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Onoda R, Kanaya K, Kiuchi T, Kobayashi S, Sano K, Ito N. Supratentorial Intraparenchymal Neurenteric Cyst Treated by Neuroendoscopic Fenestration: A Case Report and Review of Literature. NMC Case Rep J 2022; 8:493-503. [PMID: 35079509 PMCID: PMC8769454 DOI: 10.2176/nmccrj.cr.2020-0340] [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: 10/15/2020] [Accepted: 01/04/2021] [Indexed: 11/20/2022] Open
Abstract
Neurenteric cysts (NCs) are rare benign congenital neoplasms in the central nervous system that originate from endodermal elements. NCs are more commonly located in the spine than in the brain. Although almost all intracranial NCs are found in the posterior fossa, some have reported supratentorial NCs. The complete excision of the cyst wall is suggested as a curative treatment; however, endoscopic treatment is less discussed. We present a supratentorial intraparenchymal NC in the frontal lobe treated by neuroendoscopic fenestration and review the literature regarding supratentorial NCs. A 43-year-old woman presenting with right hemiparesis and gait disturbance who was found to have a huge cystic lesion with calcification in her left frontal lobe underwent endoscopic fenestration to the ipsilateral lateral ventricle and biopsy. The histopathological diagnosis was consistent with NC. Postoperatively, her right hemiparesis and gait disturbance disappeared. Postoperative MRI showed shrinkage of the cyst. She was discharged without neurological deficits and no recurrence was seen 1 year after surgery. To the best of our knowledge, there have been no reports of a supratentorial intraparenchymal NC treated by neuroendoscopic fenestration. Minimally invasive treatments, such as neuroendoscopic cyst fenestration, can be considered depending on the location of the cyst.
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Affiliation(s)
- Ryo Onoda
- Department of Neurosurgery, Iida Municipal Hospital, Iida, Nagano, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Iida Municipal Hospital, Iida, Nagano, Japan
| | - Takafumi Kiuchi
- Department of Neurosurgery, Iida Municipal Hospital, Iida, Nagano, Japan
| | - Sumio Kobayashi
- Department of Neurosurgery, Iida Municipal Hospital, Iida, Nagano, Japan
| | - Kenji Sano
- Department of Laboratory, Iida Municipal Hospital, Iida, Nagano, Japan
| | - Nobuo Ito
- Department of Laboratory, Iida Municipal Hospital, Iida, Nagano, Japan.,Department of Pathology, Aizawa Hospital, Matsumoto, Nagano, Japan
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Kalfas F, Scudieri C. Endodermal Cysts of the Central Nervous System: Review of the Literature and a Case Report. Asian J Neurosurg 2020; 15:989-996. [PMID: 33708675 PMCID: PMC7869303 DOI: 10.4103/ajns.ajns_322_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/30/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
Context Endodermal cysts are rare benign developmental cysts lined by mucin-secreting and/or ciliated, cuboidal, or columnar epithelium of probably endodermal origin. Aims Endodermal cysts are rarely intracranial, frequently located in the posterior fossa. Supratentorial location is the most infrequent and only few cases are reported in the literature, included our case. Settings and Design The authors report a case of intracranial supratentorial endodermal cyst with a review of the literature. Subjects and Methods A 40-year-old woman was admitted to our department because of progressive gait disorder for 3 months due to right brachial and crural motor deficit associated to right crural sensory disorder (tactile hypesthesia) and right Babinski response at neurological examination due to an endodermal cyst located in the left frontoparietal convexity. Discussion Total resection of endodermal cysts is recommended, despite their location and adhesion to the surrounding structures, due to its high risk of recurrence. Fenestration of the cystic content into the subarachnoid cistern may cause obstructive hydrocephalus or chemical meningism. Results Although rare, surgeons should be aware that these lesions must be differentiated clinically, radiologically, and histologically from other supratentorial cystic lesions.
