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Wang G, Shen H, Chu Z, Shen J, Zhu KC. Benign cervical intramedullary cyst without an epithelial lining:a case report. Br J Neurosurg 2023; 37:1664-1666. [PMID: 34009086 DOI: 10.1080/02688697.2021.1927983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
This paper presents a female, benign intramedullary cyst case aged 66-year-old. During the operation, it was found that the cystic wall was very thin, and the cystic fluid was colorless and transparent. The lesion with the capsule was removed partially. Surprisingly, there was no epithelial lining on the capsule wall. It is very rare and different from the benign intramedullary cysts reported in the literature.
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Affiliation(s)
- GengHuan Wang
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - HePing Shen
- Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - ZhengMin Chu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JianGuo Shen
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Kun Can Zhu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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Abstract
Spinal cord tumors are best identified by conventional MR imaging with contrast. Most intramedullary spinal cord tumors have characteristic MR imaging features that allow an accurate preoperative diagnosis. The spinal cord tumors reviewed in this article include the most common tumors, ependymomas and astrocytomas, as well as the less common tumors such as hemangioblastomas and metastases. Rare tumors such as primary CNS lymphoma and melanocytic tumors are also described. Advanced imaging techqniques of more common intramedullary tumors are also reviewed.
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Affiliation(s)
- Lubdha M Shah
- Department of Radiology, University of Utah, 30 North 1900 East, Room#1A71, Salt Lake City, UT, USA.
| | - Karen L Salzman
- Department of Radiology, University of Utah, 30 North 1900 East, Room#1A71, Salt Lake City, UT, USA
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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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Klekamp J. How Should Syringomyelia be Defined and Diagnosed? World Neurosurg 2018; 111:e729-e745. [DOI: 10.1016/j.wneu.2017.12.156] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
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Shepard MJ, Padmanaban V, Edwards NA, Chittiboina P, Ray-Chaudhury A, Heiss JD. Discovery of Aquaporin-1 and Aquaporin-4 Expression in an Intramedullary Spinal Cord Ependymal Cyst: Case Report. World Neurosurg 2017; 107:1046.e1-1046.e7. [PMID: 28826713 DOI: 10.1016/j.wneu.2017.07.151] [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] [Received: 06/20/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intramedullary ependymal cysts of the spinal cord are rare, benign, fluid-filled cysts usually situated along the ventral surface of the spinal cord. Only 32 cases have been reported since they were first described. Thus, owing to the rarity at which these cysts are encountered, their management and pathogenesis remain controversial. Whereas some investigators have advocated for cystosubarachnoid shunt placement for symptomatic ependymal cysts, others have argued for complete cyst resection or simple fenestration. Here we report the case of a 56-year-old female with a T11-T12 ependymal cyst that was successfully managed with cyst fenestration. We further investigated a potential pathological mechanism of cyst formation by performing immunohistochemistry to detect aquaporin expression in the cyst lining. CASE DESCRIPTION A 56-year-old female was found to harbor an enlarging cystic lesion of the conus that was discovered on workup of progressive paraparesis and urinary incontinence. She had lower extremity weakness and progressive myelopathy. Thoracic laminectomy with cyst fenestration arrested her neurologic deterioration. Pathological analysis revealed an intramedullary ependymal cyst. Immunohistochemistry was subsequently performed for expression of aquaporin-1 and aquaporin-4. There was dense staining of the underlying neuropil with concurrent membranous staining pattern of the cyst lining. CONCLUSIONS Intramedullary ependymal cysts are rare, cystic lesions of the spinal cord. Early cyst fenestration decompresses the cyst and prevents neurologic deterioration. Here we report for the first time that aquaporins are expressed in the cyst wall, which is consistent with a passive, osmotic pathogenic mechanism of cyst formation.
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Affiliation(s)
- Matthew J Shepard
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Department of Neurologic Surgery, University of Virginia Health System, Charlottesville, Virginia.
| | - Varun Padmanaban
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Nancy A Edwards
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Prashant Chittiboina
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Abhik Ray-Chaudhury
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - John D Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Yang T, Wu L, Fang J, Yang C, Deng X, Xu Y. Clinical presentation and surgical outcomes of intramedullary neurenteric cysts. J Neurosurg Spine 2015; 23:99-110. [PMID: 25909275 DOI: 10.3171/2014.11.spine14352] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
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Affiliation(s)
- Tao Yang
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Liang Wu
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Jingyi Fang
- 2Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chenlong Yang
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Xiaofeng Deng
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Yulun Xu
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
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Coexisting intramedullary schwannoma with an ependymal cyst of the conus medullaris: A case report. Oncol Lett 2014; 9:903-906. [PMID: 25621066 PMCID: PMC4301493 DOI: 10.3892/ol.2014.2786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 11/13/2014] [Indexed: 11/17/2022] Open
Abstract
Synchronous spinal intramedullary ependymal cysts and intramedullary schwannomas are rare. To the best of our knowledge, the present study is the first report of a case of intramedullary schwannoma coexisting with an ependymal cyst. A 35-year-old male presented with lower back pain and weakness in the left leg. Magnetic resonance imaging identified an intramedullary cystic-solid lesion at the thoracolumbar junction of T11-L2; based on the clinical presentation and radiological features, a pre-operative diagnosis of ependymoma was formed. Subsequently, the patient underwent a T11-12 laminectomy via a posterior approach, with intraoperative monitoring of somatosensory and motor-evoked potentials, achieving a gross total resection of the tumor with a well-demarcated dissection plane. Post-operative histopathological examination demonstrated a schwannoma coexisting with the ependymal cyst, and the neurological status of the patient markedly improved compared with the pre-operatively observed neurological deficit.
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