang L, Han Z, Ma J, Zhou CW, Sun CY. An acute case of paraplegia and spinal bronchogenic cyst. J Orthop Sci 2015; 20:923-6. [PMID: 24633621 DOI: 10.1007/s00776-014-0554-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Qing-Peng Liu
- Department of Orthopaedics, 2nd Hospital of Harbin Medical University, No. 246 XueFu Road, Harbin, 150081, Heilongjiang, China
| | - Jian-Nan Zhang
- Department of Orthopaedics, 2nd Hospital of Harbin Medical University, No. 246 XueFu Road, Harbin, 150081, Heilongjiang, China
| | - Lei Zhang
- Department of Orthopaedics, 2nd Hospital of Harbin Medical University, No. 246 XueFu Road, Harbin, 150081, Heilongjiang, China
| | - Zhu Han
- Department of Orthopaedics, 2nd Hospital of Harbin Medical University, No. 246 XueFu Road, Harbin, 150081, Heilongjiang, China
| | - Jun Ma
- Department of Orthopaedics, 2nd Hospital of Harbin Medical University, No. 246 XueFu Road, Harbin, 150081, Heilongjiang, China
| | - Chang-Wei Zhou
- Department of Orthopaedics, 2nd Hospital of Harbin Medical University, No. 246 XueFu Road, Harbin, 150081, Heilongjiang, China
| | - Chong-Yi Sun
- Department of Orthopaedics, 2nd Hospital of Harbin Medical University, No. 246 XueFu Road, Harbin, 150081, Heilongjiang, China.
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22
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Chakraborty S, Priamo F, Loven T, Li J, Insinga S, Schulder M. Supratentorial Neurenteric Cysts: Case Series and Review of Pathology, Imaging, and Clinical Management. World Neurosurg 2015; 85:143-52. [PMID: 26341448 DOI: 10.1016/j.wneu.2015.08.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Neurenteric cysts are rare congenital lesions along the neuroaxis, typically found in the spine, and rarely intracranially. Here, we present 3 patients who presented to our institution during a 6-year period with supratentorial intracranial neurenteric cysts and conduct a comprehensive review of the literature to describe the salient pathology, radiologic features, and clinical issues regarding these lesions. CASE REPORTS Three patients were treated surgically for supratentorial neurenteric cysts. One patient presented in extremis, whereas the others were treated electively. Each patient presented with significantly different signs and symptoms and unique radiologic findings. All patients were neurologically intact after surgery. CONCLUSIONS Neurenteric cysts present with a variety of signs and symptoms. Given the increased use of neuroimaging, supratentorial neurenteric cysts may be encountered more frequently and are important to include on the differential diagnosis and managed accordingly. Postoperative seizures occur in more than 20%, even in patients who had no preoperative seizures. Surgery can be performed safely with good neurologic outcomes.
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Affiliation(s)
- Shamik Chakraborty
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA.
| | - Francesco Priamo
- Department of Radiology, Mount Sinai Beth Israel Hospital, Icahn School of Medicine, New York, New York, USA
| | - Tina Loven
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA
| | - Jianyi Li
- Division of Neuropathology, Department of Pathology, Hofstra-Northwell School of Medicine, Lake Success, New York, USA
| | - Salvatore Insinga
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA
| | - Michael Schulder
- Department of Neurosurgery, Hofstra-Northwell School of Medicine, Manhasset, New York, USA
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23
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Breshears JD, Rutkowski MJ, McDermott MW, Cha S, Tihan T, Theodosopoulos PV. Surgical Management of Intracranial Neuroenteric Cysts: The UCSF Experience. J Neurol Surg B Skull Base 2015; 76:475-9. [PMID: 26682127 DOI: 10.1055/s-0035-1554906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
Abstract
Objective Modern surgical experience with intracranial neuroenteric cysts is limited in the literature. We review our 15-year institutional experience with these rare lesions. Design Single-institution retrospective study. Setting Large North American tertiary care center. Participants Histologically confirmed cases of intracranial neuroenteric cyst from January 2000 to September 2014. Main Outcome Measures Pre- and postoperative modified Rankin Scale (mRS) scores, extent of resection, and postoperative complications are reported. Clinical presentation, imaging features, pathology, and operative approach are discussed. Results Five spinal and six intracranial neuroenteric cysts were surgically treated over a 15-year period. Median age at presentation for the intracranial cysts was 38.5 years. Mean cyst diameter was 3.8 cm. Five cysts were located in the pre-pontomedullary cistern, and one was located in the third ventricle. Gross total resection was achieved in four of the five posterior fossa cysts through a far lateral transcondylar approach. Postoperative complications included aseptic meningitis (one), transient abducens palsy (one), and pseudomeningocele requiring reoperation (three). Postoperative mRS scores improved to ≤1 by 6.5 months median follow-up. Conclusions Intracranial neuroenteric cysts are rare lesions with a variable imaging appearance. Complete surgical resection through a far lateral transcondylar approach is possible and usually results in symptom improvement or resolution.
