Elsevier

Journal of Clinical Neuroscience

Volume 80, October 2020, Pages 261-263
Journal of Clinical Neuroscience

Case report
Conservative management of recurrent enterogenous cysts of the cervical spine: A case report

https://doi.org/10.1016/j.jocn.2020.08.010Get rights and content

Highlights

  • We describe a case of recurrent cervical spine enterogenous cyst.

  • The cyst demonstrated intermittent spontaneous recurrence and decompression.

  • Conservative management may be a valid option for recurrence.

Abstract

Enterogenous cysts are rare benign congenital tumours of the central nervous system. The aim of management is complete resection to minimise the chance of recurrence. To date, management of recurrence has favoured further surgical resection. We describe the case of a recurrent enterogenous cyst of the cervical spine, initially treated with decompression via laminectomy and fenestration. Magnetic Resonance Imaging (MRI) follow up has demonstrated spontaneous recurrence and deflation of the cyst on multiple occasions. We propose that conservative management of recurrent enterogenous cysts may be a valid management option following fenestration or partial resection of the cyst, and that recurrence may not always warrant further surgical intervention.

Introduction

Enterogenous cysts are uncommon congenital lesions of the central nervous system (CNS). They arise during embryogenesis with incomplete separation of the endoderm from the neuroectoderm resulting in primitive endodermal cells blending into the notochord and ultimately forming the cyst [1], [2]. Differential diagnoses include arachnoid cyst, epidermoid or dermoid cyst, colloid cyst, cystic schwannoma or metastasis [3]. They can be associated with tethered cord, vertebral body defects, dermal sinuses and spinal dysraphism [4]. Enterogenous cysts most commonly occur ventral to the spinal cord in the cervical and upper thoracic spine [1], [2] followed by the lumbar spine, with rare reports of intracranial occurrence [3]. The management for symptomatic lesions is surgical, with the aim of complete resection to minimise recurrence. We describe a 24-year-old woman with an enterogenous cyst at C4/5 who develops post-operative recurrence.

Section snippets

Case report

A 24-year-old woman presented following an extended period of neck pain and bilateral hand numbness. MRI of her cervical spine revealed a large T2 hyperintense lesion at C4/5 anterior to the spinal cord with marked compression of the cord (Fig. 1A,B). She underwent an uncomplicated posterior laminectomy and fenestration of the cyst with complete resolution of her symptoms thereafter. Postoperative MRI demonstrated decompression of the spinal cord and no clear evidence of expansile cyst (Fig. 1

Discussion

Enterogenous cysts were first described in 1934 [5] and comprise 0.01% of CNS tumours, and 0.7–1.3% of spinal cord tumours [6]. They present with localised pain that may progress to myelopathy or radiculopathy depending on location and degree of neural compression. Fluctuation in signs and symptoms may be attributed to the cyst undergoing slight changes in size, due to production and reabsorption of mucin by the cyst wall, osmotic pressure changes across the cyst wall, or intermittent rupture

Conclusion

Recurrent intraspinal enterogenous cysts are often managed with re-operation with the aim of complete resection. We suggest that conservative management may be an equally valid management strategy with close surveillance by MRI. We propose that by fenestrating the cyst spontaneous decompression may be enabled.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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