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Affiliation(s)
- Fotios Kalfas
- Department of Neurosurgery Padua University Hospital, Padua, Italy
| | - Claudia Scudieri
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.,Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
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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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Fujii Y, Nagaishi M, Nakae R, Takigawa T, Tanaka Y, Suzuki K. Intracranial endodermal cyst presenting with nonobstructive hydrocephalus: A case report. Medicine (Baltimore) 2019; 98:e14322. [PMID: 30732152 PMCID: PMC6380779 DOI: 10.1097/md.0000000000014322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
RATIONALE Endodermal cysts are rare benign lesions in the central nervous system. Their common symptoms include headache and neck pain caused by mass effect or inflammatory reaction. We report the case of an elderly woman with intracranial endodermal cyst who presented with nonobstructive hydrocephalus. PATIENT CONCERNS A 78-year-old woman presented with acute deterioration of consciousness caused by acute hydrocephalus. She subsequently underwent ventriculoperitoneal shunt placement. Eighteen months after this operation, she developed numbness of extremities and gait and progressive cognitive disturbances. DIAGNOSIS Initially, the endodermal cyst could not be recognized, but it became clinically evident in the craniocervical junction after ventriculoperitoneal shunt placement. MRI revealed multiple cystic lesions in the pontomedullary cistern. Postoperative pathology confirmed the diagnosis of endodermal cyst. INTERVENTIONS Subtotal resection of the cystic lesion was performed. Intra-operatively, multiple cysts containing a milky white fluid were noted and the medullary surface including the median and lateral apertures of the fourth ventricle were covered by thick, cloudy arachnoid membrane. OUTCOMES Although the numbness of extremities improved after the surgery, she remained bedridden due to deterioration in cognitive function and generalized muscle weakness. The patient developed recurrence 2 months after the surgery; however, no additional surgery was performed owing to her poor general condition. LESSONS Endodermal cysts rarely present with nonobstructive hydrocephalus caused by recurrent meningitis. In such cases, the lesions are often invisible on initial diagnostic imaging, and complete resection of the lesions is typically difficult because of strong adhesion between the cyst walls and contiguous vital structures.
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Ozgural O, Dogan I, Solmaz S, Morali Guler T, Kahilogullari G. Transcranial endoscopic treatment of thalamic neuroepithelial cyst: case report and review of the literature. Br J Neurosurg 2019:1-4. [PMID: 30636457 DOI: 10.1080/02688697.2018.1552753] [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: 10/27/2022]
Abstract
Thalamic neuroepithelial cysts are rare, benign lesions. Thirteen cases have been published in eight articles. The most frequent symptoms are headache, hemiparesis, tremor and related signs of hydrocephalus such as gait disturbance, confusion, and Paranaud's syndrome. Surgical interventions include endoscopic fenestration, open surgery and stereotaxic biopsy or aspiration. We report a case of a 63-year-old woman who had headache and right hemiparesis for 1 week, but no hydrocephalus. We treated her with transcranial neuronavigation-guided endoscopic complete resection. The patient recovered completely after cyst removal.
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Affiliation(s)
- Onur Ozgural
- a Neurosurgery Department , Ibni Sina Hospital, Ankara University School of Medicine , Ankara , Turkey
| | - Ihsan Dogan
- a Neurosurgery Department , Ibni Sina Hospital, Ankara University School of Medicine , Ankara , Turkey
| | - Serdar Solmaz
- a Neurosurgery Department , Ibni Sina Hospital, Ankara University School of Medicine , Ankara , Turkey
| | - Tugba Morali Guler
- b Neurosurgery Department , Karabuk University School of Medicine , Karabuk , Turkey
| | - Gokmen Kahilogullari
- a Neurosurgery Department , Ibni Sina Hospital, Ankara University School of Medicine , Ankara , Turkey
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Supratentorial neurenteric cyst: Analysis of 45 cases in the literature. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2017.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Neuroenteric cyst of the left lateral ventricle: case report and review of the literature. