Neurenteric cyst of the lower clivus

Tumor-Like Lesions in the Craniovertebral Junction: A Case Series, Systematic Review, and Meta-Analysis

Background: Tumor-like lesions at the craniovertebral junction mimic tumors in clinical presentation and imaging. Our study focuses on three common developmental pathologies-epidermoids, dermoids and neurenteric cysts. Methods: We conducted a retrospective analysis of a case series and a meta-analysis of 170 patients from 119 reports. Results: Neurenteric cysts predominated (81.2%). Anterior cysts were linked to neurenteric cysts, while posterior ones correlated with dermoid/epidermoid cysts (p < 0.001). Complications occurred in 27.2% of cases, with cranial nerve paresis being the most common. Most patients had excellent outcomes (75.2%) with low recurrence rates (12%). Dermoid cysts were more associated with anomalies (p < 0.001). Among 138 neurenteric cyst cases, 15 experienced recurrence, with predictors including ages 51-60 and over 70, subtotal resection, complications, and poor outcomes (p < 0.001). Cysts with total resection were significantly less likely to adhere to surrounding brain tissue (p < 0.001). CSF diversion was correlated with older age (p = 0.010) and various complications (p < 0.001). Age affected outcomes, and the hydrocephalus was linked to poor outcomes (p = 0.002). Conclusions: This meta-analysis underscores the importance of total resection in minimizing recurrence rates and emphasizes meticulous preoperative planning and imaging. Our results indicate that rim enhancement (p = 0.047) and poor outcome (p = 0.007) are significant factors associated with recurrence. Additionally, associated anomalies, as well as the patient's age and overall health, significantly influence the surgical outcomes and the likelihood of recurrence.

Adenocarcinoma arising in an ectopic enterogenous cyst: A rare case report and review of literature

Enterogenous cyst (EC) is a rare congenital lesion generally located in the central nervous system, such as in the cerebral hemispheres, posterior fossa, or spinal canal. They are usually benign lesions, and malignant transformation is rare. A 42-year-old woman felt an obvious pain in the lump and went to a local hospital for local lumpectomy. After 7 months, she again felt pain in the buttocks and difficulty in urinating and defecation. The computed tomography (CT) scan showed a mass in the pelvis. Sacrococcygeal cyst excision was performed 10 days later, and postoperative pathology showed epidermoid cyst. Shortly after, the patient recovered and was discharged from the hospital; the pain in the buttocks continued to recur. Puncture and drainage were performed five times. Later, the patient went to our hospital for treatment, and pelvic MRI showed multiple abnormal signal shadows in the presacral and sacrococcygeal regions, some of which were considered abscesses, and some were cystic lesions. She underwent tumor resection and was diagnosed with EC with locally moderately differentiated adenocarcinoma. Four months later, the patient's symptoms of swelling and pain recurred. MRI examination showed multiple high-signal T2 shadows in the anterior sacral and subcutaneous tissues of the buttocks, and enhanced scan showed partial marginal enhancement. After assessment, the patient was given a radiation dose of 60 Gy/25F. ECs in the anterior sacral and soft tissue of the buttocks are very rare, and the case of carcinomatous transformation has never been reported. Therefore, we discussed the clinicopathological features of ectopic ECs and reviewed the literature.

A practical overview of CT and MRI features of developmental, inflammatory, and neoplastic lesions of the sphenoid body and clivus

The sphenoid bone is an unpaired bone that contributes to the formation of the skull base. Despite the enormous progress in transnasal endoscopic visualisation, imaging techniques remain the cornerstones to characterise any pathological condition arising in this area. In the present review, we offer a bird's-eye view of the developmental, inflammatory, and neoplastic alterations affecting the sphenoid body and clivus, with the aim to propose a practical diagnostic aid for radiologists based on clinico-epidemiological, computed tomography, and magnetic resonance imaging features.

