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Sergeenko OM, Savin DM, Diachkov KA. Association of spinal cord abnormalities with vertebral anomalies: an embryological perspective. Childs Nerv Syst 2024; 40:1415-1425. [PMID: 38441629 DOI: 10.1007/s00381-024-06336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To analyze the relationship between spinal cord and vertebral abnormalities from the point of view of embryology. METHODS We analyzed the clinical and radiological data of 260 children with different types of spinal cord malformations in combination with vertebral abnormalities. RESULTS Among 260 individuals, approximately 109 presented with open neural tube defects (ONTDs), 83 with split cord malformations (SCMs), and 83 with different types of spinal lipomas. Pathological spina bifida emerged as the most frequent vertebral anomaly, affecting 232 patients, with a higher prevalence in ONTD. Vertebral segmentation disorders, including unsegmented bars, butterfly vertebrae, and hemivertebrae, were present in 124 cases, with a higher prevalence in SCM. The third most common spinal anomaly group consisted of various forms of sacral agenesis (58 cases), notably associated with blunt conus medullaris, spinal lipomas, and sacral myelomeningocele. Segmental aplasia of the spinal cord had a typical association with segmental spinal absence (N = 17). CONCLUSION The association between SCM and neuroenteric cyst/canal and vertebral segmentation disorders is strong. High ONTDs often coincide with pathological spina bifida posterior. Type 1 spinal lipomas and focal spinal nondisjunction also correlate with pathologic spina bifida. Segmental spinal absence or dysgenesis involves localized spinal and spinal cord aplasia, sometimes with secondary filar lipoma.
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Affiliation(s)
- Olga M Sergeenko
- Division of Spinal Surgery, Ilizarov Center, 6, M.Ulyanova Street, Kurgan, 640014, Russia.
| | - Dmitry M Savin
- Division of Spinal Surgery, Ilizarov Center, 6, M.Ulyanova Street, Kurgan, 640014, Russia
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Elshamy W, Ozaydin B, Sayyahmelli S, Salamat MS, Baskaya MK. A Neuroenteric Cyst of the Cavernous Sinus: A Case Report. J Neurol Surg Rep 2023; 84:e80-e84. [PMID: 37583572 PMCID: PMC10425234 DOI: 10.1055/s-0043-1772157] [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: 02/24/2020] [Accepted: 06/13/2023] [Indexed: 08/17/2023] Open
Abstract
Background Neuroenteric cysts (NECs) are benign lesions mostly found as intradural extramedullary lesions in the cervicothoracic spinal cord. NECs in the cavernous sinus are very rare. To the best of our knowledge, this is only the second reported case and the first in an adult. Presentation We present a left cavernous sinus NEC in a 75-year-old female with gradually worsening headache and facial pain unresponsive to medical treatment. Imaging revealed a cystic mass lesion in the left cavernous sinus encasing the distal petrosal and cavernous segment of the internal carotid artery. Initial differential diagnoses included more common pathologies located near the cavernous sinus, including cystic schwannoma, craniopharyngioma, and dermoid and epidermoid tumors. The patient underwent a left pterional craniotomy with an extradural transcavernous approach for surgical exploration and possible resection of this mass lesion. Histopathology revealed an NEC lined with benign respiratory-type epithelium. Postoperative imaging revealed gross total tumor resection. The patient remained neurologically intact with complete resolution of facial pain. Conclusion We present a rare pathology that can easily be misinterpreted as other types of lesions. NECs should be kept in mind for differential diagnosis of cavernous sinus cystic lesions. The surgical aim should be maximal safe excision.
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Affiliation(s)
- Walid Elshamy
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
- Department of Neurological Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Burak Ozaydin
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Sima Sayyahmelli
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - M. Shahriar Salamat
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Mustafa K. Baskaya
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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3
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Mahajan UV, Labak KB, Labak CM, Herring EZ, Hdeib AM. Images in Spine: A Rare Abnormal Bony Fusion. Cureus 2021; 13:e13719. [PMID: 33833930 PMCID: PMC8019583 DOI: 10.7759/cureus.13719] [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] [Indexed: 11/17/2022] Open
Abstract
Klippel-Feil syndrome (KFS) is characterized by failed segmentation of the cervical spine leading to inappropriately fused vertebral bodies. A 64-year-old male with a previous L5-S1 decompression presented with significant neck pain with radiation into the entire right upper extremity and hand. Imaging demonstrated fusion of the vertebral bodies at C2-3, C4-6, and C7-T1 with associated disc bulges at C3-4 and C6-7. Common presentation of KFS includes significant spondylosis and cervical myeloradiculopathy in addition to the classic triad of short neck, low posterior hairline, and restricted neck motion. We present exemplary images of this rare condition to aid clinicians in future diagnoses.
