Spinal Neurenteric Cyst of the Ventral Cervicothoracic Junction With Klippel-Feil Syndrome as a Symptom of Progressive Myelopathy: A Case Report

Neurenteric cysts are rare and account for only 0.7%-1.3% of all spinal tumors. Spinal neurenteric cysts are associated with spina bifida, split-cord malformations, and Klippel-Feil syndrome, a rare congenital disorder characterized by fusion of two or more cervical vertebrae. Klippel-Feil syndrome is rarely accompanied by neurenteric cysts. In this case report, we describe a cervicothoracic junction neurenteric cyst associated with Klippel-Feil syndrome in a 30-year-old man who presented with a 2-month history of neck pain with radiation of pain into both arms and a 1-month history of weakness in the left arm. Magnetic resonance imaging (MRI) of the spine revealed an expansive intradural extramedullary cystic lesion anterior to the spinal cord at the cervicothoracic junction. The neurenteric cyst was removed using an anterior approach, accompanied by C5-C6 corpectomy. The patient's condition improved postoperatively, and he was discharged after postoperative MRI. Spinal neurenteric cysts should be considered in the differential diagnosis in cases of vertebral developmental abnormalities concurrent with intraspinal cysts.

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.

Pediatric intracranial neurenteric cyst of the oculomotor nerve: a case-based review

BACKGROUND

Neurenteric cysts (NECs) of the central nervous system (CNS) are uncommon congenital entities arising from embryonal elements. Intracranial NECs in the pediatric population are rare.

METHODS

The authors describe the presentation, radiographic imaging, and pathologic findings of an 11-year-old boy with a right oculomotor nerve NEC. A literature review was performed to identify additional cases of pediatric intracranial NECs published in the English language, over the past 30 years (1990-2020). The authors discuss the presentation, investigations, management, and prognosis of this interesting entity.

RESULTS

We describe an 11-year-old boy who presented to neurosurgical attention with disconjugate gaze, anisocoria, and ptosis. Magnetic resonance imaging (MRI) demonstrated a lobulated, cystic, and peripherally enhancing mass involving the right oculomotor nerve. The patient underwent pterional craniotomy for drainage of the cyst and subtotal resection of the cyst wall. The tan-colored mass was displacing the basilar artery, compressing the cerebral peduncle, and adherent to the inferior surface of the tentorium. The lesion was within the oculomotor nerve and splitting the fibers, and the cystic contents were thick and mucinous. Histopathological examination of the specimen demonstrated a thin fibrous cyst wall with scattered inflammatory cells and lined by simple columnar epithelium containing mucin. The lining cells were immunoreactive with epithelial membrane antigen (EMA) and pan-keratin AE1/AE3. The diagnosis of a NEC was rendered. A comprehensive literature review of pediatric intracranial NECs yielded 46 additional lesions published in the literature, involving the skull base, posterior fossa, cerebral convexity, and cranial nerves. NECs present with local mass effect and less commonly, with aseptic meningitis or intracystic hemorrhage. Maximal safe GTR remains the mainstay management, although cyst drainage and marsupialization, cyst shunting, and fenestration of cystic contents into the ventricle or basal cisterns have been reported with variable success.

CONCLUSION

CNS NECs are rare congenital entities; although they occur less frequently in the intracranial components compared to the spine, their diagnosis and management should be considered for intracranial cystic lesions. Maximal safe GTR is the mainstay treatment and frequently yields favorable outcomes.

Intracranial neurenteric cyst with post-operative chemical meningitis and vagal nerve palsy

Intracranial neurenteric cysts are rare congenital lesions that, though benign, are difficult to diagnose radiologically given their similar imaging appearance to other intracranial cystic lesions. We present a case of a 21-year-old female with a pathologically proven, symptomatic neurenteric cyst in the premedullary cistern. Superimposed on this uncommon diagnosis were also rare post-operative complications of chemical meningitis and vagal nerve injury. We review the current literature surrounding intracranial neurenteric cysts, their imaging characteristics, differential diagnosis, therapeutic options, and potential complications related to their resection.

Antenatally diagnosed intraspinal-posterior mediastinal neurenteric cyst - what is the optimal management?

Neurenteric cyst is a rare congenital anomaly that belongs to the spinal dysraphism spectrum. It is classically a disease of late childhood, with some rare reports of intrauterine and adult presentation. The increase in incidental antenatal diagnosis raises new management questions. We present a case of an asymptomatic combined intraspinal-posterior mediastinal neurenteric cyst. The cyst was diagnosed on antenatal ultrasound and was initially treated with image-guided aspiration in early infancy. However, the cyst recurred and the patient developed recurrent episodes of bacterial meningitis. Two-stage surgical resection was performed, although the infection prohibited complete excision. We caution against image guided aspiration of neurenteric cysts, and suggest a management algorithm based on the available literature.

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.

Predictors for complete surgical resection of posterior fossa neurenteric cysts: A case report and meta-analysis

Background

Incomplete resection of neurenteric cysts (NCs) has been associated with increased recurrence rates in patients compared to complete resection (CR) and information on intracranial NCs appearance on diagnostic imaging is scarce. We sought to identify factors associated with CR and provide the largest up-to-date review of NCs appearances on various diagnostic images.

Methods

Data from Medline, EMBASE, and Web of Science were extracted. Univariate and multivariate logistic regression models were used to analyze factors associated with CR.