Frontal Base Endodermal Cyst: A Case Report and Review of Literature

Background: Endodermal cyst (EC) is a rare congenital cyst of endodermal origin, but the pathogenesis of this entity remains uncertain. Supratentorial EC is particularly uncommon, but some cases have been reported. Here, we report a case of supratentorial EC that developed at the frontal base which indicates posttraumatic development rather than a congenital origin. Case Description: A 65-year-old man who had a history of orbital bone fracture without rhinorrhea sustained in a traffic accident presented with gradually enlarging frontal-base cystic lesions. Multiple cystic lesions were removed via left frontal craniotomy. The cysts showed no communication with the frontal sinus. Histological examination identified EC. Postoperative course was uneventful and no recurrences have been identified as of 2 years later. Conclusions: According to reported cases, unlike ECs in other intracranial locations, frontal base ECs tend to present at advanced ages. The present case also presented with EC enlargement at an advanced age and two lesions located at the bone hiatus in the frontal base that were presumably caused by trauma. It is possible that sinus communication was repaired as the bone fracture was remodeled, and the remnant sinus epithelial tissues developed into ECs over time. This situation makes it reasonable to presume a posttraumatic rather than a congenital origin. In conclusion, as for frontal base ECs, contrary to the traditional theory, the developmental mechanisms may not necessarily be congenital.

Combined endoscopic endonasal transtubercular and transclival approaches for large neurenteric cyst in posterior cranial fossa: A case report and literature review

Background:

Intracranial neurenteric cysts (NCs) are extremely rare tumors that more commonly involve the posterior fossa than any other cranial part. While transcranial skull base surgery has been the mainstay of treatment, the utility of endoscopic transnasal surgery (ETS) remains to be established.

Case Description:

We report a case of a large posterior fossa NC extensively involving the suprasellar region, cerebellopontine angle, and prepontine cistern, which we successfully resected with ETS through a combination of transtubercular and transclival routes. Before surgery, the patient presented with abducens nerve and pseudobulbar palsies, which resolved within 2 weeks postoperatively. The patient remained free from recurrence for 3 years postoperatively.

Conclusion:

Extended ETS may offer a minimally invasive option for the posterior fossa NC, extensively occupying the ventral space of the brainstem.

Endoscope-Assisted Resection of Extra-Axial Premedullary Neurenteric Cyst via Far Lateral-Supracondylar Approach: 2-Dimensional Operative Video

Neurenteric cysts are rare congenital lesions that may compress the ventral brainstem.1-9 In this operative video, we illustrate the surgical treatment of an intradural extra-axial neurenteric cyst extending from the lower pons to the craniocervical junction. The patient, an asymptomatic 52-yr-old female, underwent surveillance imaging of the premedullary lesion for 14 yr without progression. However, after developing progressive strain-induced headaches, imaging revealed a significant enlargement of the lesion with brainstem compression and partial obstruction of the foramen magnum. Therefore, surgical resection was pursued. The patient consented to the procedure. The patient underwent a lateral suboccipital craniotomy and C1 laminectomy through a far lateral approach. The lesion was immediately visualized upon opening the dura. After identifying the cranial nerves, we resected the tumor while taking care to preserve the neurovascular elements of the cerebellopontine angle and foramen magnum. During the resection, we unexpectedly encountered a firm nodule that was adherent to the right posterior inferior cerebellar artery. This was meticulously dissected and removed en bloc using intraoperative indocyanine green (ICG) angiography. The cavity was inspected with 0-degree and 30-degree endoscopes to ensure complete resection of the lesion. Gross total resection was confirmed on postoperative magnetic resonance imaging. The patient was neurologically intact with no cranial nerve abnormalities and discharged home on postoperative day 3. This case demonstrates that the far lateral-supracondylar approach affords safe access to the ventral pontomedullary and craniocervical junctions and that intraoperative adjuncts, including ICG angiography and endoscopic visualization, can facilitate complete lesion resection with excellent clinical outcomes.

Neurenteric cysts at foramen magnum in children: presentation, imaging characteristics, and surgical management-case series and literature review

INTRODUCTION

Neurenteric cysts (NEC) are rare benign tumors of the central nervous system. Even more rare are the NEC at the ventral foramen magnum in children that are misdiagnosed. They cause distortion of the vertebrobasilar vascular system and cervicomedullary neural structures and are adherent to the latter. The inferior portion lies ventral to the upper most dentate ligament. This has implications in the surgical approach for complete excision.

METHODS AND CASE SERIES

We reviewed our series of five children with ventral foramen magnum NEC in the MRI era and analyzed presentation, radiological findings and surgical management. A literature review is also presented.

RESULTS

There were two females and five males. Headache and neurological deficit was present in all five; one child presented with recurrent meningitis. The NEC was present ventral to the cervicomedullary junction in all cases. The posterolateral transcondylar approach was used for complete excision with no recurrences.