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Affiliation(s)
- Uma V Mahajan
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Kyle B Labak
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Collin M Labak
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Eric Z Herring
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Alia M Hdeib
- Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, USA
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4
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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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Sharma R, Mahajan S, Bhardwaj M, Gupta LN, Gupta D. Concurrent Thoracic Spinal Intradural Extramedullary Epidermoid and Neurenteric Cyst in a Spinal Dysraphism Child. Pediatr Neurosurg 2021; 56:261-267. [PMID: 33784692 DOI: 10.1159/000511091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known. CASE PRESENTATION We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now. CONCLUSION Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.
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Affiliation(s)
| | | | | | | | - Deepak Gupta
- Department of Neurosurgery, AIIMS, New Delhi, India
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Weng JC, Zhang ZF, Li D, Wang JM, Li GL, Xu YL, Yang J, Zhang JT, Jia WQ. Therapeutic Strategies and Prognostic Factors Based on 121 Spinal Neurenteric Cysts. Neurosurgery 2020; 86:548-556. [PMID: 31081882 DOI: 10.1093/neuros/nyz143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/25/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited data existed to guide the management of intraspinal neurenteric cysts (ISNECs). OBJECTIVE To evaluate the risk factors for progression-free survival (PFS), elucidate the radiological features of ISNECs, and propose a treatment protocol. METHODS From 2003 to 2015, 121 patients with pathologically confirmed ISNECs treated at our institute were included in this study. Pertinent risk factors were evaluated. RESULTS Gross total resection (GTR) was achieved in 55 (44.6%) patients; 106 (87.6%), 12 (9.9%), and 3 (2.5%) ISNECs were classified as Wilkins A, B, and C, respectively. After a median follow-up duration of 64.2 mo, recurrence occurred in 25 (22.7%) patients, with a median PFS time of 43.1 mo. The actuarial PFS rates at 5 and 10 yr were 73.2% and 66.2%, respectively. The actuarial overall survival rates at 5 and 10 yr were 100% and 97.6%, respectively. Non-GTR (hazard ratio [HR], 5.836; 95% confidence interval [CI], 1.698-20.058; P = .005), Wilkins B/C (HR, 3.129; 95% CI, 1.009-9.702; P = .048), and a history of surgical resection (HR, 3.690; 95% CI, 1.536-8.864; P = .004) were adverse factors. CONCLUSION GTR and Wilkins A were favorable factors for PFS. If tolerable, GTR alone was advocated as an optimal treatment. Because of the benign nature and favorable prognosis, non-GTR was an alternative if GTR failed. Close follow-up was needed because of the recurrent tendency of ISNEC. Future study with a large cohort is necessary to verify our findings.
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Affiliation(s)
- Jian-Cong Weng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhi-Feng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.,Department of Neurosurgery, The Second Hospital of Hebei Medical University, Hebei, People's republic of china
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun-Mei Wang
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, People's Republic of China
| | - Gui-Lin Li
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing, People's Republic of China
| | - Yu-Lun Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wen-Qing Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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Abstract
A previously healthy 48-year-old female presented to the emergency department with a 2-week history of low back pain, progressive lower extremities weakness, and right leg numbness. There were no bowel or bladder dysfunction symptoms. Spine magnetic resonance imaging (MRI) showed an intradural cystic lesion dorsal to the spinal cord at the level of L1 measuring 1.6 × 2.1 × 4.1 cm, which was T1 hypointense and T2 hyperintense, with a small soft tissue component and no gadolinium enhancement (Figure 1). A small lipomatous component was also noted. There were no associated vertebral anomalies. The patient underwent a T12-L2 laminectomy and cyst resection, which was subtotal due to the cyst adherence to the conus medullaris. Histopathology showed characteristic features of a neurenteric cyst, with respiratory-type epithelium in the cyst wall (Figure 2). Eight months later, follow-up MRI showed no evidence of recurrence. The patient reported improved sensation in the lower extremities; however, there was some residual weakness predominantly in the proximal hip flexors bilaterally.
