J Neurol Surg B Skull Base 2023; 84(03): 272-280
DOI: 10.1055/a-1775-0865
Original Article

Surgical Experience and Management of Intracranial Neurenteric Cysts: Single-Center Experience and Review of the Literature

1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
,
Kunal Vakharia*
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
,
Rachael A. Vaubel
2   Department of Pathology, Mayo Clinic, Rochester, Minnesota, United States
,
M. Adelita Vizcaino
2   Department of Pathology, Mayo Clinic, Rochester, Minnesota, United States
,
John C. Benson
3   Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
,
David J. Daniels
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
,
Michael J. Link
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
,
1   Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
› Author Affiliations
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Abstract

Introduction Neurenteric cysts (NECs) are rare, congenital lesions lined by endodermal cell-derived columnar or cuboidal epithelium. Based on previous studies, gross total removal of the capsule has been presumed to be the ideal surgical goal.

Objective This series was undertaken to further understand the risk of recurrence based on the extent of capsule resection.

Methods Records were retrospectively reviewed for all patients with radiographic or pathological evidence of intracranial NEC from 1996 to 2021.

Results A total of eight patients were identified; four of eight (50%) presented with headache, and four had signs of one or more cranial nerve syndromes. One patient (13%) presented with third nerve palsy, one (13%) had sixth nerve palsy, and two (25%) with hemifacial spasm. One patient (13%) presented with signs of obstructive hydrocephalus. Magnetic resonance imaging demonstrated T2 hyper- or isointense lesions. Diffusion-weighted imaging was negative in all patients (100%) and T1 contrast-enhanced imaging demonstrated minimal rim enhancement in two patients (25%). In three of eight (38%), a gross total resection (GTR) was achieved, while in four (50%), a near-total resection, and in one (13%), a decompression was performed. Recurrences occurred in two (25%) patients, one with decompression and another with near-total resection, among these 1/2 required repeat surgery after a mean follow-up of 77 months.

Conclusion In this series, none from GTR group demonstrated recurrence, while 40% of those receiving less than GTR recurred, underpinning the importance of maximally safe resection in these patients. Overall patients did well without major morbidity from surgery.

Previous Publication

Abstract of this article has been presented to the Congress of Neurological Surgeons 2021 Annual Meeting that will take place in Austin, Texas, United States from October 16 to 20, 2021. Abstract is submitted for digital poster/oral presentation.


Author Contributions

K.J.Y. contributed to conceptualization, methodology, software, validation, formal analysis, investigation, data curation, writing—original draft, and visualization. K.V. contributed to conceptualization, methodology, software, validation, formal analysis, investigation, writing—original draft, and visualization. R.A.V., M.A.V., and J.C.B. helped in investigation, collecting resources, data curation, and writing—review and editing. D.J.D. and M.J.L. helped in collecting resources and writing—review and editing. J.J.V.G. contributed to conceptualization, methodology, validation, investigation, collecting resources, writing—review and editing, visualization, supervision, and project administration.


* These are the cofirst authors.




Publication History

Received: 12 November 2021

Accepted: 14 February 2022

Accepted Manuscript online:
17 February 2022

Article published online:
19 April 2022

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