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-016-0065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Vasquez CA, Casey M, Folzenlogen Z, Ormond DR, Lillehei K, Youssef AS. Third Ventricular Cerebrospinal Fluid Cysts of Thalamic Origin: Review of Embryologic Origin, Presentation, and Management Strategies with a Case Series. World Neurosurg 2017; 103:210-219. [PMID: 28391023 DOI: 10.1016/j.wneu.2017.03.138] [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: 01/30/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Third ventricular cerebrospinal fluid (CSF) cysts of thalamic origin are rare. The objective of this study is to review their possible pathogenesis, clinical presentation, and management strategies with a case series describing management via an endoscopic approach with fenestration using a single burr-hole technique. METHODS A systematic literature review of reported cases of thalamic cysts was conducted with further meta-analysis of CSF cysts that involve the third ventricle. The mode of presentation, pathologic analysis, surgical management, and outcomes were analyzed. RESULTS Twenty-two studies reported between 1990 and 2013 described 42 cases of thalamic cyst. Of those cases, 13 were consistent with CSF cyst that originated in the thalamus and involved the third ventricle. Eight cases (61.5%) were treated via endoscopic fenestration, 2 cases (15.4%) were surgically drained, 2 cases (15.4%) were stereotactically aspirated, and 1 case (7.69%) was observed. The most common presenting symptoms were gait disturbance (26.3%) and headaches (26.3%) followed by tremors (15.8%) and weakness (15.8%). In our series, a single burr-hole technique was a successful definitive treatment, with an average period of 23 months. CONCLUSIONS Third ventricular CSF cysts of thalamic origin most commonly present with hydrocephalus. They can be safely definitively treated via endoscopic fenestration to the CSF circulation using a single burr-hole technique. Long-term follow-up shows lasting improvement in symptoms without reaccumulation of the cyst.
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Affiliation(s)
- Ciro A Vasquez
- Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
| | - Michael Casey
- Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
| | - Zach Folzenlogen
- Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
| | - David R Ormond
- Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
| | - Kevin Lillehei
- Department of Neurosurgery, University of Colorado, Denver, Colorado, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado, Denver, Colorado, USA.
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Third-ventricle enterogenous cyst presentation mimicking a colloid cyst: uncommon presentation of a rare disease and literature review. Acta Neurochir (Wien) 2017; 159:465-468. [PMID: 27981391 DOI: 10.1007/s00701-016-3052-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
Enterogenous cysts (ECs) are endodermal lesions resulting from splitting anomalies in the neuroenteric canal. We report the case of a 64-year-old patient who presented with a sudden headache followed by collapse. Brain computed tomography revealed a hyperdense lesion in the anterior part of the third ventricle with obstructive hydrocephalus. A presumptive diagnosis of colloid cyst was made and he underwent a right transcortical approach for lesion resection. The histopathological examination revealed an EC. ECs are common lesions in the cervical-thoracic spine but rare in the supratentorial compartment with only two previously described cases occurring in the third ventricle.
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Arishima H, Arai H, Kodera T, Kitai R, Kikuta KI, Takeuchi H. A Large Endodermal Cyst with Xanthogranuloma at the Frontal Skull Base, Slowly Recurring with Hemorrhage. NMC Case Rep J 2016; 3:39-43. [PMID: 28663995 PMCID: PMC5386149 DOI: 10.2176/nmccrj.cr.2015-0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/21/2015] [Indexed: 11/20/2022] Open
Abstract
A 45-year-old man with a past history of the removal of a degenerated hematoma two times presented with general convulsion. Computed tomography (CT) showed a high-density lobular mass growing from the right frontal skull base and occupying the right frontal lobe. Magnetic resonance imaging (MRI) demonstrated a homogeneously hyperintense mass on T1-weighted imaging and a homogeneously hypointense mass on T2- and T2*-weighted imaging. We removed the lesion, which intraoperatively showed a blackish-brown and jellylike mass with machine oil-like fluid. There was a thin and elastic membrane at the boundary between the mass and degenerated brain tissue, and we removed as much of the membrane as possible. On light microscopy, most parts of the mass consisted of a degenerated hematoma with xanthogranuloma, while the thin and elastic membrane revealed one or two layers of non-ciliated columnar epithelial cells based on thin fibrous tissues with microvessels. Immunohistochemical staining showed that these epithelial cells contained periodic acid-Schiff (PAS)-positive granules, and were positive for cytokeratin (CAM5.2), carcinoembryonic antigen (CEA), and epithelial membrane antigen (EMA). Ultrastructual examination showed numerous microvilli at the surface of non-ciliated cells, and an interdigitation-like, dense adhesion structure. On the basis of pathological findings, the patient was considered to have a large endodermal cyst (EC) at the frontal skull base, probably derived from Seessel’s pouch. We speculate that EC developed inflammatory changes with xanthogranuloma, which caused further damage to the blood vessels and continuous hemorrhage.