CONCLUSIONS

Neurenteric cysts at the ventral foramen magnum can be confused with other cystic lesions. Headaches are the most common presentation. The posterolateral transcondylar approach to the ventral cervicomedullary junction provides the most reliable avenue for entire resection.

A novel management proposal for intrinsic brainstem neurenteric cysts: case report

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.

Single-Center Clinical Characteristics and Treatment Experience of Foramen Magnum Neurenteric Cyst: Report of 6 Cases and Brief Review of the Literature

OBJECTIVE

To retrospectively analyze the clinical data of 6 patients with foramen magnum (FM) neurenteric (NE) cysts, and summarize the clinical characteristics and treatment experience for this rare disease in our single center.

METHODS

Between January 2011 and December 2015, 6 patients with FM NE cyst were surgically treated at Xuan Wu Hospital of Capital Medical University. We summarize the treatment experience of these patients through a retrospective review of the clinical information, imaging features, surgical details, and follow-up outcomes.

RESULTS

All 6 patients were female, ranging in age from 15 to 54 years (mean age, 36.8 ± 12.9 years). Occipital headache along with cranial nerve injury were the most common symptoms. Preoperative brain magnetic resonance imaging identified all lesions in the FM region, with an oblong or lobulated shape. The surgical approach was far lateral in 4 patients and suboccipital midline in 2 patients. Total lesion removal was completed in 4 patients, and subtotal excision was performed in the other 2 patients, in whom the cyst wall was intensely adherent to surrounding structures. In all 6 patients, the preoperative symptoms were significantly relieved after surgery. No recurrence was seen after a mean follow-up of 27.3 months (range, 3-70 months).

CONCLUSIONS

Our present study identified a female predominance among patients with intracranial FM NE cyst. Surgical excision is the optimum treatment strategy for this rare disease. Our findings indicate that subtotal removal of an FM NE cyst may be associated with favorable outcomes, but strict long-term follow up is needed.

Intraspinal bronchogenic cyst: Series of case reports and literature review

PURPOSE

Spinal bronchogenic cysts (SBCs) are rare congenital lesions. The clinical and imaging characteristics and treatment of SBCs are not well known. We studied three cases of SBCs retrospectively, which were registered in our department and analyzed eight case reports which were all published in English, focusing on providing a deeper knowledge of SBCs.

METHODS

Three patients with SBCs registered in our department were retrospectively reviewed. Eight reported SBCs cases published from 1992 to 2015 were enrolled in our study. Imaging diagnosis was confirmed by computed tomography (CT), MRI, and computed tomography angiography (CTA). All of our patients and reviewed cases had undergone surgical resection and the final diagnosis was made by pathological examination.

RESULTS

Five lesions were located at the cervical spinal canal. Most patients presented with pain in the limbs and back, which might be related to compression of the spinal cord and the reduced blood supply of the anterior spinal artery. The signal intensity on MRI was correlated with cystic fluid traits to a large extent. Seven lesions were partially removed because of the adhesions to the nearby spinal cord. All reported cases had no recurrence in the later follow-up.

CONCLUSIONS

SBCs can occur anywhere in the spinal canal, but they are more likely to present at the cervical canal and might be present along with some developmental malformations of the spine. We emphasize the role of CT and MRI findings in the disease diagnosis. It is recommended that the lesion should be removed as completely as possible.

Giant multi-compartmental suprasellar Rathke's cleft cyst with restriction on diffusion weighted images

Rathke's cleft cysts are congenital lesions seen in sellar-suprasellar regions. We report a case of giant Rathke cyst in a 43-year-old patient with multi-compartmental involvement who presented with seizures with almost normal visual acuity. We discuss radiological and pathological features of various differential diagnoses for the giant suprasellar Rathke's cyst.