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Affiliation(s)
- Jonathan D Breshears
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Martin J Rutkowski
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Michael W McDermott
- Department of Neurological Surgery, University of California, San Francisco, California, United States
| | - Soonmee Cha
- Department of Radiology and Neurological Surgery, University of California, San Francisco, California, United States
| | - Tarik Tihan
- Department of Pathology, University of California, San Francisco, California, United States
| | - Philip V Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, California, United States
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24
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Choi DY, Lee HJ, Shin MH, Kim JT. Solitary cervical neurenteric cyst in an adolescent patient. J Korean Neurosurg Soc 2015; 57:135-9. [PMID: 25733997 PMCID: PMC4345193 DOI: 10.3340/jkns.2015.57.2.135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 04/02/2014] [Accepted: 05/23/2014] [Indexed: 11/27/2022] Open
Abstract
Spinal neurenteric cysts are uncommon congenital lesions, furthermore solitary neurenteric cysts of the upper cervical spine are very rare. A 15-year-old boy having an intraspinal neurenteric cyst located at cervical spine presented with symptoms of neck pain and both shoulders pain for 2 months. Cervical spine magnetic resonance (MR) imaging demonstrated an intradural extramedullary cystic mass at the C1-3 level without enhancement after gadolinium injection. There was no associated malformation on the MR imaging, computed tomography, and radiography. Hemilaminectomy at the C1-3 levels was performed and the lesion was completely removed through a posterior approach. Histological examination showed the cystic wall lined with ciliated pseudostratified columnar epithelium containing mucinous contents. Neurenteric cyst should be considered in the diagnosis of spinal solitary cystic mass.
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Affiliation(s)
- Doo Yong Choi
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Myung Hoon Shin
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
| | - Jong Tae Kim
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
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25
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Srinivas H, Kumar A. Silent neurenteric cyst with split cord malformation at conus medullaris: Case report and literature review. J Pediatr Neurosci 2015; 9:246-8. [PMID: 25624928 PMCID: PMC4302545 DOI: 10.4103/1817-1745.147579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Split cord malformations (SCM) are a common pediatric abnormality where children present with features of tethering and backache along with varying neurological deficits. Multiple neural tube defects may co-exist in children having defects of primary and/or secondary neurulation. Co-existent neurenteric cysts along with type 1 SCM have been described very rarely in the literature. We report a case of silent neurenteric cyst at conus medullaris with SCM type 1 where the cyst was missed in the preoperative imaging. Until date, only 8 such cases of neurenteric cysts with SCM at lumbar region have been reported. We review the literature regarding co-existing dual pathologies of neurenteric cysts and type 1 SCMs in light of limited capacity of imaging modalities to detect small neurenteric cysts in presence of co-existent neural tube defects. Multiple spinal neural tube defects in children need more attention and precise microneurosurgical skills as management differs in each of them. Co-existence of such pathologies detected intra-operatively may need modifications in preoperative planning to achieve the best possible outcomes.
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Affiliation(s)
- Hanuma Srinivas
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ashish Kumar
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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26
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Visvanathan V, Crowther J, Taylor W. Neurenteric cyst presenting with stridor and dysphagia: case report and literature review. Scott Med J 2014; 60:e4-7. [PMID: 25471489 DOI: 10.1177/0036933014563239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Neurenteric cysts are rare lesions that account for 0.7-1.3% of all spinal cord tumours. We report the first ever case of a neurenteric cyst presenting with stridor and dysphagia. A literature review on the presentation and management of these lesions is also included. METHODS A MEDLINE search of articles using the terms 'neurenteric cyst', 'intraspinal cyst', 'enterogenous cyst', 'intramedullary cyst' along with diagnosis, presentation and management was performed. Suitable references from these articles were also reviewed. RESULTS All published evidence on neurenteric cysts are either case series or case reports (level IV/V) with the largest case series reporting 23 patients from a single institution. CONCLUSION Neurenteric cysts are rare spinal cord lesions that usually present with focal neurological signs and managed within neurosurgical units. This is the first reported case of a neurenteric cyst presenting with upper aerodigestive tract symptoms warranting specialist ear, nose and throat input.