Results

A total of 120 publications reporting 162 original cases on posterior fossa NCs met the inclusion criteria for analysis. Eighty-nine (55.6%) of the patients were female, the mean (SD) age of the patients' during operation was 34.3 (16.9) years, and CR was achieved in 98 (60%) of patients. Univariate analysis identified male sex as a statistically significant predictor for complete reaction (OR 2.13, 95% Cl 1.10-4.11, P = 0.02). The retrosigmoid approach (OR 1.89, 95% Cl 0.98-3.63, P = 0.06), far lateral approach (OR 0.46, 95% Cl 0.21-1.02, P = 0.06), and pediatric patient (OR 2.45, 95% Cl 0.94-6.56, P = 0.07) may be possible predictors for CR, however, they were not statistically significant. NCs are mainly hypodense on CT (32 [61.5%]), varied greatly in intensity on T1WI, hyperintense on T2WI magnetic resonance imaging (98 [67.1%]), and hyperintense on fluid-attenuated inversion recovery (17 [63.0%]).

Conclusion

We recommend utilizing various diagnostic imaging tests to help reduce misdiagnoses when identifying intracranial NCs. For patient safety, CR should be achieved when possible, to reduce risk of additional operations due to recurrence.

Anterior Craniocervical Junctional Neurenteric Cyst

Intracranial neurenteric cyst at the anterior craniocervical junction is very rare, and its treatment and prognosis have not been established. We report a case of neurenteric cyst at the anterior craniocervical junction and review the relevant literature. A 16-year-old girl presented with a 2-month history of slowly progressive headache. MRI revealed a well-defined intradural extramedullary cyst in the anterior medulla and brain stem with C1 cord compression. We performed gross total resection of the cyst using a far-lateral transcondylar approach. Surgical resection is the treatment of choice for neurenteric cysts at anterior craniocervical junction, the far-lateral transcondylar approach might be the optimal surgical approach.

Concurrent Thoracic Spinal Intradural Extramedullary Epidermoid and Neurenteric Cyst in a Spinal Dysraphism Child

INTRODUCTION

Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known.

CASE PRESENTATION

We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now.

CONCLUSION

Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.

Early Recurrence of an Infantile Endodermal Oculomotor Nerve Cyst following Surgical Fenestration: A Case Report

INTRODUCTION

Infantile endodermal oculomotor nerve cyst (EONC) is an extremely rare entity. There are very few pediatric cases reported in the literature, and as expected, oculomotor palsy is the most common presenting symptom. To date however, the risk of recurrence of these lesions following surgical intervention is unclear due to a lack of long-term radiological follow-up.

CASE PRESENTATION

We present a case of a 13-month-old male patient with an EONC and detail his surgical fenestration and postoperative course. Somewhat surprisingly, re-expansion occurred within 6 months and remained stable 2 years later.

DISCUSSION

A surgical approach to fenestration of an EONC in an infant is possible and should be performed by an expert neurosurgeon. Early recurrence is underreported in the current literature, and we encourage longer term radiological surveillance of these lesions after surgery to optimize primary and recurrent management in the future.

Intracranial neurenteric cyst: A case report and differential diagnosis of intracranial cystic lesions

Neurenteric cysts are uncommon, benign lesions that are rarely located intracranially. These cysts are likely due to aberrant embryologic development of the notochord. Clinically, neurenteric cysts may present with symptoms of mass effect, or they can be asymptomatic and incidentally discovered. Imaging features of neurenteric cysts have significant overlap with other intracranial cystic lesions, which can make diagnosis difficult. We present a case of a 35-year-old female with a histopathologically confirmed neurenteric cyst in the premedullary and left cerebellomedullary cistern, with associated symptoms of headache, dizziness, tinnitus, and dysphagia. The patient underwent surgical resection, with improvement in symptoms. We present a review of literature, and a discussion of typical features of multiple intracranial cystic lesions. We hope to promote accurate preoperative diagnosis, to allow for appropriate surgical technique to reduce the risk of recurrence.

Therapeutic Strategies and Prognostic Factors Based on 121 Spinal Neurenteric Cysts

BACKGROUND

Limited data existed to guide the management of intraspinal neurenteric cysts (ISNECs).

OBJECTIVE

To evaluate the risk factors for progression-free survival (PFS), elucidate the radiological features of ISNECs, and propose a treatment protocol.

METHODS

From 2003 to 2015, 121 patients with pathologically confirmed ISNECs treated at our institute were included in this study. Pertinent risk factors were evaluated.

RESULTS

Gross total resection (GTR) was achieved in 55 (44.6%) patients; 106 (87.6%), 12 (9.9%), and 3 (2.5%) ISNECs were classified as Wilkins A, B, and C, respectively. After a median follow-up duration of 64.2 mo, recurrence occurred in 25 (22.7%) patients, with a median PFS time of 43.1 mo. The actuarial PFS rates at 5 and 10 yr were 73.2% and 66.2%, respectively. The actuarial overall survival rates at 5 and 10 yr were 100% and 97.6%, respectively. Non-GTR (hazard ratio [HR], 5.836; 95% confidence interval [CI], 1.698-20.058; P = .005), Wilkins B/C (HR, 3.129; 95% CI, 1.009-9.702; P = .048), and a history of surgical resection (HR, 3.690; 95% CI, 1.536-8.864; P = .004) were adverse factors.

