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

  • Clinical Article - Spine
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Abstract

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.

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Acknowledgments

This study has been approved by the institute ethics committee.

All persons included in this study gave their informed consent prior to their inclusion in the study.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India

    Mukesh Shukla, Sanjay Behari, Guruprasad B, Kuntal Kanti Das, Anant Mehrotra, Arun Kumar Srivastava, Rabi Narayan Sahu & Awadhesh K. Jaiswal

  2. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India

    Manoj Jain

Authors
  1. Mukesh Shukla
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  2. Sanjay Behari
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  3. Guruprasad B
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  4. Kuntal Kanti Das
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  5. Anant Mehrotra
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  6. Arun Kumar Srivastava
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  7. Rabi Narayan Sahu
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  8. Awadhesh K. Jaiswal
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  9. Manoj Jain
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Corresponding author

Correspondence to Sanjay Behari.

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Video 1

Far lateral approach to a long segment anteriorly placed neurenteric cyst at the foramen magnum. Vertebral artery mobilisation and condylar drilling were not required. The terminal portion of the cyst capsule was adherent to anterior cervical spinal cord by a fibrous band. (MPG 50160 kb)

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Shukla, M., Behari, S., B, G. et al. Spinal neurenteric cysts: Associated developmental anomalies and rationale of surgical approaches. Acta Neurochir 157, 1601–1610 (2015). https://doi.org/10.1007/s00701-015-2484-7

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  • DOI: https://doi.org/10.1007/s00701-015-2484-7

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