Case reportConservative management of recurrent enterogenous cysts of the cervical spine: A case report
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.
References (7)
Iso-intense neurenteric cyst in the lower cervical spine treated with ventral resection and anterior fusion utilising sternal notch exposure: case report, technical note and literature review
J Clin Neurosci
(2003)Enterogenous cyst of cervical spine: clinical and radiological aspects (including CT and MRI)
Neuroradiology
(1987)- et al.
Solitary cervical neruenteric cyst in an adolescent patient
J Korean Neurosurg Soc
(2015)