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Affiliation(s)
- V Visvanathan
- Specialist Trainee ENT/Head and Neck Surgery, Southern General Hospital, UK
| | - J Crowther
- Consultant ENT/Skull Base Surgeon, Southern General Hospital, UK
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27
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Janczar K, Tybor K, Papierz W. Supratentorial neurenteric cyst—A case report. Neurol Neurochir Pol 2014; 48:219-22. [DOI: 10.1016/j.pjnns.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/04/2014] [Indexed: 10/25/2022]
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Neurenteric cysts found on the outer membrane of a subdural haematoma. Case Rep Neurol Med 2013; 2013:130597. [PMID: 24106623 PMCID: PMC3784174 DOI: 10.1155/2013/130597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/01/2013] [Indexed: 11/28/2022] Open
Abstract
We report on a patient initially diagnosed with a chronic subdural haematoma that was resistant to treatment. After the second burr hole craniostomy within a half month failed to resolve the subdural haematoma (SDH), we performed a craniotomy to identify the point of bleeding. Macroscopic evaluation showed that most of the outer membrane of the SDH was transparent; however, further examination revealed the presence of multiple white regions. Pathologic examination showed that the white regions were fluid filled and surrounded by columnar ciliated epithelial cells. These lesions were pathologically diagnosed as neurenteric cysts. To our knowledge, this is the first report on a patient with neurenteric cysts found on the outer membrane of a CSDH. We agree that a craniotomy is a treatment of last resort for recurrent CSDHs; however, sometimes this procedure can be very useful for identifying underlying causes of obstinate SDHs as well as for their treatment.
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29
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Supratentorial neurenteric cyst with spontaneous repetitive intracystic hemorrhage mimicking brain abscess: a case report. Neurosurg Rev 2013; 37:153-9. [DOI: 10.1007/s10143-013-0476-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 01/17/2013] [Accepted: 03/10/2013] [Indexed: 11/30/2022]
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Al-Ahmed IH, Boughamoura M, Dirks P, Kulkarni AV, Rutka JT, Drake JM. Neurosurgical management of neurenteric cysts in children. J Neurosurg Pediatr 2013; 11:511-7. [PMID: 23452031 DOI: 10.3171/2013.1.peds1290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Neurenteric cysts (NCs) are endothelium-lined structures of presumed endodermal origin. There have been few pediatric series of intracranial NCs reported previously. The authors present their experience in the management of these lesions. METHODS A retrospective chart review of all cases of NCs identified between 1977 and 2007 was carried out. Demographics, details of clinical presentation, surgical therapy, and outcome data were extracted. RESULTS Eleven cases were identified, involving 6 girls and 5 boys. The patients' average age was 4.6 years (range 1 day-14 years). Limb weakness was the most common presenting symptom. The location of the cysts was cervical in 2 cases, cervicothoracic in 4 cases, and thoracic in 3 cases. One cyst was anterior to the pons with extension to the left cerebellopontine angle and 1 cyst was at the craniocervical junction. Five patients had an apparently complete initial excision, with 1 recurrence. Four patients were initially treated with incomplete excision and/or cyst drainage, usually into an Ommaya reservoir. A neonate with a large cervicothoracic cyst died of multiple congenital anomalies without any intervention. All other patients were alive at last follow-up. One patient with a radiologically identified presumed cyst, which remained stable, was simply followed up. Several patients required multiple procedures and 1 patient developed hydrocephalus after aseptic meningitis and was treated with CSF shunting. CONCLUSIONS Neurenteric cysts are rare in the pediatric population. Total resection, if possible, provides the best long-term outcome. Incomplete excision may lead to multiple procedures, including cyst drainage, but can lead to long-term stability.
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Affiliation(s)
- Ibrahim H Al-Ahmed
- Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada.
