Spinal intramedullary ependymal cyst: a case report

A Rare Case of Isolated Intramedullary Spinal Cord Cysticercosis

Neurocysticercosis is a parasitic disease often involving the central nervous system by Taenia solium and is commonly seen in developing countries. The majority of these cases have either isolated brain involvement or combined involvement of the brain and spinal cord. Isolated involvement of the spinal cord is very rare. We report the case of a 20-year-old Indian man who was hospitalized for progressive weakness in all extremities. Magnetic resonance imaging showed a well-defined, round, thick-walled, peripherally enhancing lesion in the intramedullary region, a provisional diagnosis of isolated cysticercosis of the intramedullary region of the spinal cord was made. The patient improved upon needle aspiration of the cystic lesion after surgery, which on post-surgical histological examination confirmed the diagnosis by showing the presence of cysticerci.

Congenital Spinal Cysts: An Update and Review of the Literature

Congenital spinal cysts are rare and encompass a wide variety of diseases including arachnoid, enterogenous, teratomatous, neurenteric, foregut, bronchogenic, epithelial, ependymal, dermoid, and epidermoid cysts. Here, we elucidate the epidemiology, pathology, pathogenesis, and diagnostic findings of the most common congenital spinal cysts, followed by a discussion of their presentation and treatment options. Differentiating the cause of each lesion is crucial for targeted clinical and surgical management for the patient. Our review describes how arachnoid cysts can be observed, fenestrated, percutaneously drained, or shunted; however, the primary goal for neurenteric, dermoid, and epidermoid cysts is removal. Further, we discuss how patient presentation is dependent on the rate of growth and location of compression on the spinal cord and nerve roots. However, although many of these lesions are discovered incidentally on imaging, the spectrum of possible symptoms include pain, weakness, ataxia, bladder incontinence, and progressive or acute neurologic deficits. We present and review the histology and imaging of a variety of cysts and discuss how although the goal of treatment is resection, the risks of surgery must be considered against the benefits of complete resection in each case.

Mobile Myxopapillary Ependymoma with Associated Filum Terminale Cyst

BACKGROUND

Intradural ependymal cysts are benign, fluid-filled cysts usually situated along the ventral surface of the spinal cord. There are previous reports of 19 intradural cysts in the literature, including one cyst of the filum terminale. Here, we report for the first time the presence of a radiographically occult filum terminale cyst associated with a myxopapillary ependymoma. We propose that mobility of the tumor may provide indirect evidence of the presence of a cyst.

CASE DESCRIPTION

A 65-year-old male patient presented with a homogenously enhancing ovoid mass measuring 25 mm × 10 mm within the thecal sac at the L3 through L4 levels. Repeat magnetic resonance imaging demonstrated migration of the tumor 12 mm rostrally. Following the L2 through L4 laminectomy and resection of the intradural tumor, we identified a filum terminale ependymal cyst superior to the tumor, which was also resected.

CONCLUSIONS

Ependymal cysts associated with spinal tumors are rare and may be radiographically occult. The change in cyst size may explain tumor mobility. Complete resection of the cyst and histopathologic analysis is recommended to differentiate between ependymal cyst and cystic tumor tissue.

Discovery of Aquaporin-1 and Aquaporin-4 Expression in an Intramedullary Spinal Cord Ependymal Cyst: Case Report

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.

Spinal cysticercosis: an unusual presentation

Spinal intramedullary cysticercosis is an uncommon clinical condition that may mimic an intramedullary tumour and can lead to irreversible neurological deficits if untreated. We report a case of a 35-year-old man who clinically presented as Brown-Sequard syndrome, having thoracic cord cysticercosis at T11 level. MRI of the spine revealed a well-defined round intramedullary inflammatory lesion with scolex and perilesional oedema at D11 level.

Coexisting intramedullary schwannoma with an ependymal cyst of the conus medullaris: A case report

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.

Intramedullary spinal cysticercosis: a case report and review of literature

To report a case of spinal intramedullary cysticercosis in thoracic spine. A 47-year old man living in Korea referred to our hospital with both feet tingling sensation for about a year. Laboratory evaluations, including serologic tests were not helpful. Magnetic resonance imaging revealed a 1.7 cm intramedullary mass at T10-11 level, which believed to be a tumor instead, rather than a cysticercosis preoperatively. Successful operation was done with a histopathological result confirmed it as cysticercosis. Even though the prevalence of intramedullary spinal cysticercosis is extremely rare, and radiologic exams mimic other common tumors like ependymoma or astrocytoma, the disease should be considered as differential diagnosis.