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Affiliation(s)
| | - Hiroshi Arai
- Department of Neurosurgery, University of Fukui, Yoshida-gun, Fukui
| | - Toshiaki Kodera
- Department of Neurosurgery, University of Fukui, Yoshida-gun, Fukui
| | - Ryuhei Kitai
- Department of Neurosurgery, University of Fukui, Yoshida-gun, Fukui
| | | | - Hiroaki Takeuchi
- Department of Neurosurgery, Tan-nan Regional Medical Center, Sabae, Fukui
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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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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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Abstract
Background:Neurenteric cysts are congenital cysts of the central nervous system that are believed to be of endodermal origin. In this report we present the unique case of a supratentorial neurenteric cyst that is contained entirely within the brain parenchyma.Methods:Apatient presented with an intraparenchymal cystic lesion that was subsequently identified as a neurenteric cyst. This lesion is reviewed in light of the available literature.Case report:A 35-year-old female presented with a one year history of progressive headaches and seizure-like episodes. Her examination revealed no deficits. Magnetic resonance imaging showed a 4 cm x 4 cm x 4 cm cystic lesion within the parenchyma of the right frontal lobe. A right frontal craniotomy and complete excision of the cystic lesion was performed. Pathologic examination confirmed that it was a neurenteric cyst. Postoperatively the patient's symptoms improved.Conclusion:Review of the literature revealed this to be the first case of a surgically excised, pathologically confirmed supratentorial neurenteric cyst, contained entirely within the brain parenchyma.
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Affiliation(s)
- Edward Kachur
- Division of Neurosurgery, Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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Cebula H, Gobej I, Cristescu A, Bernier M, Pierre-Kahn V, Gaillard S. [Orbital neurenteric cyst. A case report and review of the literature]. Neurochirurgie 2014; 60:180-3. [PMID: 24910402 DOI: 10.1016/j.neuchi.2014.03.008] [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: 11/16/2013] [Revised: 03/01/2014] [Accepted: 03/29/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Neurenteric cysts defined as a cyst lined by endodermal-type epithelium are extremely rare. We report a rare case of an orbital neurenteric cyst. CASE REPORT A 19-year-old female presented with an orbital cyst tumor that had cosmetic consequences. The signal of the cyst was not enhanced after administration of gadolinium on MRI examination. The patient underwent surgery due to the increase in size of the tumor. A complete cyst removal including the cyst wall through the inferior palpebral fold was performed. The histological examination confirmed the diagnostic of neurenteric cyst. The patient was discharged home in excellent condition. CONCLUSION This report discusses the clinical presentation, neuroradiological aspect, pathological findings and therapeutic consideration of the neurenteric cyst. We described a rare case of orbital neurenteric cyst. Due to the local recurrence rate observed after partial resection, the goal of the surgery should be a total resection of the cyst with the cyst wall.
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Affiliation(s)
- H Cebula
- Service de neurochirurgie, hôpital Hautepierre, 1, avenue Molière, 67000 Strasbourg, France.
