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Tsukamoto S, Errani C, Facchini F, Papagelopoulos P, Mavrogenis AF. Fluid-fluid Levels in Musculoskeletal Tumor Imaging. Curr Med Imaging 2021; 17:157-165. [PMID: 32767947 DOI: 10.2174/1573405616666200806173258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
Fluid-fluid levels result from the separation of two fluids of differing densities within a cavernous space with the boundary between the two layers running in a horizontal plane at 90 degrees to the direction of gravity. Magnetic resonance imaging is the most sensitive imaging modality to identify fluid-fluid levels. Although the most common bone lesions containing fluid-fluid levels are aneurysmal bone cyst and telangiectatic osteosarcoma, fluid-fluid levels can be observed in a wide variety of bone and soft tissue lesions. Therefore, fluid-fluid levels cannot be considered diagnostic of any particular type of tumor and the diagnosis should be made on the basis of other clinical, radiological and pathological findings. This article summarizes the pathophysiology and imaging characteristics of fluid-fluid levels and discusses the differential diagnosis of tumors with this imaging sign.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Costantino Errani
- Department Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fabio Facchini
- Intensive Care and Pain Therapy, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Panayiotis Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Congenital Spinal Cysts: An Update and Review of the Literature. World Neurosurg 2020; 145:480-491.e9. [PMID: 32822959 DOI: 10.1016/j.wneu.2020.08.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023]
Abstract
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.
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Abstract
Spinal neurenteric cysts are rare congenital anomalies and the natural history of the cyst is not fully understood. We evaluated a case of spontaneous absorption of a cyst. The patient was a 5-year-old boy who had experienced pain in the bilateral upper extremities 3 days before his admission. Neurological examination revealed severe motor weakness of the upper extremities and mild motor weakness of the lower extremities. Magnetic resonance imaging (MRI) revealed an extramedullary cystic lesion with a fluid-fluid level in the cervical region. One week later, the pain spontaneously improved with bed rest, and the patient showed good neurological recovery. MRI performed 6 months later revealed spontaneous reduction of the cyst. Enlargement and contraction of the cyst were observed over 3 years on MRI. Since the size of the cyst changes, MRI should be performed annually for patient follow-up.
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D’HERBEMONT SOPHIE, MORALES-MARTÍNEZ ANDRÉSHUMBERTO, NAVARRO-CHÁVEZ IGNACIOPAVEL. CERVICAL NEURENTERIC CYST: A CASE REPORT. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191803172096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective Neurenteric cysts account for 0.7–1.3% of all spinal cord tumors. These rare lesions are composed of heterotopic endodermal tissue. Methods A 26-year-old woman with a 13-month history of severe cervicalgia and brachial paresthesia. Clinically she had mildbilateral brachial paresis (4/5), generalized hyperreflexia and a left Babinski Sign. Past medical history was significant for a cervical fistula closure when she was 1yearold. The superior somatosensory evoked potentials revealed medullary axonal damage with a left predominance. A cervical magnetic resonance imaging of the neck was performed showing a dorsal homogeneous cystic intradural extramedullary lesion with high signal intensity on T2. Computed tomography revealed a Klippel-Feil syndrome. Results A posterior laminectomy and surgical excision were performed without complications. Post-operative follow-up showed a complete recovery of arm strength. The histopathological report confirmed the preoperative diagnosis of neurenteric cyst. Most neurenteric cysts are located in the spine, mainly in a ventral position. A total of 95% of neurenteric cysts are found in the intradural/intramedullary compartment. Symptomatic neurenteric cysts typically appear in the second and third decades of life and are 1.5 to 3 times more common in men. In 50% of the cases, other vertebral malformations have also been reported. In this case, a congenital dorsal enteric cyst and a Klippel-Feil syndrome were observed. Conclusions The intraspinal neurenteric cysts are rare lesions that must be included in the differential diagnosis of a dorsal, intradural cystic structure. The diagnosis may be overlooked, especially in cases of chronic neck pain without neurological deficit. Level of evidence V; Expert Opinion.
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Spinal cord neurenteric cyst: clinical and diagnostic findings and long term follow-up in two dogs. Vet Q 2019; 38:106-111. [PMID: 30675815 PMCID: PMC6831020 DOI: 10.1080/01652176.2018.1542515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Goel A, Ranjan S, Shah A, Rai S, Gore S, Dharurkar P. Subtemporal “Interdural” Surgical Approach for “Giant” Facial Nerve Neurinomas. World Neurosurg 2018; 110:e835-e841. [DOI: 10.1016/j.wneu.2017.11.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/24/2022]
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Jung HS, Park SM, Kim GU, Kim MK, Song KS. Unique Imaging Features of Spinal Neurenteric Cyst. Clin Orthop Surg 2015; 7:515-8. [PMID: 26640637 PMCID: PMC4667122 DOI: 10.4055/cios.2015.7.4.515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/11/2014] [Indexed: 11/06/2022] Open
Abstract
A 50-year-old male presented with acutely progressed paraplegia. His magnetic resonance imaging demonstrated two well-demarcated components with opposite signals in one cystic lesion between the T1- and T2-weighted images at the T1 spine level. The patient showed immediately improved neurological symptoms after surgical intervention and the histopathological exam was compatible with a neurenteric cyst. On operation, two different viscous drainages from the cyst were confirmed. A unique similarity of image findings was found from a review of the pertinent literature. The common findings of spinal neurenteric cyst include an isointense or mildly hyperintense signal relative to cerebrospinal fluid for both T1- and T2-weighted images. However, albeit rarer, the signals of some part of the cyst could change into brightly hyperintensity on T1-weighted images and hypointensity on T2-weighted images due to the differing sedimentation of the more viscous contents in the cyst.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Min Park
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Gang-Un Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Kyung Kim
- Department of Pathology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Mahore A, Avinash KM, Muzumdar D, Ramadasi R. Infected cervico-dorsal dermoid cyst with fluid - fluid level. J Pediatr Neurosci 2015; 10:137-9. [PMID: 26167217 PMCID: PMC4489057 DOI: 10.4103/1817-1745.159208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of a 22-year-old female who was operated at the age of 3 months for cervico-dorsal swelling. She presented with gradual onset, progressively worsening dull aching pain in the cervico-dorsal region, 21 years following previous surgery. Magnetic resonance imaging showed intradural dermoid cyst with the fluid level. She underwent excision of the dermoid cyst with excision of the wall. The clinical profile, etiopathogenesis, radiological features, and management of intraspinal dermoid cysts are discussed in the light of current literature.
