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.

A Recurrent Cervical Neurenteric Cyst Treated Anteriorly: Safe, Gross-Total Excision Facilitated by Prophylactic Unilateral Vertebral Artery Exposure, Microdissection, and Spinal Cord Monitoring-A Case Report and Technical Note

This study reports on a 67-year-old woman with partial Brown-Séquard syndrome due to a recurrent cervical neurenteric cyst at C3 to C4. The myelopathic symptoms reappeared 22 years after a previous shunting operation performed posteriorly with a silicone tube connecting the intradural cervical cyst cavity to the subarachnoid space. We have now succeeded in removing the cyst nearly completely with the anterior approach. The surgical procedure consisted of right vertebral artery exposure at C3 and C4 and a subtotal corpectomy of C3 followed by microdissection of the cyst, duraplasty, and iliac strut graft fusion. Spinal cord monitoring with motor-evoked potential studies helped us safely dissect the cyst wall tightly adhering to the spinal cord. Duraplasty with Gore-Tex patch-grafting in conjunction with postoperative lumbar subarachnoid drainage worked well in preventing a spinal fluid fistula. At two years after surgery, the patient showed a nearly complete return of function without any recurrence of the cyst.

[Spinal stroke in a pregnant female with an endodermal cyst of the cervical spinal cord (a case report and literature review)]

AIM

The study purpose was to present a clinical case of spinal stroke in a pregnant female, which was caused by an endodermal cyst of the cervical spinal cord, and to analyze treatment tactics.

RESULTS

A 20 week pregnant female presented with acute transverse spinal cord injury at the of C3-C5 spinal segment level. CT revealed an extramedullary space-occupying lesion in the ventrolateral position, with compression of the spinal cord at this level. The patient in the state of progressive deterioration with respiratory failure was transferred to the Neurosurgical Institute on the 5th day after disease onset. The patient underwent surgery on the 7th day after disease onset. Doctors of various specialties participated in preparation for surgery. During surgery, total resection of the space-occupying lesion and spinal cord decompression were performed. An obstetrician-gynecologist conducted intraoperative fetal monitoring by ultrasound. The histological diagnosis was an endodermal cyst. There was no improvement of neurological symptoms in the early postoperative period. After stabilization of the condition, the patient was discharged for follow-up care at the place of residence. According to the follow-up report, the patient underwent the cesarean section because of exacerbation of lung infection and a significant delay in the fetal development. After a few days, the patient died due to multiple organ failure. The child was alive, in serious condition, under mechanical ventilation.

CONCLUSION

In the case of spinal stroke, the decision on treatment tactics should be made no later than 12 hours after its onset; otherwise, the outcome is usually unfavorable, and a neurological deficit is irreversible. The decision about continuing pregnancy should be made individually in each case, and an approach to the choice of appropriate treatment tactics should be multi-disciplinary.