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8
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Abstract
Spinal neurenteric cysts are rare congenital anomalies and the natural history of the cyst is not fully understood. We evaluated a case of spontaneous absorption of a cyst. The patient was a 5-year-old boy who had experienced pain in the bilateral upper extremities 3 days before his admission. Neurological examination revealed severe motor weakness of the upper extremities and mild motor weakness of the lower extremities. Magnetic resonance imaging (MRI) revealed an extramedullary cystic lesion with a fluid-fluid level in the cervical region. One week later, the pain spontaneously improved with bed rest, and the patient showed good neurological recovery. MRI performed 6 months later revealed spontaneous reduction of the cyst. Enlargement and contraction of the cyst were observed over 3 years on MRI. Since the size of the cyst changes, MRI should be performed annually for patient follow-up.
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Kemp OAG, Deepak S, Salem O, Arzoglou V. The oldest presenting neurenteric cyst of the spinal cord. Br J Neurosurg 2019:1-4. [PMID: 31825252 DOI: 10.1080/02688697.2019.1681361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe an 81-year-old gentleman presenting with mild myelopathic symptoms in the upper limbs. Imaging showed a C1-3 intradural extramedullary lesion initially thought to be an arachnoid cyst. A C1 + 2 hemilaminectomy and partial excision was performed with histology revealing a neurenteric cyst (NC). NCs are congenital tumours that usually present within the third decade of life, they account for 1% of all spinal tumours. A literature search was conducted and we found that the age of presentation might actually be earlier than previously described. We also found that there has never before been a case described in the eighth decade of life, making this the oldest known symptomatic presentation of this rare condition.
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Affiliation(s)
- Oliver A G Kemp
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK
| | - Srihari Deepak
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK
| | - Osama Salem
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK
| | - Vasileios Arzoglou
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK
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10
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Abstract
CLINICAL ISSUE Spinal cysts can be classified as meningeal, not meningeal, and tumor-associated cysts. Due to the widespread availability of high-resolution computed tomography and magnet resonance imaging, spinal cysts can be detected with high sensitivity these days. Concerning the variety of potential cystic differential diagnoses, a precise classification is difficult and can often only be realized after surgical inspection or histological examination. PRACTICAL RECOMMENDATIONS Spinal cysts are generally incidental findings during a routine diagnostic workup and need no further therapy. Surgical treatment can be necessary if the spinal cyst reaches a certain size and causes neurological symptoms due to the compression of the spinal cord or the nerve root.
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11
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Liu CX, Meng B, Li YB, Bai H, Wu ZX. A rare case of thoracic spinal intradural extramedullary enterogenous cyst with acute onset: case report and literature review. Ann R Coll Surg Engl 2019; 101:e142-e146. [PMID: 31155903 PMCID: PMC6554576 DOI: 10.1308/rcsann.2019.0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 12/25/2022] Open
Abstract
The intraspinal enterogenous cyst, also called an neurenteric cyst, is a rare congenital disease. It was reported to be local to the C1 to L2 spinal segments, with the majority located in the cervicothoracic region. Most patients present with symptoms of progressive focal pain, myelopathic signs or radicular symptoms. We report a rare case of thoracic spinal intradural extramedullary enterogenous cyst with rapidly progressive weakness of both lower extremities. Additionally, we analysed the literature concerning the clinical features, diagnosis and prognosis of this disease.