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31
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Natrella F, Mariottini A, Rocchi R, Miracco C. Supratentorial neurenteric cyst associated with a intraparenchymal subependymoma. BMJ Case Rep 2012; 2012:bcr.01.2012.5566. [PMID: 22891004 DOI: 10.1136/bcr.01.2012.5566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurenteric cyst is a rare developmental lesion that very infrequently is localised supratentorially. Intraparenchymal subependymoma is an even more rare benign tumour. The authors report the case of a 45-year-old gentleman with a background of drug resistant epilepsy. An MRI was performed which showed a left frontal cystic lesion with a solid component. Histopathology confirmed a type C neurenteric cyst associated with an intraparenchymal subependymoma. Following enlargement of the lesion and worsening of symptoms he was referred to our institution for further management. A frontotemporal craniotomy was performed for excision of the lesion but recurrence occurred within 1 year. The lesion was further excised and 19 months post re-excision the patient is seizure free with no evidence of recurrence on MRI.
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Affiliation(s)
- Francesco Natrella
- Department of Neurology, Neurosurgery and Behavioral Sciences, Section of Neurosurgery, University of Siena, Siena, Italy.
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32
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Gauden AJ, Khurana VG, Tsui AE, Kaye AH. Intracranial neuroenteric cysts: A concise review including an illustrative patient. J Clin Neurosci 2012; 19:352-9. [DOI: 10.1016/j.jocn.2011.10.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/09/2011] [Indexed: 10/14/2022]
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Balasubramaniam S, Tyagi DK, Sawant HV. Intramedullary enterogenous cyst of the conus medullaris presenting as lower limb pain. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2011; 2:46-8. [PMID: 22013376 PMCID: PMC3190431 DOI: 10.4103/0974-8237.85314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Enterogenous cysts account for 0.7-1.3% of spinal axis tumors. Cervical and thoracic segments are most often affected and they are rare in the lumbar region. Intramedullary variant which comprises less than 5% of enterogenous cysts are densely adherent to the surrounding tissue and preclude total excision. Partial excision is associated with recurrence and is the most common unfavorable outcome in these cysts. Hence, such patients need follow-up with serial imaging. We describe a case of conus medullaris enterogenous cyst presenting as lower limb pain. Due to dense adhesion of the cyst to the surrounding neural tissue, subtotal excision was done. The patient is symptom and tumor free at one year interval. We describe our case, discuss its uniqueness and review the literature on this rare but difficult to cure tumor.
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Savage JJ, Casey JN, McNeill IT, Sherman JH. Neurenteric cysts of the spine. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2011; 1:58-63. [PMID: 20890417 PMCID: PMC2944853 DOI: 10.4103/0974-8237.65484] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Jesse J Savage
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
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HASHIMOTO M, YAMAMOTO J, TAKAHASHI M, SAITO T, KITAGAWA T, TSUCHIMOCHI H, FUKUSHIMA Y, HARADA T, NAKASHIMA Y, NISHIZAWA S. Surgical Strategy for Intracranial Endodermal Cyst-Two Case Reports-. Neurol Med Chir (Tokyo) 2011; 51:531-4. [DOI: 10.2176/nmc.51.531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Masanori HASHIMOTO
- Department of Neurosurgery, University of Occupational and Environmental Health
| | - Junkoh YAMAMOTO
- Department of Neurosurgery, University of Occupational and Environmental Health
| | - Mayu TAKAHASHI
- Department of Neurosurgery, University of Occupational and Environmental Health
| | - Takeshi SAITO
- Department of Neurosurgery, University of Occupational and Environmental Health
| | - Takehiro KITAGAWA
- Department of Neurosurgery, University of Occupational and Environmental Health
| | | | | | - Tatsuo HARADA
- Department of Pediatrics, Fukuoka Red Cross Hospital
| | | | - Shigeru NISHIZAWA
- Department of Neurosurgery, University of Occupational and Environmental Health
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Tucker A, Miyake H, Tsuji M, Ukita T, Ito S, Matsuda N, Ohmura T. Neurenteric cyst of the lower clivus. Neurosurgery 2010; 66:E224-5. [PMID: 20023530 DOI: 10.1227/01.neu.0000361998.93841.c3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neurenteric cysts (NCs) typically arise as benign ventral intradural extramedullary developmental malformations of the spine which contain heterotopic epithelium resembling the intestinal or respiratory tracts. Intracerebral NCs are extremely rare, though the frequency of symptomatic reports and incidental findings is increasing, perhaps because of advances in neuroimaging. Recognition of the unique radiographic and histopathologic features of this entity is of growing importance in the treatment of cysts of the neural axis. We present an unusual case of an NC arising at the lower clivus. CLINICAL PRESENTATION A 58-year-old man presented with occipitalgia, diplopia, a bilateral hearing deficit, and mild dysphagia. Computed tomography and magnetic resonance imaging demonstrated a 5 x 2 x 3-cm extra-axial cystic midline mass anterior to the brainstem at the lower clivus with posterior cyst wall enhancement. INTERVENTION The patient underwent a left lateral suboccipital total macroscopic resection of the lesion. Microscopic examination and histopathologic findings were consistent with a diagnosis of NC. CONCLUSION We describe the clinical presentation, imaging, and histopathologic characteristics, and discuss the diagnosis and surgical treatment of this rare lesion and related pathologic entities. Because of the remote possibility of delayed recurrence, even in cases of apparent total cyst wall removal, long-term serial imaging and a consideration of reoperation for recurrences is advisable.
