Is total excision of spinal neurenteric cysts possible?

Abstract

Spinal neurenteric cysts are intradural cystic lesions. These represent a part of the spectrum of developmental anomalies. These are rare lesions. Most of the data in literature is review of case reports. This made us evaluate our results of 23 cases and review the literature. This is a retrospective study of 23 patients managed at our institute over 20 years. The slides were retrieved and histopathological features studied. Twenty patients were less than 30 years old and 21 were males. Follow-up was available for 21 patients with mean duration of 71 months (range 2 months to 23 years). The typical presentation was backache with progressive neurological deficits pertaining to the level. Atypical presentations as acute onset, recurrent episodic events and aseptic meningitis were also noted. The cervicothoracic region was the most common site. 16 patients had cyst in intradural extramedullary plane and seven had intramedullary location. Associated vertebral anomalies as hemivertebrae, Klippel-Feil and spina bifida were noted in seven patients. There were two histological types of cysts with no correlation between the type of cysts and associated vertebral anomalies and extent of outcome. Partial excision though had higher risk of recurrence, was not associated with poorer outcome. Dorsal approach is an acceptable route with reasonably good results for this lesion. Spinal neurenteric cysts present at younger age with varied clinical presentations. These are commonly located intradurally ventral to the cord. Histological types have no effect on the outcome. Total excision is the choice of treatment. However, partial excision is a feasible option in intramedullary lesions and when significant adhesions occur. Although associated with higher risk of recurrence, the outcome is still good in these patients on re-excision.

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

“…The incidence of NEC is approximately 0.7–1.3% of all intradural spinal cord tumors [3]. It can manifest already at the 5th week of age up to 6th decade of life, with occurrence in 2nd and 3rd decades being most common.…”

Clinical presentation and surgical outcomes of intramedullary neurenteric cysts

“…The GTR rates for IDEM NECs in the literature range from 71% to 75%. 8,10,12 However, GTR is not feasible for intramedullary NECs. In 8 cases in the present study, the cyst wall showed no adhesion to the spinal cord, and GTR was achieved by using microsurgical techniques.…”

“…3,18,19,21,24,37,40,41 In contrast, bone anomalies were more common in extramedullary NECs. 12 Thus, the diagnosis of an isolated intramedullary NEC without concurrent malformations becomes even more challenging.…”

“…12,25 The recurrence rates of IDEM NECs range from 0% to 37%. 8,9 We reviewed the literature and found the recurrence rate of intramedullary NECs to be 23.3%.…”

“…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.…”