| | - I Gobej
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - A Cristescu
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - M Bernier
- Service d'anatomo-pathologie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - V Pierre-Kahn
- Service d'ophtalmologie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
| | - S Gaillard
- Service de neurochirurgie, hôpital Foch, 40, rue Worth, 92151 Suresnes, France
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Yang T, Wu L, Deng X, Yang C, Fang J, Zhao L, Wang G, Yang J, Xu Y. Clinical characteristics and surgical outcomes of spinal intramedullary ependymal cysts. Acta Neurochir (Wien) 2014; 156:269-75. [PMID: 24322584 DOI: 10.1007/s00701-013-1964-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/28/2013] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.6 Tiantan Xili, Dongcheng District, Beijing, 100050, China,
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Enterogenous cyst of the third ventricle. J Clin Neurosci 2014; 21:161-3. [DOI: 10.1016/j.jocn.2012.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/10/2012] [Accepted: 10/19/2012] [Indexed: 11/24/2022]
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Arabi M, Ibrahim M, Camelo-Piragua S, Shah G. Supratentorial neurenteric cyst mimicking hydatid cyst: A case report and literature review. Avicenna J Med 2013; 3:73-80. [PMID: 24251235 PMCID: PMC3818783 DOI: 10.4103/2231-0770.118463] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurenteric (NE) cysts are uncommon congenital cysts of endodermal origin. These cysts are commonly encountered in the posterior fossa surrounding the brain stem structures. We present a case of pathologically proven supratentorial NE cyst that mimicked a hydatid cyst in its clinical presentation and imaging appearance. Including this pathology in the differential diagnosis of supratentorial cystic lesions is important due to the differences in medical and surgical management.
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Affiliation(s)
- Mohammad Arabi
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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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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Shah A, Muzumdar D, Goel N, Goel A. Fulminant fatal meningitis following partial resection of an endodermal cyst. Acta Neurochir (Wien) 2010; 152:729-30. [PMID: 20148272 DOI: 10.1007/s00701-009-0528-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 09/21/2009] [Indexed: 11/28/2022]
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20
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Mittal S, Petrecca K, Sabbagh AJ, Rayes M, Melançon D, Guiot MC, Olivier A. Supratentorial neurenteric cysts—A fascinating entity of uncertain embryopathogenesis. Clin Neurol Neurosurg 2010; 112:89-97. [DOI: 10.1016/j.clineuro.2009.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Revised: 11/01/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
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21
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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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22
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Naran S, Lallu S, Bethwaite P. Aspiration cytodiagnosis of an endodermal cyst located at L1/L2 region of spinal canal. Diagn Cytopathol 2008; 36:605-6. [PMID: 18618729 DOI: 10.1002/dc.20856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Kato M, Nakamura H, Suzuki E, Terai H, Wakasa K, Wakasa T, Takaoka K. Ependymal cyst in the lumbar spine associated with cauda equina compression. J Clin Neurosci 2008; 15:827-30. [DOI: 10.1016/j.jocn.2006.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 12/21/2006] [Accepted: 12/25/2006] [Indexed: 11/26/2022]
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24
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Chen PY, Wu CT, Lui TN, Jung SM. Endodermal cyst presenting as a prenatally diagnosed large intracranial cyst. Case report and review of the literature. J Neurosurg 2007; 106:506-8. [PMID: 17566411 DOI: 10.3171/ped.2007.106.6.506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Endodermal cysts of the central nervous system are unusual lesions. Most reported cysts develop in the spinal canal, whereas others, which occur intracranially, are usually located in the posterior fossa. Although endodermal cysts are considered congenital, a prenatal diagnosis has not been reported. In this report the authors present an extremely rare case of a large intracranial endodermal cyst detected prenatally and treated successfully after birth.
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Affiliation(s)
- Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China.
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25
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Miyagi A, Katayama Y. NEURENTERIC CYST ARISING IN THE HIGH CONVEXITY PARIETAL LESION. Neurosurgery 2007; 60:E203-4; discussion E204. [PMID: 17228229 DOI: 10.1227/01.neu.0000249255.71170.c0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Supratentorial neurenteric cysts (NC) are rare; only 16 cases were reported previously, the majority of which were located in the anterior fossa or in the deep midline structure. We report a case of NC arising in the high convexity parietal lesion and briefly discuss the histogenesis of NC in such an unusual location.
CLINICAL PRESENTATION
A 63-year-old man presented with a 1-month history of progressive headache and dizziness. Computed tomographic and magnetic resonance imaging scans demonstrated a 4 × 5 × 5 cm extra-axial cystic lesion in the right parietal convexity adjacent to the sagittal sinus without contrast enhancement. A translucent thin-walled cyst containing a milky-white fluid was partially excised via a right parietal craniotomy.