CONCLUSION

GTR and Wilkins A were favorable factors for PFS. If tolerable, GTR alone was advocated as an optimal treatment. Because of the benign nature and favorable prognosis, non-GTR was an alternative if GTR failed. Close follow-up was needed because of the recurrent tendency of ISNEC. Future study with a large cohort is necessary to verify our findings.

Neurenteric Cyst Masquerading as Acute Flaccid Paralysis in a 2-Month-Old Infant

BACKGROUND

Neurenteric cysts rarely present in infancy. Compressive myelopathy or meningitis are the usual presenting features of these cysts in infants.

CASE DESCRIPTION

We discuss a case of intradural extramedullary neurenteric cyst at the cervicomedullary junction in a 2-month-old infant who presented with features of acute onset flaccid upper limb weakness. The cyst was excised completely and the child improved.

CONCLUSIONS

Although rare, compressive lesions such as neurenteric cysts may present with acute flaccid paralysis in very young children. Differentiating from other causes and timely intervention bears an excellent outcome.

Resection of a Posterior Fossa Endodermal Cyst With Exoscopic Assistance: 2-Dimensional Operative Video

Neurenteric cysts are rare benign congenital tumors of endodermal origin that most commonly occur in the cervical and upper thoracic spine, with only about 10% to 18% of the reported cases occurring intracranially.1 A definitive preoperative diagnosis is complicated by the variable appearance of neurenteric cysts on magnetic resonance (MR) imaging.2 The recommended treatment of neurenteric cysts is complete surgical resection when possible.3,4 We present a case of a posterior fossa neurenteric cyst. A 33-yr-old man without medical history presented with left-sided headache and mild left-sided facial numbness and weakness. Admission MR imaging revealed a nonenhancing mass, which was hyperintense on T1-weighted MR images, compressing the brainstem anteriorly. The lesion was isointense on T2 FLAIR images and hypointense on diffusion-weighted imaging, initially read as possible epidermoid cyst. The patient underwent a left-sided retrosigmoid craniotomy via far lateral transcondylar approach. The tumor was adjacent to both vertebral arteries, the left PICA, and cranial nerves (CN) VII-XII with superior extension to CN V. The cyst was encased in a thin capsule, and its contents were yellowish in color and ranged from thick liquid to colloidal and caseous consistency. The cyst also contained heavily calcified portions, which were excised using sharp dissection. Images of the cyst wall show that it is focally lined with ciliated columnar epithelium with intracellular mucin confirming an endodermal or neurenteric cyst. After the operation, the patient's symptoms resolved, and he was discharged on postoperative day 4. Postoperative MR images confirmed gross total resection. The patient consented to video production.

Neurenteric cyst secondary to lumboperitoneal shunt

Background:

Neurenteric cysts are rare lesions that typically present in the upper thoracic and cervical spine and are occasionally found intracranially. The optimal treatment is gross total excision as subtotal/partial excisions are associated with high recurrence rates.

Case Description:

For the past 10 years, a patient with pseudotumor cerebri required repeated lumboperitoneal (LP) shunt revisions. This resulted in multiple neuroenterogenous cysts occurring around the proximal LP subarachnoid shunt catheter, a finding likely attributable to retrograde flow from the peritoneal cavity.

Conclusion:

Unlike ventriculoperitoneal (VP) shunts and LP shunts do not contain valves, making the retrograde passage of enterogenous cells possible when abdominal pressure exceeds lumbar subarachnoid pressure, especially in the morbidly obese patient.

A Dorsally Located Endodermal Cyst in the Foramen Magnum Mimicking an Arachnoid Cyst: A Case Report

INTRODUCTION

Endodermal cysts are congenital benign cystic lesions in the central nervous system and cause various symptoms. Although some have been reported in the posterior fossa, endodermal cysts located dorsal to the brainstem are extremely rare.

CASE PRESENTATION

The case was of a 10-year-old girl who presented with bilateral upper limb weakness and tremor. Magnetic resonance imaging demonstrated a 4.5-cm cystic lesion with T1-weighted hypointense and T2-weighted hyperintense content in the midline of the cisterna magna dorsal to the medulla oblongata. The cyst was cerebrospinal fluid-like, causing us to suspect a symptomatic arachnoid cyst. The lucent cyst wall had no apparent attachment, and complete recovery ensued following total excision of the cyst wall. Pathology confirmed a diagnosis of endodermal cyst.

DISCUSSION/CONCLUSION

Herein, we review the past literature on this rare entity. An endodermal cyst in the cisterna magna tends to be less strongly attached and to show a cerebrospinal fluid-like component on magnetic resonance images that mimics an arachnoid cyst. The characteristics of dorsally located endodermal cysts may differ from those in other locations.

Recurrent neurenteric cysts compressing the brainstem

Background:

Neurenteric cysts, also referred to as endodermal cysts and enterogenous cysts, are rare lesions of the neuroaxis occurring most frequently within the spinal cord and rarely intracranially. In the literature describing these lesions, examples of intraoperative imaging and cytology preparations are rare to non-existent.

Case Description:

Here, we describe a case of a recurrent posterior fossa neurenteric cyst compressing the brainstem in a 47-year-old female and causing incontinence and progressive quadriparesis. Intraoperative findings and cytologic and histologic features are presented.

Conclusion:

Neurenteric cysts are generally considered to be benign and slow-growing though recurrence is common. This case of a recurrent neurenteric cyst is illustrated by intraoperative macroscopic and cytologic images.