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Affiliation(s)
- Adam Tucker
- Department of Neurological Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, 12-1 Imazu Yamanaka-cho, Nishinomiya, Hyogo 663-8211, Japan. tucker @nk-hospital.or.jp
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Anterior cervicothoracic approach to an upper thoracic spinal endodermal cyst. J Clin Neurosci 2009; 16:557-9. [DOI: 10.1016/j.jocn.2008.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 06/03/2008] [Indexed: 11/23/2022]
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Wang W, Piao YS, Gui QP, Zhang XH, Lu DH. Cerebellopontine angle neurenteric cyst with focal malignant features. Neuropathology 2009; 29:91-5. [DOI: 10.1111/j.1440-1789.2008.00930.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yasuda M, Nakagawa H, Ozawa H, Inukai C, Watabe T, Mizuno J, Takayasu M. Disseminated neurenteric cyst. J Neurosurg Spine 2008; 9:382-6. [PMID: 18939927 DOI: 10.3171/spi.2008.9.10.382] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case report presents the unusual holospinal dissemination of a neurenteric cyst, which was successfully treated by fenestration and placement of a subarachnoid-peritoneal (SP) shunt. The patient was a 46-year-old Japanese woman with a history of fourth ventricle neurenteric cysts, which were managed with cyst fenestration in 1996 and 2005. She had been doing well until January 2006, when she developed dizziness and an unsteady gait. A neurological examination revealed a disturbance in the deep sensation of the feet. A neuroimaging evaluation demonstrated multiple cystic lesions in the whole spinal canal, which significantly distorted the spinal cord. Because the spinal cord distortion was the most severe in the lower cervical to upper thoracic areas, a unilateral osteoplastic laminotomy with an endoscopic cyst fenestration was performed in these areas, followed by placement of an SP shunt. The pathological diagnosis was a disseminated neurenteric cyst. There was no malignancy, and the patient has been well, with an improved gait and no signs of peritoneal dissemination, for > 1 year. The present case showed a unique extent of dissemination, which was most likely a secondary characteristic. Neurenteric cysts are well known for their tendency to recur, and total removal is usually difficult because of adhesion of the cyst membrane to important structures. The lesion also compromises cerebrospinal fluid circulation. Cyst fenestration combined with SP shunt placement might be a treatment option in such a case.
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Affiliation(s)
- Muneyoshi Yasuda
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan.
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Takumi I, Mori O, Mizutani N, Akimoto M, Kobayashi S, Teramoto A. Expansile neurenteric cyst arising in the frontal lobe associated with status epilepticus: report of a case and discussion of epileptogenesis. Brain Tumor Pathol 2008; 25:97-101. [DOI: 10.1007/s10014-008-0238-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 08/19/2008] [Indexed: 11/29/2022]
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Scarone P, Boissonnet H, Heran F, Gray F, Robert G. [Neurenteric cyst of the posterior fossa. Case report and review of the literature]. Neurochirurgie 2008; 55:45-52. [PMID: 18571207 DOI: 10.1016/j.neuchi.2008.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 03/26/2008] [Indexed: 10/22/2022]
Abstract
Intracranial neurenteric cysts are rare entities. The term is currently used to describe epithelial cysts that are lined with a presumed endodermal-derived epithelium and are mostly located in the posterior fossa. Preoperative diagnosis is often difficult because of their clinical presentation, which may resemble a subarachnoid hemorrhage, and the radiological aspect, which can mimic vascular pathologies. We describe a posterior fossa neurenteric cyst in a 27-year-old woman, who presented with sudden headache as the only symptom and who was addressed to our hospital for subarachnoid hemorrhage. Diagnostic angiography was negative and MRI revealed a prepontine cystic lesion. The patient underwent a posterolateral approach on the right side, with subtotal resection of the lesion. We discuss the embryologic, diagnostic and therapeutic aspects of these cysts and review the literature.