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Affiliation(s)
- CX Liu
- Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China
| | - B Meng
- Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China
| | - YB Li
- Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China
| | - H Bai
- Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China
| | - ZX Wu
- Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, China
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Čota S, Žagar I, Delimar V, Pap M, Perić D, Perić P. Klippel-Feil syndrome misdiagnosed as spondyloarthropathy: case-based review. Rheumatol Int 2019; 39:1655-1660. [PMID: 31214770 DOI: 10.1007/s00296-019-04346-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/11/2019] [Indexed: 11/29/2022]
Abstract
Spondyloarthropathy refers to any joint disease of the vertebral column, but the term is mainly used for a specific group of disorders called seronegative spondyloarthropathies (SpAs). The axial skeletal involvement, peripheral and extra-articular manifestations and an association with the major histocompatibility complex class I human leukocyte antigen-B27 (HLA B27) are commonly shared features of SpAs. Klippel-Feil syndrome (KFS) is a rare congenital disorder characterized by the fusion of one or more cervical vertebrae, accompanied by various skeletal and extra-skeletal anomalies. We report a case of an adult male patient with HLA B27 positivity presenting with chronic cervical spine pain accompanied by morning stiffness and periodic night pain, with radiologically confirmed ankylosis and fusion of several cervical segments. His medical history included urogenital abnormalities operated in childhood and mild mitral prolapse. Initially suspected diagnosis of an early axial form of SpA was rejected after thorough workup. Instead, the nature of vertebral defects along with the past medical history of urogenital and cardiac abnormalities pointed towards the diagnosis of KFS. HLA B27 presence can be a confounder in patients presenting with spinal pain and that is why the differential diagnosis of CSD-s and SpA can be challenging in some patients.
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Affiliation(s)
- Stjepan Čota
- Children's Hospital Zagreb, Klaićeva 16, 10000, Zagreb, Croatia
| | - Iva Žagar
- School of Medicine, University of Zagreb, Šalata 3, 10000, Zagreb, Croatia. .,Clinic for Rheumatic Diseases and Rehabilitation, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Valentina Delimar
- Special Hospital for Medical Rehabilitation Krapinske Toplice, Gajeva 2, 49217, Krapinske Toplice, Croatia
| | - Mislav Pap
- Clinic for Rheumatic Diseases and Rehabilitation, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Doroteja Perić
- School of Medicine, University of Zagreb, Šalata 3, 10000, Zagreb, Croatia
| | - Porin Perić
- School of Medicine, University of Zagreb, Šalata 3, 10000, Zagreb, Croatia.,Clinic for Rheumatic Diseases and Rehabilitation, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
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Spinal cord neurenteric cyst: clinical and diagnostic findings and long term follow-up in two dogs. Vet Q 2019; 38:106-111. [PMID: 30675815 PMCID: PMC6831020 DOI: 10.1080/01652176.2018.1542515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Isolated Dorsal Thoracic Neuroenteric Cyst with Spinal Cord Compression: Case Reports in Pediatrics. World Neurosurg 2018; 118:296-300. [DOI: 10.1016/j.wneu.2018.07.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 11/20/2022]
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15
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Lan ZG, Richard SA, Lei C, Huang S. Thoracolumbar spinal neurenteric cyst with tethered cord syndrome and extreme cervical lordosis in a child: A case report and literature review. Medicine (Baltimore) 2018; 97:e0489. [PMID: 29668630 PMCID: PMC5916695 DOI: 10.1097/md.0000000000010489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Neurenteric cysts, are rare benign tumors of the central nervous system that are mostly located in the spinal cord and predominantly seen in male children although adult form of the disorder also occurs. The etiology and treatment of this disorder is still a matter of debate. Our case further throws more light on the pathogenesis and treatment of this disorder. PATIENT CONCERNS A 4-year-old boy presented with 5-month history of cervical lordosis and bilateral lower extremity pain that progressed to his abdomen and upper body. The pain was general, recurrent, non-persistent and progressive in nature with no paralysis. The pain was aggravated by trunk stretching and relieved when he assumed opisthotonos position so he preferred sleeping in this position at night. DIAGNOSES Magnetic resonance imaging (MRI) revealed a cystic lesion at the thoracolumbar spine with tethering of spinal cord and cervical lordosis. INTERVENTIONS He was operated on successfully and the cervical lordosis and pain resolved. OUTCOMES The child recovered well with no tumor recurrence and massive improvement of his life. LESSONS The gold standard treatment for this disorder is surgery although the precise surgical approach is still a matter of debate. We are of the view that surgical approach should be individualized and aim at total excision of the cyst.