The oldest presenting neurenteric cyst of the spinal cord

We describe an 81-year-old gentleman presenting with mild myelopathic symptoms in the upper limbs. Imaging showed a C1-3 intradural extramedullary lesion initially thought to be an arachnoid cyst. A C1 + 2 hemilaminectomy and partial excision was performed with histology revealing a neurenteric cyst (NC). NCs are congenital tumours that usually present within the third decade of life, they account for 1% of all spinal tumours. A literature search was conducted and we found that the age of presentation might actually be earlier than previously described. We also found that there has never before been a case described in the eighth decade of life, making this the oldest known symptomatic presentation of this rare condition.

A rare presentation of a pediatric neurenteric cyst as an intra-axial pontine lesion: A case report with a 5-year follow-up

Background

Intracranial neurenteric cysts are rare, benign, and slow-growing tumors. However, we encountered a pediatric case that the cyst expansion occurred in a short period of time resulting in rapid deterioration of the patient's symptoms.

Case Description

A previously healthy 7-year-old girl had a week history of dysarthric speech and diplopia along with headaches. Her magnetic resonance images (MRI) showed an abnormal cystic mass in her brainstem. Her symptoms were deteriorated for 1 month and her second MRI revealed an enlargement of the cystic lesion. The tumor biopsy and cyst drainage were carried out and histopathological examination of the cyst wall showed columnar epithelium containing ciliated cells. The final diagnosis of her tumor was neurenteric cyst.

Conclusion

We report a pediatric case of a neurenteric cyst in the brainstem, which expanded in a short period, and review this rare entity.

Diagnostic Dilemma in Discriminating Between Spinal Neurenteric Cysts and Simple Arachnoid Cysts Based on Embryogenesis and Surgical Correlation

BACKGROUND

Neurenteric cyst (NEC) is a rare intradural spinal tumor, but a correct preoperative diagnosis remains challenging. A misdiagnosis of arachnoid cyst (AC) often leads to conflicting surgical management and significantly higher recurrence.

CASE DESCRIPTION

We report the case of a 26-year-old woman who presented with progressive spastic quadriparesis with myelopathy below the C4 level, which was caused by a ventral intradural extramedullary cystic tumor at the C3-4 level. Magnetic resonance images showed the cystic content as identical to cerebrospinal fluid, which prompted the tentative diagnosis of spinal AC. Surgical fenestration was scheduled. However, intraoperative findings of a thick-walled cyst and severe adhesion to the neural structure without a history of trauma and inflammation were more compatible with the pathogenesis of an NEC. Because of the high recurrence rate after an incomplete resection of an NEC, we did a complete resection of the cyst with adhesive rootlets instead. Pathology analysis and immunohistochemical staining confirmed the diagnosis of an endodermal-derived NEC.

CONCLUSIONS

NECs must be differentiated from ACs because they are different diseases and require different surgical management. In cases with clear cystic content, however, the diagnosis is likely to be AC, but a thick cystic wall and structural adhesions should suggest the differential diagnosis of NEC. Gross total removal of NECs should be attempted to reduce NEC recurrence.

Unusual Presentation and Imaging Findings of a Rare Supratentorial Neurenteric Cyst

This is a case of a 30-year-old right-handed male patient who presented to the hospital in 2014 after hitting his head on the mat during a wrestling match followed by headache and temporary peripheral vision limitation. The patient's past medical history was unremarkable. On physical examination, Glasgow Coma Scale was 15 with no focal neurological deficits. Unenhanced head computed tomography (CT) and enhanced brain magnetic resonance imaging (MRI) were performed (Figure 1). The patient was managed conservatively, and follow-up CT and MRI in 2015 (Figure 2) demonstrated significant decrease in size of the previously seen right frontoparietal lesion with also changes in its radiological features. The patient remained asymptomatic for about 3 years when in 2018 he presented to the Emergency Department with increasing headaches and peripheral vision loss. MRI demonstrated an increase in the right frontal lesion size (Figure 3). He underwent surgical resection of the lesion.

Resection of a lateral supratentorial endodermal cyst complicated by postoperative seizures: A case report

Background:

Endodermal cysts are uncommon cystic lesions usually located at the ventral aspects of the spine. A lateral supratentorial location of such cysts is extremely rare. A unique case of a lateral supratentorial endodermal cyst that required surgical intervention due to uncal herniation, complicated with postoperative seizures, is presented.

Case Description:

A 48-year-old man presented with transient motor aphasia and diplopia. Magnetic resonance imaging showed a cystic lesion occupying the left frontal and temporal convexity with midline shift and uncal herniation. Cyst resection was performed, and cyst contents with mucous-like components were aspirated. Histopathological examination showed an endodermal cyst. The patient showed no neurological deficits immediately after surgery but developed tonic-clonic seizures 9 h after surgery. Sedation and intubation were required to control the seizures. After administering multiple antiepileptic drugs, he was extubated on the 5^th day after surgery. He was discharged home in a month with mild impairment in dexterity of his right hand.

Conclusions:

Surgical intervention for endodermal cysts can be complicated by postoperative seizures caused by chemical irritation of brain cortex due to spillage of cyst contents. It is important to irrigate the cyst wall very well intraoperatively and pay attention not to spill the cyst fluid to unaffected locations. Preoperative administration of antiepileptic drugs should also be considered if endodermal cysts, not simple arachnoid cysts, are suspected preoperatively.