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Affiliation(s)
- P Scarone
- Service de neurochirurgie, fondation ophtalmologique Adolphe-de-Rothschild, 25-29 rue Manin, 75940 Paris cedex 19, France.
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Gessi M, Legnani FG, Maderna E, Casali C, Solero CL, Pollo B, DiMeco F. MUCINOUS LOW-GRADE ADENOCARCINOMA ARISING IN AN INTRACRANIAL ENTEROGENOUS CYST. Neurosurgery 2008; 62:E972-3; discussion E973. [DOI: 10.1227/01.neu.0000318186.10536.f6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Enterogenous cysts (ECs) of the central nervous system are developmental malformations that occur in the spinal canal, posterior fossa, or cerebral hemispheres. They are usually benign lesions, and malignant transformation is rare. To date, only three cases of malignant transformation have been reported in the literature. We present a case of a cerebellopontine EC showing foci of epithelial dysplasia and malignant transformation into a low-grade papillary mucinous adenocarcinoma.
CLINICAL PRESENTATION
A 25 year-old man with a 6-year history of hypoacusia presented to our department with facial nerve deficit, visual disturbances, and gait instability. A magnetic resonance imaging scan demonstrated a multiloculated cerebellopontine angle cyst with supratentorial hydrocephalus.
INTERVENTION
A retrosigmoidal approach was used to achieve cyst removal. This was followed several months later by ventriculoperitoneal shunt placement. The cyst was adherent to the brainstem, cranial nerves, and vessels, and it resembled a thin encapsulated structure filled with mucinous-like substance. No solid component was identified. Histopathological examination revealed an EC with foci of malignant transformation in a mucinous papillary adenocarcinoma. Magnetic resonance imaging was performed 5 months postoperatively due to progressive clinical worsening; this scan revealed lesion recurrence with severe brainstem compression. Emergency surgery was performed, and a large decompression was achieved. Subsequent follow-up computed tomographic scans showed progression of the residual tumor. The patient's neurological condition rapidly worsened, ultimately resulting in death.
CONCLUSION
The present report suggests that a careful histological examination of all ECs after surgery should be made to exclude dysplastic foci or carcinomatous transformation. Although the clinical behavior of ECs with malignant trasformation is unpredictable, surgery remains the treatment of choice. The use of possible adjuvant chemo- or radiotherapy has not been established.
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Affiliation(s)
- Marco Gessi
- Division of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federico G. Legnani
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuela Maderna
- Division of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carlo L. Solero
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Division of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Endodermal cyst of the cranio-cervical junction. Acta Neurochir (Wien) 2008; 150:257-63; discussion 263. [PMID: 18213442 DOI: 10.1007/s00701-007-1395-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
Abstract
We reviewed 36 patients with endodermal cysts occurring at the craniocervical junction. They were aged between 3 and 66 years. Headache, motor weakness, and neck pain were commonly observed symptoms. Radiographically, T1-weighted magnetic resonance imaging of the tumours demonstrated a hypointense, isointense, or hyperintense signal according to the cystic content. In most cases, the cyst walls did not enhance after gadolinium administration. Histologically, the cysts were found to be lined by a single layer of epithelium. Histochemical and immunohistochemical studies showed that almost all were reactive to periodic acid schiff stain, epithelial membrane antigen, and carcino-embryonic antigen, but negative to glial fibrillary acidic protein. Mainly, the suboccipital approach with or without a laminectomy, or the trans-oral approach were selected for surgical excision of these tumours. In 17 of the 36 patients, total or gross total resections were performed, and subtotal resections were achieved in sixteen. Three patients developed recurrences.
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