Ventral foramen magnum neurenteric cysts: a case series and review of literature

Neurenteric cysts (NEC) are uncommon, benign, congenital lesions. Ventral foramen magnum (FM) location is very rare. The difficulties in diagnosis and management aspects are detailed with a review of the pertinent literature. We report four new cases of ventral FM NEC, all managed surgically and present a literature review of ventral FM NEC. A retrospective analysis of histopathologically confirmed cases of ventral FM NEC, operated from 2010-2013 at our institute, was performed. For review, only those cases of NEC extending from the lower clivus to the C2 level constituting the foramen magnum were included. Including our four cases, a total of 47 cases were identified. The male to female ratio was 1.2:1. Mean age was 33.5 years (range 1-60 years). Neck pain and occipital headache were the most common symptoms, followed by limb weakness and cranial nerve paresis. Recurrent meningitis was noted in three cases. Hyperintensity on both T1- and T2-weighted sequences with absent enhancement was the most common finding on MRI. Surgical approaches were as follows: suboccipital (n = 21), far/extreme lateral (n = 18), retrosigmoid (n = 6), and transoral (n = 4). The extent of resection was as follows: total, 26; near total, 6; subtotal, 9; and partial, 3 cases. Cerebrospinal fluid diversion was done in four cases for intracranial hypertension. Mean follow-up duration was 26.8 months (range 1 month-9 years). Recurrence was noted in four (8.5 %) cases. One (2 %) case had malignant transformation. Mortality rate was 4 %. Foramen magnum neurenteric cysts are rare, benign tumors of the central nervous system. Accurate preoperative diagnosis can often be established with MRI. Surgical removal is the treatment of choice. Complete excision is ideal but often not possible. Near total removal would suffice with good progression-free periods. A long-term follow-up with radiological studies is necessary as delayed recurrences can occur.

Spinal neurenteric cysts: Associated developmental anomalies and rationale of surgical approaches

BACKGROUND

Neurenteric cysts (NC) occur due to failure of separation of neurectoderm from endoderm at the 3rd week of embryogenesis. This study focuses on key clinico-radiological features of NCs, with emphasis on surgical nuances involved in resecting anteriorly placed NC, especially at the foramen magnum (FM).

METHOD

Sixteen consecutive patients having a spinal NC were included. Their clinico-radiological status, surgical nuances and follow-up status were noted.

RESULTS

The duration of spasticity/paraparesis/quadriparesis ranged from 15 days to 48 months. Twelve patients had an intradural extramedullary (IDEM; nine anterior and three anterolateral) cyst and four had an intramedullary (IM) cyst. Six of them had an anteriorly placed FM lesion (five IDEM and one IM). Amongst ten subaxial NCs, four were anterior, two antero-lateral and one postero-lateral; three were IM. Three patients had the characteristic stigmata of occult spinal dysraphism: two, a large mesenteric cyst, and one, a posterior mediastinal cyst. Excision was total in 13 patients. Subtotal excision of tumour capsule was performed for two recurrent cysts and an IM cyst. A far lateral approach was adopted for anteriorly placed FM lesions and posterior laminectomy for subaxial lesions. Histopathology revealed eight type A cysts, four type B cysts and four type C cysts. At follow-up (range, 8 months to 12 years; median, 60 ± 45.84 months), complete neurological recovery occurred in seven patients; six patients had persistent spasticity but only minor disability; two patients had difficulty in walking; and one patient with an anteriorly placed thoracic recurrent NC had sustained neurological deterioration.

CONCLUSIONS

Surgical difficulties in addressing NCs are related to their anterior or IM location, presence of adhesions and inability to dissect the tumour capsule from the spinal cord due to fibrous or lipomatous connections. The associated developmental anomalies must be specifically sought and addressed.

Supratentorial Neurenteric Cysts: Case Series and Review of Pathology, Imaging, and Clinical Management

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.

Clinical features and MRI manifestations of intraspinal enterogenous cysts

AIM: To explore the clinical features and magnetic resonance imaging (MRI) manifestations of intraspinal enterogenous cysts.

METHODS: Case reports concerning intraspinal enterogenous cysts were retrieved from CNKI and WanFang Data and screened according to the inclusion and exclusion criteria. The clinical features and MRI manifestations of intraspinal enterogenous cysts were analyzed.

RESULTS: A total of 60 case reports with 80 patients were included. The male to female ratio was 46:33. The mean age was 19.9 years ± 14.6 years. The mean course of disease was 2.87 years ± 5.00 years. There were 37.50% of patients with chief complaint or first symptom of neck-shoulder-back pain or discomfort. Most of the patients (82.50%) had motor dysfunction, and 13 patients had complications. The lesions were mostly located in the cervical (45.00%), ventral (83.33%) and subdural (94.87%) spinal cord. The signal was mostly hypointensity (67.35%) on T1 weighted imaging and hyperintensity (91.84%) on T2 weighted imaging in MRI examination. No enhancement was observed in most post-contrast images. Thinning and displacement can be observed in the corresponding spinal segments due to compression of cysts. All patients underwent surgery, and 95.74% of them recovered well. There were three cases of recurrence.