Supratentorial Neurenteric Cyst: A Rare Differential for a Frontal Cyst

Supratentorial neurenteric cyst is a rare entity. They are usually isointense to slightly hyperintense on T1W images and hyperintense on T2-weighted/fluid attenuated inversion recovery images. There was a diagnostic dilemma in this case due to the cerebrospinal fluid intensity of the cyst on magnetic resonance imaging. Postoperative residual lesion predisposes to hemorrhage and seizures.

A rare case of thoracic spinal intradural extramedullary enterogenous cyst with acute onset: case report and literature review

The intraspinal enterogenous cyst, also called an neurenteric cyst, is a rare congenital disease. It was reported to be local to the C1 to L2 spinal segments, with the majority located in the cervicothoracic region. Most patients present with symptoms of progressive focal pain, myelopathic signs or radicular symptoms. We report a rare case of thoracic spinal intradural extramedullary enterogenous cyst with rapidly progressive weakness of both lower extremities. Additionally, we analysed the literature concerning the clinical features, diagnosis and prognosis of this disease.

Neurenteric Cyst of the Ventral Craniocervical Junction: Case Report and Review of the Literature

BACKGROUND

Neurenteric cysts (NCs) are rare, non-neoplastic lesions arising from a failure of dissolution of the transient neurenteric canal between the foregut and the notochord. They are most frequently seen in the intradural extramedullary space in the lower cervical and upper thoracic spine. The authors describe a rare case of NC arising from the ventral cervicomedullary junction that was totally resected via a posterior approach.

CASE DESCRIPTION

A 24-year-old woman presented with a 4-week history of neck pain and progressive left hemiparesis. Admission magnetic resonance imaging scans demonstrated an intradural extramedullary cystic mass lesion ventral to the upper spinal cord from medulla to C2. We performed a posterior approach and the lesion was totally removed. Surgical treatment resulted in resolution of the neurologic impairments. The histological results were consistent with NC. Postoperative course was uneventful. At the 6-month follow-up, the patient is asymptomatic and magnetic resonance imaging scan shows no residual lesion.

CONCLUSIONS

NC is a rare lesion of the craniospinal junction and should be considered among differential diagnoses. Complete excision is the treatment of choice. In most instances a dorsal surgical approach will be satisfactory.

A midline prepontine cyst: Serial magnetic resonance imaging over 20 years shows very slow growth after its rapid shrinkage

An otherwise healthy 22-month-old boy suffered high fever, irritability, nausea, dysphagia, dysarthria and right hemiparesis. Magnetic resonance imaging showed a cystic mass, 15 mm in diameter, with surrounding oedema in the base of the lower pons. The symptoms subsided in about 10 days after onset, followed by a rapid decrease of the cyst size to 5 mm. Thereafter, the patient's psychomotor growth has been normal. Annual follow-up magnetic resonance imaging scans showed very gradual enlargement of the cyst located on the ventral surface of the pontomedullary junction, reaching 16 mm in diameter in 21 years after onset. It was hyperintense on T1-weighted and isointense on T2-weighted magnetic resonance imaging. No haemosiderin deposition or gadolinium enhancement was seen. This is a rare report of a two decade longitudinal follow-up of a midline prepontine cyst showing asymptomatic and very slow growth. The possible nature of the cyst includes neurenteric, dermoid and epidermoid cyst.

Multiple Neurenteric Cysts along the Spinal Axis of an Infant: A Rare Entity

A spinal neurenteric cyst is a rare entity. It commonly presents already at 5 weeks of age up to the 6th decade of life. The most common location is the cervical region followed by thoracic and lumbosacral regions. We report a 9-month-old male infant with sudden onset of weakness in both lower limbs. MRI revealed 2 cystic lesions at cervical and thoracic level with spinal cord compression. He underwent laminectomy and excision of the cervical lesion. The child improved significantly. The postoperative MRI shows complete excision of a dorsal lesion and presence of a cervical lesion. Later, he underwent cervical laminotomy and partial wall excision followed by shunt placement. The histopathological report revealed a neurenteric cyst. Two neurenteric cysts presented in the neuroaxis of the same patient: one was located ventral (thoracic) and the other dorsal (cervical). At the 2-year follow-up, the child was active and walking without support. Multiple cystic lesions in the neuroaxis can be neurenteric cysts.

Intracranial neurenteric cyst arising at the suprasellar cistern with extension to middle cranial fossa

INTRODUCTION

Intracranial neurenteric cysts are rare and are not often found in the supratentorial space. We present a case of an intracranial neurenteric cyst that arose at the suprasellar cistern with extension to the middle cranial fossa.

HISTORY

A 3-year-old girl presented with seizure. Neuroimaging showed a huge extra-axial cyst involving the suprasellar cistern and left middle cranial fossa. Under the impression of an arachnoid cyst, she underwent fenestration of the cyst with basal cisterns and ventricle. The pathologic diagnosis was neurenteric cyst. Four years after the surgery, MRI showed no recurrence but did show poorly developed myelination of the left temporal white matter. Three years after surgery, seizures recurred. We consider epilepsy surgery in case of uncontrolled seizure.

DISCUSSION

We discuss the unique case of supratentorially located neurenteric cyst that is just treated by fenestration. A close follow-up is needed for children with intracranial neurenteric cysts to surveil not only recurrence of lesion but also normal brain development.