Clinical characteristics and surgical outcomes of spinal intramedullary ependymal cysts

OBJECT

Intramedullary ependymal cysts are exceedingly rare lesions, and have been previously reported in the literature as case reports. The aim of this study was to discuss the clinical presentation and the outcomes of microsurgery for these benign lesions.

METHODS

The authors retrospectively reviewed the records of ten patients who underwent microsurgery for intramedullary ependymal cysts. All patients had preoperative and postoperative magnetic resonance imaging. The surgical treatment included gross total resection and biopsy plus a cyst-subarachnoid shunt. The diagnosis of intramedullary ependymal cysts was based on radiological and pathological criteria. All patients were followed up, with a mean duration of 47.6 months.

RESULTS

Intramedullary ependymal cysts were hypointense on T1-weighted images and hyperintense on T2-weighted images. Contrast-enhanced T1-weighted images showed no enhancement. Gross total resection was achieved in one case. Biopsy of the cyst wall plus cyst-subarachnoid shunt placement was achieved in nine cases. Long-term neurological function was improved in eight patients. No recurrence was observed on magnetic resonance imaging.

CONCLUSIONS

Ependymal cysts should be considered in the differential diagnosis of intramedullary cysts. For symptomatic patients, early surgery should be performed before neurological deficits deteriorate. Complete decompression and cyst-subarachnoid shunt placement is the optimal treatment and the outcome may be favorable.

Spinal intramedullary ependymal cysts : a case report and review of the literature

We report a rare case of a spinal intramedullary ependymal cyst in a 46-year-old female and review the 17 pathologically proven cases in the literature. The patient presented with a two-week history of gradually increasing tingling in her left posterior thigh and calf. A preoperative magnetic resonance image revealed a well-defined intramedullary cystic lesion on the ventral side of the spinal cord at the T11 to T12 levels. The lesion was hyper intense in T2-weighted images and hypointense in T1-weighted. The patient underwent a right-side hemilaminectomy at the T11 to T12 levels and fenestration of the cyst wall. After having the cyst wall partially removed and communication established between the cyst and the subarachnoid space, the patient improved neurologically. A histological study of the surgical specimens revealed that the cyst wall consisted of glial cells lined by a simple cuboidal to columnar epithelium. An immunohistochemical examination of the cells lining the cyst wall was positive for S-100 protein, glial fibrillary acidic protein, epithelial membrane antigen, and cytokeratin. We suggest that the optimal treatment of intramedullary ependymal cysts creates adequate communication between the cyst and the subarachnoid space.

Quadriparalytic disseminated neurocysticercosis

Cysticercosis is the most common parasitic infection of the central nervous system. Cysticercosis infrequently affects the spine, but when it does, it can present with symptoms similar to other more common spinal diseases. Here, the authors report a case of disseminated cysticercosis, with simultaneous involvement of brain and the spinal cord. Initially, the patient was misdiagnosed as tuberculoma on the basis of cerebrospinal fluid examination and CT scan of brain and was being treated with antitubercular therapy. Later on the patient developed quadriparesis which was investigated and diagnosed to be disseminated neurocysticercosis.

[Intramedullary neuroglial cyst: a case report]

BACKGROUND AND PURPOSE

Neuroglial cysts are uncommon congenital lesion with own wall, which can be confined into or outside the central nervous system. In the central nervous system the cyst is located commonly in the brain. Spinal intramedullary neuroglial cyst are exceptional. Our objective is to present a case of intramedullary neuroglial cyst, to discuss the differentiels diagnosis and to show difficulties of its medical taking care.

CASE REPORT

A 60 year-old man, without past history, was admitted to the hospital with a compression of conus medullaris since one year. The clinical examination revealed paraparesis and genito-sphincterian disorders. MRI of the spine revealed intramedullary cyst at T12-L1 level. The patient underwent cystic evacuation, a large marsupialization of the cavity and a wall biopsy. Histopathological examination confirmed the diagnosis of neuroglial cyst. The postoperative outcome was favourable with a partial improvement of motor weakness. Postoperative MRI showed a persistent residual cavity.

CONCLUSION

Neuroglial intramedullary cyst is uncommon. It is a benign lesion. Complete surgical resection is very difficult seen the absence of defined plan cleavage.