INTERVENTION
The cyst wall was composed of a thin fibroconnective tissue lined by a single layer of ciliated columnar epithelial cells and pseudostratified columnar epithelium. Mucous-secreting goblet cells of epithelial lining reacted to periodic acid-Shiff staining. The internal epithelial cells were immunoreactive to cytokeratin and epithelial membrane antigen, but not to carcinoembryonic antigen, glial fibrillary acidic protein, or S-100 protein. A follow-up magnetic resonance imaging scan taken 6 months later showed resolution of mass effect without evidence of cyst recurrence. The patient was discharged home in excellent condition.
CONCLUSION
A case of NC arising in the high convexity parietal lesion is described. Supratentorial NCs located far from the location of the primitive endoderm suggest the possibility that NCs could arise from ectopic endodermal tissue through an undetermined process of anomalous differentiation. Total surgical excision of the cyst wall and contents is the best treatment for the symptomatic cases. Subtotal or partial resection without injury to important neurovascular structures are reasonable alternatives, but long-term careful follow-up magnetic resonance imaging or computed tomography is necessary to monitor for recurrence of any residual lesion.
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Affiliation(s)
- Atsushi Miyagi
- Department of Neurosurgery, Shirahigebashi Hospital, Tokyo, Japan.
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26
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Okunaga T, Tsutsumi K, Hayashi T, Nagata I. Endodermal Cyst of the Oculomotor Nerve: Case Report. Neurosurgery 2006; 58:E994; discussion E994. [PMID: 16639308 DOI: 10.1227/01.neu.0000210253.25288.f3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
Endodermal cysts are commonly found in the anterior spinal cord. Reports of intracranial cases are uncommon. We report a case of endodermal cyst located on the left oculomotor nerve.
CLINICAL PRESENTATION:
A 16-year-old female experienced diplopia followed by headache. Neurological examinations revealed left oculomotor nerve palsy. Magnetic resonance imaging scans showed a well-defined multilocular cystic mass in the proximity of the left oculomotor nerve at its exit from the midbrain.
INTERVENTION:
This patient underwent biopsy and drainage of the cyst. At surgery, the cyst seemed to be intrinsic to the oculomotor nerve and could not be totally resected. Pathological examination confirmed the diagnosis of endodermal cyst.
CONCLUSION:
Intracranial endodermal cysts are rare, particularly when associated with the cranial nerves. To our knowledge, this is the second case of endodermal cyst located on the oculomotor nerve. A detailed discussion and review of these case reports are presented.
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Affiliation(s)
- Tomohiro Okunaga
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan.
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27
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Tan GS, Hortobágyi T, Al-Sarraj S, Connor SEJ. Intracranial laterally based supratentorial neurenteric cyst. Br J Radiol 2004; 77:963-5. [PMID: 15507425 DOI: 10.1259/bjr/77185587] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neurenteric cysts are rare developmental cysts lined by endodermal derived epithelium. We present the case of a 68-year-old patient presenting with seizures who was found to have an extra-axial low density lesion with associated wall calcification on CT. Aspiration and biopsy of the cyst revealed a neurenteric cyst. Such lesions of the lateral supratentorial convexity are extremely rare and calcification has not been previously reported in these intracranial cysts.
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Affiliation(s)
- G S Tan
- Department of Radiology, Kings College Hospital, Denmark Hill, London, UK
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28
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Christov C, Chrétien F, Brugieres P, Djindjian M. Giant Supratentorial Enterogenous Cyst: Report of a Case, Literature Review, and Discussion of Pathogenesis. Neurosurgery 2004; 54:759-63; discussion 763. [PMID: 15028155 DOI: 10.1227/01.neu.0000109538.07853.7f] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2003] [Accepted: 11/06/2003] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE
To describe a histologically well-documented adult case of a giant supratentorial enterogenous cyst (EC). Fewer than 15 cases of supratentorial ECs are on record: 8 associated with the brain hemispheres or the overlying meninges, 4 with the sellar region, and 2 with the optic nerve.
CLINICAL PRESENTATION
A 31-year-old woman complained of long-standing mild left brachial and crural motor deficit precipitated by headache and signs of intracranial hypertension. Magnetic resonance imaging revealed a huge cyst overlying the frontoparietal brain.