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.

Management of an unusual, recurrent neurenteric cyst in an infant: case report and review of the literature

PURPOSE

Neurenteric cysts are rare congenital remnants formed by a failure of separation between endoderm and ectoderm in utero.

METHODS

We describe a case of a 7-month-old male with a large cervical neurenteric cyst presenting with intermittent neck stiffness and irritability.

RESULTS

This cyst was resected, recurred, and required repeat surgery. The patient's postoperative course included aseptic meningitis and hydrocephalus requiring ventriculoperitoneal shunt and later management of tethered cord, necessitating detethering.

CONCLUSION

Unique features of this case include the presence of intermittent pain symptoms, which may be attributable to cyst filling and emptying. Hydrocephalus is an uncommon finding that may be secondary to aseptic meningitis from cyst rupture. Tethered cord is also an unusual entity that can accompany this diagnosis, warranting additional imaging work-up and monitoring.

Fourth Ventricle Neurenteric Cyst Mimicking Hemangioblastoma

This report presents a case of fourth ventricle neurenteric cyst (NE cyst) mimicking hemangioblastoma, which developed in a 50-year-old woman. A tiny enhancing mural portion of the fourth ventricle in MRI suggested that the cyst was hemangioblastoma, but pathological evidence showed that the cyst was in fact NE cyst in the fourth ventricle. In order to make proper decision on to what extent of surgical resection should be done, considering every possibility in differential diagnosis might be helpful. This case reports an unusual pathology in 4th ventricle, considering the patient's age, and demonstrates that a rarer disease may share radiological features of a common disease.

Intracranial neurenteric cyst mimicking an ependymoma: imaging features, pathologic correlation and review of literature

We present a case of a 57-year-old female with four-months of diplopia and vertigo. MRI revealed a mixed cystic and solid partially enhancing lesion of the 4th ventricle, foramen of Luschka and cerebellopontine angle. Preoperative differential diagnosis favored ependymoma. Biopsy revealed a neurenteric cyst, a benign developmental lesion that rarely occurs intracranially. This case highlights several atypical manifestations of intracranial neurenteric cyst, with regions of histologically benign solid enhancement, multicompartmental extra-axial location mimicking an ependymoma, and rapid recurrence without evidence of underlying malignancy.

An enterogenous cyst with atypical pathological findings and chemical meningitis

INTRODUCTION

Intracranial enterogenous cysts are rare and mainly occur in the posterior fossa. These cysts are usually extra-axial, midline, anterior to the brainstem, or at the cerebellopontine angle. We report a case of an enterogenous cyst in which diagnosis was difficult because the lesion showed atypical pathologic findings.

CASE PRESENTATION

A healthy 41-year-old man complained of paroxysmal occipital headaches lasting over a week, with increased severity for 3 days accompanied by slight dizziness and mild nausea. Magnetic resonance imaging showed a cystic lesion between clivus and brainstem. The patient underwent surgery for removal of the lesion via the right-sided far-later approach, and the lesion was resected totally. Although pathologic examinations showed a cyst had a mono-to-multilayered squamous epithelium, which are not accord with typical enterogenous cyst, the diagnosis was finally made based on the presence of basement membrane and immunohistochemical results.

DISCUSSION AND EVALUATION

To confirm the diagnosis of enterogenous cyst, further pathologic examinations were performed and immunohistochemical characters were summarized. Chemical meningitis, a rare complication of enterogenous cyst, happened in current case. Use a syringe and aspirate the contents before incision might be a procedure to prevent chemical meningitis.

CONCLUSIONS

To our knowledge, this is the first report of an enterogenous cyst associated with mono-to-multilayered squamous epithelium. Although during the follow-up time, no recurrence happened, long-term follow-up is needed.

Neurenteric Cyst Presenting with Bleeding Per Rectum

Neurenteric cyst in the thoracic cavity may produce a myriad of clinical features. We report a 7-month-old girl who presented with significant bleeding per rectum. On imaging, a mediastinal cystic structure with air-fluid levels was evident with cervico-thoracic vertebral anomalies. The cyst was excised and histopathology showed intestinal mucosal lining with heterotopic pancreatic tissue confirming the diagnosis of neurenteric cyst.

Mucinous adenocarcinoma arising from a residual supratentorial neurenteric cyst and expressing mutated KRAS: a case report

Malignant transformation of intracranial neurenteric cysts (NCs) has been reported in only 7 cases, but the molecular characteristics leading to malignant transformation remain unclear. A 61-year-old woman presented with headache and dizziness. Imaging revealed a 10-cm, extra-axial cystic mass in both middle fossae. A partial resection was performed, and the residual mass size gradually decreased. She had repeated ventriculoperitoneal shunts to relieve symptoms of hydrocephalus. Eight years later, follow-up images revealed marked enlargement of the mass and a newly developed lesion. After a second partial resection, a mucinous adenocarcinoma infiltrating the brain was identified. Transitions from benign-looking cuboidal cells to dysplastic cells were observed. A KRAS mutation, which might be associated with malignant NC transformation and was not present in the initial specimen, was identified in the adenocarcinoma. In conclusion, KRAS-mutant mucinous adenocarcinoma may arise in a longstanding residual NC after partial resection.