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Affiliation(s)
- Zhi Gang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
- Department of Immunology, Jiangsu University, Zhenjiang, Jiangsu, P.R. China
- Department of Surgery, Volta Regional Hospital, Ghana-West Africa
| | - Chuanfen Lei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Siqing Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
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Martynova MA, Konovalov NA, Lubnin AY, Shmigel'skiy AV, Savin IA, Tabasaranskiy TF, Akhvlediani KN, Sinbukhova EV, Onoprienko RA. [Spinal stroke in a pregnant female with an endodermal cyst of the cervical spinal cord (a case report and literature review)]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 80:74-81. [PMID: 28139576 DOI: 10.17116/neiro201680674-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The study purpose was to present a clinical case of spinal stroke in a pregnant female, which was caused by an endodermal cyst of the cervical spinal cord, and to analyze treatment tactics. RESULTS A 20 week pregnant female presented with acute transverse spinal cord injury at the of C3-C5 spinal segment level. CT revealed an extramedullary space-occupying lesion in the ventrolateral position, with compression of the spinal cord at this level. The patient in the state of progressive deterioration with respiratory failure was transferred to the Neurosurgical Institute on the 5th day after disease onset. The patient underwent surgery on the 7th day after disease onset. Doctors of various specialties participated in preparation for surgery. During surgery, total resection of the space-occupying lesion and spinal cord decompression were performed. An obstetrician-gynecologist conducted intraoperative fetal monitoring by ultrasound. The histological diagnosis was an endodermal cyst. There was no improvement of neurological symptoms in the early postoperative period. After stabilization of the condition, the patient was discharged for follow-up care at the place of residence. According to the follow-up report, the patient underwent the cesarean section because of exacerbation of lung infection and a significant delay in the fetal development. After a few days, the patient died due to multiple organ failure. The child was alive, in serious condition, under mechanical ventilation. CONCLUSION In the case of spinal stroke, the decision on treatment tactics should be made no later than 12 hours after its onset; otherwise, the outcome is usually unfavorable, and a neurological deficit is irreversible. The decision about continuing pregnancy should be made individually in each case, and an approach to the choice of appropriate treatment tactics should be multi-disciplinary.
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Affiliation(s)
| | | | - A Yu Lubnin
- burdenko Neurosurgical Institute, Moscow, Russia
| | | | - I A Savin
- burdenko Neurosurgical Institute, Moscow, Russia
| | | | - K N Akhvlediani
- moscow Regional Research Institute of obstetriics and Gynecology, Moscow, Russia
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17
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Bruzek AK, Kucia EJ, Oppenlander ME. Intramedullary and Extramedullary Cervical Neurenteric Cyst Requiring Fixation and Fusion. World Neurosurg 2016; 95:621.e7-621.e12. [PMID: 27535627 DOI: 10.1016/j.wneu.2016.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spinal neurenteric cysts are rare in the literature, described by sporadic case reports and small case series. In the vast majority of cases, these lesions are intradural extramedullary. We report the novel case of a cervical neurenteric cyst that was simultaneously intramedullary and extramedullary. CASE DESCRIPTION A 47-year-old man underwent C2 through C7 laminectomies for microsurgical resection of a large cystic intradural mass, with C1 through T1 instrumentation and fusion. Gross total resection was obtained. Fusion was necessary after removal of the posterior elements because the vertebrae were thinned extensively and remodeled around the tumor, a treatment paradigm that has not been described adequately for neurenteric cysts previously. CONCLUSIONS A novel case of cervical intramedullary and extramedullary neurenteric cyst is presented with clinical, radiographic, and histologic details. Given the potential for bony remodeling around these developmental tumors, the possibility exists for instability after certain neurenteric cysts are resected. Thus, the present case adds fixation and fusion to the potential treatment paradigm for select spinal neurenteric cysts.
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Affiliation(s)
- Amy K Bruzek
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Elisa J Kucia
- Ann Arbor Spine Center, Michigan Brain and Spine Institute, Ypsilanti, Michigan, USA
| | - Mark E Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA; Ann Arbor Spine Center, Michigan Brain and Spine Institute, Ypsilanti, Michigan, USA.
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