INTERVENTION
Symptoms were relieved by evacuation of the cyst content by means of a Rickam's reservoir, and the lesion was subsequently removed in toto. Histological and immunohistochemical examination of the cyst wall clearly established the enterogenous nature of its epithelium. Follow-up for up to 2 years after intervention showed no sign of recurrence, and symptoms, including treatment-resistant seizures in the postoperative period, have entirely subsided.
CONCLUSION
Supratentorial ECs, distinctly rare in adult patients, may in some cases present as giant lesions. Total removal seems to be curative once careful examination has eliminated the possibility of a metastasis from an unknown primary. A correct histological diagnosis is important because, in contrast to other benign cysts of similar location and size, ECs may be prone to intraoperative dissemination.
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Affiliation(s)
- Christo Christov
- Département de Pathologie, Service d'Histologie, Hôpital Henri Mondor-Assistance Publique-Hôpitaux de Paris, Créteil, France
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29
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Monaco R, Boscaino A, Di Blasi A, D'Antonio A, Profeta G, De Falco R, Nappi O. Intraepithelial carcinoma arising in an endodermal cyst of the posterior fossa. Neuropathology 2003; 23:219-24. [PMID: 14570291 DOI: 10.1046/j.1440-1789.2003.00497.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endodermal cysts of the central neuraxis are benign, non-neoplastic epithelium-lined cysts arising from endodermal tissue that have been displaced early in fetal life. Intracranial endodermal cysts are rare and usually located in the posterior fossa. The present study involves a 36-year-old man with a typical epithelial cyst in the posterior fossa. Microscopically, the cyst has a simple columnar epithelium with mucus-producing cells, containing an area composed of dysplastic epithelium with evidence of an intraepithelial carcinoma. The atypical cells have a high proliferative fraction demonstrated by Ki-67 immunostain. Based on these findings, the authors view this case as evidence of a malignant transformation of a classic endodermal cyst. The clinicopathologic features and a review of the literature are discussed.
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Affiliation(s)
- Roberto Monaco
- Operative Unit of Anatomic Pathology, A. Cardarelli Hospital, Naples, Italy
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30
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Vlaho S, Gebhardt B, Gerlach R, Weidauer S, Kieslich M. Cyst of the third ventricle as an unusual cause of acquired hydrocephalus. Pediatr Neurol 2003; 28:225-7. [PMID: 12770679 DOI: 10.1016/s0887-8994(02)00515-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cysts of the third ventricle are rare congenital suprasellar malformations of arachnoidal, endodermal, or neuroepithelial origin. Depending on their size and location, they can cause space-occupying intracranial lesions and hydrocephalus occlusus by obstruction of the aqueduct or foramen of Monro. They can be missed on routine computer tomography and magnetic resonance imaging. A 2-year-old boy presented signs of intracranial pressure. Initial magnetic resonance imaging revealed a triventricular internal hydrocephalus with no visible etiologic lesion. An extended investigation with the constructive interference in steady state-technique showed a mobile cystic cerebrospinal fluid-intense lesion within the third ventricle, causing transient occlusion of the foramen of Monro. A suprasellar cyst of the third ventricle is an important differential diagnosis in apparently "idiopathic" internal hydrocephalus. In such cases, magnetic resonance imaging using the constructive interference in steady state-technique with a slice thickness of 1 mm is the method of choice for detecting intraventricular cysts. Neurosurgical fenestration and/or resection of the cyst by neuroendoscopy can resolve cerebrospinal fluid circulation disturbances and seems to be superior to a shunt.
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Affiliation(s)
- Stefan Vlaho
- Department of Pediatric Neurology, Johann Wolfgang GoetheUniversity, Frankfurt/Main, Germany
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31
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IKEDA N, WAKABAYASHI S, TORIYAMA H, ICHIOKA T, WAKABAYASHI C, KAJIKAWA H, SUGIE A, KUROIWA T, NAKAYAMA H. A Case of Posterior Fossa Neurenteric Cyst. ACTA ACUST UNITED AC 2003. [DOI: 10.7887/jcns.12.617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Naokado IKEDA
- Departments of Neurosurgery, Suiseikai Kajikawa Hospital
| | | | | | | | | | | | - Akira SUGIE
- Department of Neurosurgery, Osaka Medical College
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32
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Abstract
This article explores the association between normal pressure hydrocephalus and psychiatric symptoms, such as depressed mood, delusions, and hallucinations. We are reporting a case of a 30-year-old female with a history of congenital hydrocephalus, is used to illustrate this association. Such patients may benefit from treatment with ventriculoperitoneal or ventriculoatrial shunt procedures.
