Intramedullary bronchogenic cyst of the conus medullaris

Abstract

<jats:p>Spinal bronchogenic cysts are rare congenital lesions. The authors describe their experience in the treatment of a 17-year-old boy who presented with back pain and paresthesia in both lower extremities. Lumbar MR imaging revealed the presence of an intramedullary cystic lesion at the conus medullaris and histopathological analysis revealed a bronchogenic cyst. To the best of the authors' knowledge, this is the first report of an intramedullary spinal bronchogenic cyst arising at the conus; all previously reported spinal bronchogenic cysts were either intradural extramedullary or not located at the conus.</jats:p>

Microsurgical fenestration of idiopathic intramedullary cysts in adult patients

“…In our series, intraoperatively obtained tissue samples were available only in two cases, revealing a neuroenterogenic and a bronchogenic cyst, respectively. These histopathological findings are in accordance with previous reports suggesting that the cysts may be remnants of the primitive foregut [12,15]. Despite the published data reporting recurrences rates of *25 % for neuroenterogenic cysts, we found microsurgical fenestration to be an effective method for those cases as well [12].…”

“…All observed and evaluated symptoms (i.e., pain, motor and sensory, bladder dysfunction, and gait ataxia) appear to benefit from surgery. This is in accordance with previous publications, commonly reporting postoperative symptom improvement in symptomatic cases [1,3,4,8,11,15]. When reviewing our neurological outcome analyses, taking into consideration the limitation of a small sample size, we found motor deficits and pain syndromes to show the best overall postoperative outcome rates.…”

“…All patients were treated within a standardized setting including preoperative 3D-CISS MRI and multimodal electrophysiological monitoring facilitating preoperative planning and surgery. Contrary to other studies, aim of surgery was unanimous in achieving a sufficient fenestration of the parenchyma layer covering the cysts; no catheter placement or cyst resection was performed [8,11,12,15]. Since the increase in MR imaging capacities and the improvement in MR sequence techniques, especially heavily T2-weighted 3D sequences such as in this study applied constructive interference in steady-state sequences (CISS) helps to delineate subtle pathologies between spinal cord and cavities.…”

“…Due to the lack of larger studies, the optimal course of treatment remains debatable with some authors preferring a conservative approach, especially in oligo-or asymptomatic cases, and others advocating invasive treatment [2,5,8,9,15]. Available options consist of decompressive surgery via fenestration or cyst wall resection as recommended by others [1,4,5,8,11,12,15,16].…”

Clinical presentation and surgical outcomes of intramedullary neurenteric cysts

“…22 To our knowledge, only 38 cases of NEC (with or without concurrent malformations) have been described since the publication of the earliest report in 1954. [2][3][4]8,10,[12][13][14]16,[18][19][20][21][22][24][25][26][27][29][30][31][32][33][34][35][37][38][39][40][41][42]44,45 Most previous publications regarding intramedullary NECs have been case reports. Therefore, the optimal management for this lesion has not been fully determined.…”