Intramedullary and Extramedullary Cervical Neurenteric Cyst Requiring Fixation and Fusion

BACKGROUND

Spinal neurenteric cysts are rare in the literature, described by sporadic case reports and small case series. In the vast majority of cases, these lesions are intradural extramedullary. We report the novel case of a cervical neurenteric cyst that was simultaneously intramedullary and extramedullary.

CASE DESCRIPTION

A 47-year-old man underwent C2 through C7 laminectomies for microsurgical resection of a large cystic intradural mass, with C1 through T1 instrumentation and fusion. Gross total resection was obtained. Fusion was necessary after removal of the posterior elements because the vertebrae were thinned extensively and remodeled around the tumor, a treatment paradigm that has not been described adequately for neurenteric cysts previously.

CONCLUSIONS

A novel case of cervical intramedullary and extramedullary neurenteric cyst is presented with clinical, radiographic, and histologic details. Given the potential for bony remodeling around these developmental tumors, the possibility exists for instability after certain neurenteric cysts are resected. Thus, the present case adds fixation and fusion to the potential treatment paradigm for select spinal neurenteric cysts.

Imaging alterations due to squamous metaplasia in intracranial neurenteric cysts: A report of two cases

Intracranial neurenteric cysts are rare congenital abnormalities with a broad imaging spectrum, and therefore are occasionally mistaken for other common intracranial cysts such as epidermoid and arachnoid cysts. We report two cases of neurenteric cysts in the posterior cranial fossa that were initially mistaken for other types of cysts. They exhibited signal intensity alterations in magnetic resonance imaging with significant volume expansion during their long-term observation. Both cases received surgical treatment because of clinical deterioration. Histologically, the cysts were lined by flattened or cuboidal epithelium, occasionally showing squamous metaplasia. Xanthogranulomatous inflammation and accumulation of cholesterol clefts, dry keratin and proteinaceous substance were observed in the cysts. These findings may indicate that chronic inflammation in neurenteric cysts induces squamous metaplasia, keratinization and high proteinaceous content, and causes MRI signal intensity alterations and volume expansion. We propose that MRI signal intensity alterations in neurenteric cysts may be a warning sign of their volume expansions, and thus require closer follow-up imaging and eventually surgical treatment.

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.

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.

Spinal Neurenteric Cyst in Association with Klippel-Feil Syndrome: Case Report and Literature Review

BACKGROUND

Spinal neurenteric cysts, also known as endodermal or enterogenous cysts, are rare epithelium-lined structures of presumed endodermal origin. Congenital vertebral anomalies are frequently seen in patients with neurenteric cysts, most typically anterior spina bifida, butterfly vertebrae, and hemivertebrae. However, few series of intraspinal neurenteric cysts accompanied by Klippel-Feil syndrome have been reported previously.

CASE DESCRIPTION

Our purpose is to present the clinical, radiological, and histological results of a 29-year-old patient with a spinal neurenteric cyst associated with Klippel-Feil syndrome and to review previous reported cases of neurenteric cysts associated with Klippel-Feil syndrome. In our patient, cervical radiography demonstrated C5-T1 vertebral fusion and magnetic resonance imaging revealed a large intradural cystic mass. The cystic lesion was removed successfully, and it was histopathologically diagnosed as a neurenteric cyst.

CONCLUSION

Neurenteric cysts should always be considered in the differential diagnosis of an intraspinal cystic mass seen in the setting of vertebral anomalies.

Solitary cervical neurenteric cyst in an adolescent patient

Spinal neurenteric cysts are uncommon congenital lesions, furthermore solitary neurenteric cysts of the upper cervical spine are very rare. A 15-year-old boy having an intraspinal neurenteric cyst located at cervical spine presented with symptoms of neck pain and both shoulders pain for 2 months. Cervical spine magnetic resonance (MR) imaging demonstrated an intradural extramedullary cystic mass at the C1-3 level without enhancement after gadolinium injection. There was no associated malformation on the MR imaging, computed tomography, and radiography. Hemilaminectomy at the C1-3 levels was performed and the lesion was completely removed through a posterior approach. Histological examination showed the cystic wall lined with ciliated pseudostratified columnar epithelium containing mucinous contents. Neurenteric cyst should be considered in the diagnosis of spinal solitary cystic mass.

Neurenteric cyst presenting with stridor and dysphagia: case report and literature review

OBJECTIVE

Neurenteric cysts are rare lesions that account for 0.7-1.3% of all spinal cord tumours. We report the first ever case of a neurenteric cyst presenting with stridor and dysphagia. A literature review on the presentation and management of these lesions is also included.

METHODS

A MEDLINE search of articles using the terms 'neurenteric cyst', 'intraspinal cyst', 'enterogenous cyst', 'intramedullary cyst' along with diagnosis, presentation and management was performed. Suitable references from these articles were also reviewed.

RESULTS

All published evidence on neurenteric cysts are either case series or case reports (level IV/V) with the largest case series reporting 23 patients from a single institution.

CONCLUSION

Neurenteric cysts are rare spinal cord lesions that usually present with focal neurological signs and managed within neurosurgical units. This is the first reported case of a neurenteric cyst presenting with upper aerodigestive tract symptoms warranting specialist ear, nose and throat input.

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.

Diagnostic and surgical implications of ventral vertebrobasilar displacement by posterior fossa neurenteric cysts

OBJECTIVE

Neurenteric cysts (NECs) are uncommonly encountered lesions of the central nervous system with heterogeneous imaging characteristics. The object of this study was to review the preoperative imaging findings represented among a cohort of surgically treated posterior fossa NECs. These findings are considered in the context of surgical technique, and inform an understanding of aberrant neuroembryological development associated with NECs.

