Spinal Intramedullary Ependymal Cysts : A Case Report and Review of the Literature

Abstract

We report a rare case of a spinal intramedullary ependymal cyst in a 46-year-old female and review the 17 pathologically proven cases in the literature. The patient presented with a two-week history of gradually increasing tingling in her left posterior thigh and calf. A preoperative magnetic resonance image revealed a well-defined intramedullary cystic lesion on the ventral side of the spinal cord at the T11 to T12 levels. The lesion was hyper intense in T2-weighted images and hypointense in T1-weighted. The patient underwent a right-side hemilaminectomy at the T11 to T12 levels and fenestration of the cyst wall. After having the cyst wall partially removed and communication established between the cyst and the subarachnoid space, the patient improved neurologically. A histological study of the surgical specimens revealed that the cyst wall consisted of glial cells lined by a simple cuboidal to columnar epithelium. An immunohistochemical examination of the cells lining the cyst wall was positive for S-100 protein, glial fibrillary acidic protein, epithelial membrane antigen, and cytokeratin. We suggest that the optimal treatment of intramedullary ependymal cysts creates adequate communication between the cyst and the subarachnoid space.

Discovery of Aquaporin-1 and Aquaporin-4 Expression in an Intramedullary Spinal Cord Ependymal Cyst: Case Report

“…The optimal surgical approach, however, is controversial. 7,16,17,19 Regardless of treatment strategy, most patients in the literature improved following surgery. Longer duration of symptoms was inversely correlated with symptom resolution, indicating that prompt surgical decompression is imperative.…”

“…19 While some authors have advocated cyst fenestration of symptomatic ependymal cysts, others have advocated for total resection or cysto-subarachnoid shunt placement. 7,16,17,19 We describe a case of an intramedullary spinal cord ependymal cyst in a 56-year-old female that was successfully managed with cyst fenestration. In order to investigate a pathogenic mechanism of cyst formation, we assessed whether these rare cysts express aquaporin-1 and aquaporin-4.…”

Intracranial Cysts: An Imagery Diagnostic Challenge

“…These lesions occur also in other sites, such as subarachnoid space, brainstem, juxtaventricular, spinal cord, and very rarely in the cerebellopontine angle [21, 22]. Ependymal cells line the thin walls of cysts and secrete a clear serous fluid.…”

“…The lesions are isointense with CSF on MRI T1- and T2-weighted images and have nonenhancing walls [21]. …”

Coexisting intramedullary schwannoma with an ependymal cyst of the conus medullaris: A case report

“…Ependymal cysts are ependymal-lined fluid collections within the CNS, the majority of which are generally located in the paraventricular white matter of the frontal and parietal lobes ( 6 ). Intramedullary ependymal cysts are particularly rare, with few pathologically determined cases to date ( 7 ). Although these cysts are completely independent from the central canal, only 28% of intramedullary ependymal cysts could be totally resected ( 7 ).…”