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Affiliation(s)
- Amit Mahore
- Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
| | - K M Avinash
- Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
| | - Dattatraya Muzumdar
- Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
| | - Raghvendra Ramadasi
- Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
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Yang T, Wu L, Fang J, Yang C, Deng X, Xu Y. Clinical presentation and surgical outcomes of intramedullary neurenteric cysts. J Neurosurg Spine 2015; 23:99-110. [PMID: 25909275 DOI: 10.3171/2014.11.spine14352] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Intramedullary neurenteric cysts (NECs) are exceedingly rare lesions and have been previously reported in case reports. The aim of this study was to determine the clinical manifestations, radiological features, and long-term prognosis of patients with such lesions.
METHODS
The authors retrospectively reviewed the records of 13 patients with an intramedullary NEC. Each patient underwent MRI, laminotomy, and microsurgery. The accurate diagnosis was based on imaging and pathology findings. Each patient's follow-up status was determined through individual office visits and a structured telephone interview.
RESULTS
The series included 7 male and 6 female patients. Progressive or intermittent motor deficit was the main symptom associated with or without pain or sensory disturbance. Five cysts were located in the cervical cord, 1 in the cervicothoracic cord, 3 in the thoracic cord, and 4 in the conus medullaris. Concurrent malformations included scoliosis (3 cases), fusion of rib (1 case), enlarged spinal canal (1 case), tethered spinal cord (1 case), and ectocardia (1 case). Gross-total resection of the cyst was achieved in 8 cases, and subtotal resection (STR) was achieved in 5 cases. All patients were followed up, with a mean duration of 66.5 months. Cyst recurrence was observed in 4 cases after STR. In 2 cases the patients underwent reoperation; the other 2 patients remained clinically stable and did not undergo reoperation. At the last evaluation, neurological function was improved in 11 patients and remained stable in 2 patients.
CONCLUSIONS
Intramedullary NECs should be considered in the differential diagnosis of a middle-aged patient with intermittent neurological symptoms and concurrent malformations. Early surgery is advocated to prevent permanent neurological deficits. When gross-total resection cannot be achieved, maximally safe removal under the protection of intraoperative neuromonitoring is advised. Because of the high risk of cyst recurrence, routine follow-up MRI is needed. If a residual cyst shows obvious regrowth and results in neurological deficits, timely reoperation with a goal of STR should be performed.
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Affiliation(s)
- Tao Yang
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Liang Wu
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Jingyi Fang
- 2Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chenlong Yang
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Xiaofeng Deng
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
| | - Yulun Xu
- 1Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital; and
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Tripathi M, Savardekar A, Chhabra R, Radotra BD, Gupta SK. Unusual imaging finding of a "fluid-fluid" level in a neurenteric cyst at anterior margin of the cervico-medullary junction. Br J Neurosurg 2014; 29:432-4. [PMID: 25547007 DOI: 10.3109/02688697.2014.993594] [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: 11/13/2022]
Abstract
Intracranial neurenteric cysts are rare. Diagnosis can only be established on histopathology with the demonstration of mucin-secreting cells in cyst wall. We report a midline, ventral, cystic lesion at the cervico-medullary junction, with the unusual radiological finding of a "fluid-fluid" level. Intraoperatively, the cyst contained fluid along with pus-like material with white flakes and specks of calcification, suggesting a dermoid cyst. However, histopathology confirmed the diagnosis of neurenteric cyst. The patient was managed with right lateral inferior suboccipital approach and near-total excision of the lesion.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery Post-graduate Institute of Medical Education and Research , Chandigarh , India
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Vachhani JA, Fassett DR. Intramedullary neurenteric cyst associated with a tethered spinal cord: Case report and literature review. Surg Neurol Int 2012; 3:80. [PMID: 22937480 PMCID: PMC3424674 DOI: 10.4103/2152-7806.98525] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 06/15/2012] [Indexed: 11/06/2022] Open
Abstract
Background: Neurenteric cysts are benign tumors of the central nervous system (CNS) that represent 0.3% to 0.5% of all spinal cord tumors. They are usually extramedullary and found in the lower cervical and thoracic spine. Only 12.2% of neurenteric cysts are documented to be intramedullary. Case Description: The authors report a case of a 35-year-old female that presented with progressive weakness and loss of coordination in her legs. Magnetic resonance imaging (MRI) showed an intramedullary cystic lesion in the thoracolumbar region and a low-lying conus medullaris suggesting tethered cord. The patient was taken to the operating room for detethering of her spinal cord and resection of the lesion. Pathologic examination of the tissue confirmed the diagnosis of a neurenteric cyst. Conclusion: A search of the literature since the advent of MRI showed 29 published cases of intramedullary neurentic cysts. Of the 24 published cases with a follow-up MRI, the average recurrence rate was 25% with a mean follow up of 51 months.
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Affiliation(s)
- Jay A Vachhani
- Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, Illinois
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