METHODS

A single-institution, multisurgeon series of 7 consecutive patients (5 female and 2 male patients, mean age 36 years, range 19 to 57 years) treated surgically for histopathologically confirmed posterior fossa NECs was retrospectively reviewed. Lesion imaging and anatomic characteristics were noted on preoperative magnetic resonance imaging (MRI). Imaging comparisons were made against an additional cohort of 266 consecutive surgically treated posterior fossa masses to validate unique anatomic findings.

RESULTS

T1 and T2 MRI signal characteristics were variable when compared across lesions. All NECs were found to be anteriorly located within the posterior fossa, but always situated between the brainstem pial surface and the vertebrobasilar system, causing ventral displacement of vertebrobasilar vessels.

CONCLUSIONS

Posterior fossa NECs display variable patterns of MRI signal and are commonly considered as part of a broad differential of cystic posterior fossa masses. We identified tumor insinuation between the ventral brainstem and vertebrobasilar system as a highly sensitive and specific radiographic sign for NECs. This finding was not observed among a large cohort of posterior fossa masses representative of other multiple pathologies.

Microsurgical excision of the craniocervical neurenteric cysts by the far-lateral transcondylar approach: case report and review of the literature

Neurenteric cysts in the anterior craniocervical junction (CCJ) region can be found in extremely rare cases. We report one case with craniocervical neurenteric cyst that was excised by the far-lateral transcondylar (FLT) approach. A 43-year-old man presented with a history of recurrent episodes of mild neck pain and dysesthesia in his bilateral hands of 2 years' duration with rapid deterioration 3 weeks prior to admission. Magnetic resonance imaging (MRI) of the CCJ region revealed a well-defined intradural cystic lesion located ventral from the pontomedullary junction to C1 vertebra with medulla and C1 cord compression. This patient underwent total excision of the lesion via the FLT approach without any postoperative neurological deficits, and the histopathologic diagnosis was neurenteric cyst. Follow-up MRI has revealed no evidence of recurrence. The clinical features, imaging studies, and surgical approach options involved in resecting craniocervical neurenteric cysts are discussed, along with a review of the literature.

Posterior fossa neurenteric cysts can expand rapidly: case report

Neurenteric cysts are considered congenital lesions that may slowly expand over time. Although more commonly found in the spinal canal, they may be found intracranially, particularly in the posterior fossa. Here, we present an unusual case of a large, rapidly expanding histologically confirmed posterior fossa neurenteric cyst in a 53-year-old woman, who presented with quadriparesis. Computed tomography imaging done ~1.5 years before admission failed to demonstrate any obvious abnormality; however, the lesion had grown to 4 cm in maximal dimension at presentation with significant mass effect. The lesion was resected microsurgically using a retrosigmoid approach. The patient improved postoperatively and was neurologically intact at last follow-up. We could find no other documented case of marked, rapid expansion of a neurenteric cyst in the literature. We conclude that, although neurenteric cysts are thought to be congenital, they can undergo rapid expansion even in adults. The mechanism of expansion is unknown but may involve increased secretion, hemorrhage, or inflammation. We discuss the surgical management and review the literature in view of this surprising finding.

Abdominal neurenteric cyst

Neurenteric cysts are extremely rare congenital anomalies, often presenting in the first 5 years of life, and are caused by an incomplete separation of the notochord from the foregut during the third week of embryogenesis. They are frequently accompanied with spinal or gastrointestinal abnormalities, but the latter may be absent in adults. Although usually located in the thorax, neurenteric cysts may be found along the entire spine. We present a 24-year-old woman admitted for epigastric pain, nausea, vomiting, low grade fever and leucocytosis. She underwent cystogastrostomy for a loculated cyst of the distal pancreas at the age of 4 years, which recurred when she was at the age of 11 years. Ultrasound and computer tomography (CT) scan revealed a 16 cm × 15 cm cystic mass in the body and tail of pancreas, with a 6-7 mm thickened wall. Laboratory data and chest X-ray were normal and spinal radiographs did not show any structural abnormalities. The patient underwent a complete cyst excision, and after an uneventful recovery, remained symptom-free without recurrence during the 5-year follow-up. The cyst was found to contain 1200 mL of pale viscous fluid. It was covered by a primitive single-layered cuboidal epithelium, along with specialized antral glandular parenchyma and hypoplastic primitive gastric mucosa. Focal glandular groups resembling those of the body of the stomach were also seen. In addition, ciliary respiratory epithelium, foci of squamous metaplasia and mucinous glands were present. The wall of the cyst contained a muscular layer, neuroglial tissue with plexogenic nerve fascicles, Paccini corpuscle-like structures, hyperplastic neuro ganglionar elements and occasional psammomatous bodies, as well as fibroblast-like areas of surrounding stroma. Cartilagenous tissue was not found in any part of the cyst. Immunohistochemistry confirmed the presence of neurogenic elements marked by S-100, GFAP, NF and NSE. The gastric epithelium showed mostly CK7 and EMA immunoexpression, and the respiratory epithelium revealed a CK8 and CK18 immunoprofile without CK 10/13 positive elements, though neither CEA or AFP positive cells were found. To our knowledge, this is the first reported case of an abdominally located neurenteric cyst with no associated spinal anomalies.