Spinal intramedullary ependymal cyst

Abstract

Three cases of spinal intramedullary ependymal cyst, two at the thoracolumbar junction and one in the cervical spinal cord, are reported in women in their fifth to seventh decades. Neurological signs and symptoms were extremity dysesthesias, paresthesias, and weakness. Plain cervical and lumbothoracic x-ray films were normal for the patients' age. Magnetic resonance (MR) imaging demonstrated a rounded cystic intramedullary mass at the thoracolumbar junction in two cases and at C3-7 in one case. The signal intensity of the cyst contents approximated that of cerebrospinal fluid on T1- and T2-weighted images. Upon administration of gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA), MR imaging showed no enhancement in the cyst wall or cavity. Myelotomy and cyst drainage were performed in each case, and the neurological status of each patient improved. The lining of the cyst was biopsied in one of the three patients undergoing surgery and was composed of a single layer of cuboidal cells supported by glial tissue. Periodic acid-Schiff staining of the tissue did not reveal a basement membrane. The findings in these cases suggest that the Gd-DTPA-enhanced MR imaging appearance of intramedullary spinal ependymal cyst is consistent and allows for accurate preoperative diagnosis with or without biopsy.

Intramedullary neurenteric cyst without any associated malformation one case evaluated by RMI and electron microscopic study

“…As far as we know, only one case of intramedullary neurenteric cyst without any associated malformation was evaluated by RMI [18]: the morphology of the lesion, the kind of signal in the two sequences, and the absence of nodular contrast enhancement should exclude a tumour with or without associated syringomyelia. However it seems impossible to distinguish an intramedullary neurenteric cyst from an ependymal cyst [19], especially when it is located in the conus medullaris.…”

Spinal Intramedullary Ependymal Cyst

“…Cystic intramedullary lesions in children are very rare and comprise only 4.7% of lesions of this location, hydromyelia and syringomyelia being the commonest [7]. Various types of intramedullary developmental tumors have been described which include the neuroenteric cyst, the teratomatous cyst, intramedullary lipoma and the epidermoid and dermoid cyst [9].…”

“…No mucinous production or glycoprotein can be detected by periodic acid-Schiff. Alcian blue and mucicarmine staining [1, 6, 7]. These cysts are also variously referred to as glioependymal cyst, neuroepithelial cyst and choroidal epithelial cyst [10].…”

“…A cystosubarachnoid shunt has been described [7], which involves a silicone catheter with one end into the cyst cavity and the other into the subarachnoid space. However, there is the possibility of blocking the tubing along with the silicone tubing causing scarring and tethering of the cord in a pediatric patient.…”

“…Ependymal cysts, which are rare cystic lesions of the nervous system, are extraventricular in location and generally affect the white matter of the frontal and temporoparietal lobes in adults. Spinal intramedullary ependymal cysts are extremely rare and reports of pathologically proven cases of intramedullary ependymal cyst are scarce in the world literature [1, 2, 3, 4, 5, 6, 7, 8]. We report 2 pediatric cases of biopsy-proven intramedullary ependymal cysts with a review of the literature.…”