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Affiliation(s)
- A O Alao
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York 13210, USA.
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33
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Mishra GP, Sharma RR, Musa MM, Pawar SJ. Endodermal cyst of septum pellucidum and pregnancy: a case report. SURGICAL NEUROLOGY 2000; 53:583-5. [PMID: 10940427 DOI: 10.1016/s0090-3019(00)00247-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Endodermal or Neurenteric cysts are commonly found in spine. Their intracranial occurrence is rare and such a cyst in the septum pellucidum is exceptional. METHOD We report a woman, with 33 week pregnancy, presenting in a semiconscious state due to raised intracranial pressure (ICP) due to hydrocephalus caused by a large lesion in the septum pellucidum. Computed tomography (CT) revealed the lesion which was better characterised by the Magnetic Resonance Imaging (MRI). First baby was delivered by LSCS and bilateral ventriculo-peritoneal shunts were inserted; and later on the cyst was excised. RESULT There was full neurological recovery following the insertion of VP shunt. After excision of cyst cerebrospinal fluid (CSF) pathway was established and shunts could be removed. Post-operative period was complicated by septic ventriculitis. Eventually patient was discharged home in excellent condition. CONCLUSION Endodermal cyst of septum pellucidum is an uncommon condition. Such lesions may be large when revealed, good outcome is expected after surgical excision.
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Affiliation(s)
- G P Mishra
- Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman, Saudi Arabia
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34
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Winkler PA, Ilmberger J, Krishnan KG, Reulen HJ. Transcallosal interforniceal-transforaminal approach for removing lesions occupying the third ventricular space: clinical and neuropsychological results. Neurosurgery 2000; 46:879-88; discussion 888-90. [PMID: 10764261 DOI: 10.1097/00006123-200004000-00020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The present study was undertaken to describe the clinical and prospective neuropsychological results for our group of 30 patients who were treated using a transcallosal interforniceal-transforaminal microsurgical approach. METHODS The transcallosal interforniceal and transcallosal-transforaminal approaches were used to treat 30 patients with space-occupying lesions located in the anterior part of the third ventricle. We used a modified anterior transcallosal microsurgical approach, as described recently. The patients underwent extensive, pre- and postoperative, prospective neuropsychological testing, using a specially designed test battery. RESULTS Twenty-three of 30 patients (77%) experienced excellent clinical outcomes (Glasgow Outcome Scale Grade V). The surgical procedures described in this report did not themselves impair attentional function. In both the early and late postoperative neuropsychological testing sessions, deficits in verbal memory were only rarely observed and were not noted to be correlated with the surgical procedures. The most relevant neuropsychological results for individual patients are reported in detail. CONCLUSION The approach described here can be successfully used for the resection of various space-occupying lesions in the anterior part of the third ventricle. The anatomic landmarks we recently defined and described (for example, the midline vessel on the trunk of the corpus callosum, to direct the callosotomy) guide the surgical path. Furthermore, we recommend the use of neuropsychological test batteries for both scientific and rehabilitative purposes.
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Affiliation(s)
- P A Winkler
- Department of Neurosurgery, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Germany
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35
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Winkler PA, Ilmberger J, Krishnan KG, Reulen HJ. Transcallosal Interforniceal-Transforaminal Approach for Removing Lesions Occupying the Third Ventricular Space: Clinical and Neuropsychological Results. Neurosurgery 2000. [DOI: 10.1227/00006123-200004000-00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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36
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Sampath S, Yasha TC, Shetty S, Chandramouli BA. Parasellar Neurenteric Cyst: Unusual Site and Histology: Case Report. Neurosurgery 1999. [DOI: 10.1227/00006123-199906000-00103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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