Spinal intramedullary cysticercosis: a case report and literature review

Neurocysticercosis, involvement of the central nervous system by taenia solium, is one of the most common parasitic diseases of the CNS. However, spinal involvement by neurocysticercosis is uncommon. Here, we reported a 40-year-old woman with intramedullary cysticercosis in the thoracic spinal cord. MRI revealed two well-defined round intramedullary lesions at T4 and T5 vertebral levels, which were homogeneously hypointense on T1WI and hyperintense on T2WI with peripheral edema. Since the patient had progressive neurological deficits, surgery was performed to decompress the spinal cord. Histopathology examination of the removed lesion proved it was intramedullary cysticercosis. In this report, we also discussed the principles of diagnosis and treatment of intramedullary cysticercosis in combination of literature review.

Neuroglial cyst of the sacral canal. Case report

Spinal neuroglial cysts are rare. Although there are a few case reports, none describe such cysts within the sacral canal. The authors describe the case of a 29-year-old man who presented with symptoms of urinary retention over a period of several months. Imaging of his lumbar spine demonstrated the presence of an extradural cystic lesion within the sacral canal. He underwent resection of the cyst, with complete reversal of his bladder impairment. Histopathological studies confirmed the presence of a sacral neuroglial cyst.

Imagerie des lésions kystiques du canal rachidien chez l’adulte

Intrarachidian cystic lesions are frequent, with highly varied causes. They can be classified according to their location into intramedullary cystic lesions and extramedullary cystic lesions. In these two categories, they can then be regrouped according to the tissue from which they develop. MRI is the first-choice examination for the study of the intracanal contents and the differential diagnosis between the various lesions.

Spinal intramedullary neuroepithelial (ependymal) cyst. A rare cause of treatable acute para paresis

An 8-yr-old female child presented with acute onset of severe pain in the lower limbs and difficulty in walking. Spine MRI showed hyperintense signals on T2 weighted images at T2-T3 level, which was intramedullary in location. The patient was operated and histopathology reported as neuroepithelial cyst. Spinal intramedullary neuroepithelial cysts are rare. Spinal cord compression due to the cyst is very uncommon and because of its rarity the present case is being reported. The clinical features, embryogenesis and literature were reviewed briefly.

Spinal intramedullary ependymal cyst and tethered cord in an adult

✓ Spinal intramedullary ependymal cysts are extremely rare. Fourteen cases have been reported in the literature, and only one was associated with another congenital lesion. The authors describe the case of a 33-year-old man in whom an intramedullary ependymal cyst and filar lipoma were present. These lesions were diagnosed using magnetic resonance imaging and were treated surgically. Pathological examination confirmed the diagnosis. At 6 months post-surgery, there was no evidence of recurrence.

Screening for intracranial aneurysms in autosomal dominant polycystic kidney disease. Review Article

Screening patients with autosomal dominant polycystic kidney disease (ADPKD) for asymptomatic intracranial aneurysms has been proposed as a method of reducing the morbidity and mortality associated with aneurysm rupture. However, recent studies have shown lower spontaneous rupture rates of small aneurysms and higher risks of significant complications with interventions than previously reported. Risk-benefit analysis has not demonstrated any benefit of screening ADPKD patients without a history of subarachnoid haemorrhage (SAH) for intracranial aneurysms, and has suggested that screening might cause harm.

Neuroepithelial cysts of the middle ear

Neuroepithelial cysts are lesions of the central nervous system that have previously been reported in cerebral parenchyma, in the spinal cord, and within the ventricles in association with the choroid plexus. We describe 2 cases of neuroepithelial cysts of the middle ear. One was diagnosed after surgery for a retraction pocket and chronic otitis media complicated by an intraoperative cerebrospinal fluid (CSF) leak. The other produced bilateral spontaneous CSF otorrhea and mimicked the presentation of arachnoid granulations. Both cases were verified with immunohistochemical stains. Neuroepithelial cysts, although rare, should be considered in the differential diagnosis of spontaneous CSF otorrhea or an epitympanic mass.

Hemifacial spasm associated with an ependymal cyst in the cerebellopontine angle. Case report

No previous case of hemifacial spasm associated with an ependymal cyst has been reported in the literature. In this article the authors report the first case in which hemifacial spasm accompanied an ipsilateral cerebellopontine angle ependymal cyst in a 27-year-old woman. Cyst fenestration and arterial decompression of the facial nerve at the root exit zone resulted in complete resolution of the patient's symptoms. A histopathological study including immunohistochemical methods identified an ependymal cyst.