CONCLUSION: Intraspinal enterogenous cyst is a rare congenital disease. It can be diagnosed early and treated timely based on the clinical features and MRI manifestations. MRI examination provides an important tool for preoperative diagnosis, surgical planning and prognosis evaluation of intraspinal enterogenous cysts.

An unusual case of large posterior fossa neurenteric cyst involving bilateral cerebellopontine angle cisterns: report of a rare case and review of literature

BACKGROUND

Intracranial neurenteric cysts are rare cystic masses of endodermal origin lined with mucin producing low columnar or cuboidal epithelium. Approximately 141 cases have been reported so far. Most of the posterior fossa neurenteric cysts are typically small, located anteriorly to the brainstem in the midline or in the cerebellopontine angle cistern area.

CASE REPORT

We present a rare, histologically proven case of a large lobulated intracranial neurenteric cyst measuring 4.2 centimeters in the maximal transverse dimension and involving bilateral cerebellopontine angle cisterns. We also present a review of the literature on this uncommon finding.

CONCLUSIONS

Imaging features of neurenteric cyst are non-specific and it should be considered in the differential diagnosis for any intracranial extraaxial cystic lesion.

Neurenteric cyst of the area postrema

Neurenteric cysts are CNS lesions most frequently occurring in the spinal cord. Intracranial neurenteric cysts are rarer, typically presenting with headache, mass effect, or location-specific symptoms. The area postrema is known as the emetic center of the brain; lesions can cause nausea and vomiting. Our case, featuring a neurenteric cyst of the area postrema, illustrates the importance of considering a neurological etiology for nonspecific symptoms that otherwise elude explanation. Our patient presented with acute decompensated hydrocephalus upon exploratory abdominal laparoscopy for unresolving abdominal pain. The patient had an eight-month history of unexplained intermittent nausea, vomiting, and abdominal pain. These bouts increased in frequency during the weeks before acute presentation, prompting exploratory abdominal laparoscopy. The acute decompensation was managed by ventriculostomy, and cranial MRI revealed a cystic mass by the floor of the fourth ventricle. After the patient stabilized and returned to neurological baseline, suboccipital craniectomy and resection were performed. The mass was histologically identified as a neurenteric cyst. The patient was free from neurological complaints at one-year follow-up, indicating that the successful resection of the area postrema-associated neurenteric cyst resolved her previous symptoms. Thus, some intracranial lesions can masquerade as nonspecific symptoms, presenting a challenge to accurate diagnosis.

[Orbital neurenteric cyst. A case report and review of the literature]

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.

Spinal cord malformations

Malformations of the spinal cord are one of the most frequent malformations. They should be clearly divided into two completely different families of malformations: open dysraphisms and occult dysraphisms. Open dysraphism mostly consists in myelomeningocele (MMC). Its incidence is 1/1000 live births with a wide variation. Folic acid supplementation has been shown to reduce its risk. In most cases, the diagnosis is done prenatally by serum screening and ultrasound and may lead to termination of pregnancy. In case of decision to continue pregnancy, surgical treatment must be achieved during the first days of life, and in 50 to 90% of cases, a ventricular shunt must be installed. The follow-up of these children must be continued throughout life looking for late complications (Chiari II and syringomyelia, vertebral problems, neuropathic bladder, tethered cord). Occult dysraphisms are a heterogeneous group of malformations. Lipomas (filum and conus) are the most frequent and their treatment remains controversial. Diastematomyelia, neurenteric cysts, dermal sinus, and more complex forms (Currarino syndrome) belong to this group. Most of them can and must be diagnosed prenatally or at birth by careful examination of the lower back for the cutaneous stigmata of the disease to decrease the risk of neurological, urological, or orthopedic permanent handicap.

Neurenteric cyst of the ventral cervicomedullary region

Neurenteric cysts are rare, benign, endodermally derived tumors of the central nervous system. Intracranial neurenteric cysts are rare with posterior fossa being the most common location among them. Neurenteric cyst of the craniocervical region is very rare. Authors report a rare case of neurenteric cyst located in the ventral cervicomedullary region. The pertinent literature is reviewed regarding this uncommon entity.