Download PDF
Skull Base 2010; 20(6): 435-442
DOI: 10.1055/s-0030-1265823
CASE REPORT

© Thieme Medical Publishers

Microsurgical Excision of the Craniocervical Neurenteric Cysts by the Far-Lateral Transcondylar Approach: Case Report and Review of the Literature

Wei Shi1 [*] , Da-Ming Cui2 [*] , Jin-Long Shi1 , Zhi-Kai Gu1 , Shao-Qing Ju1 , Jian Chen1
  • 1Department of Neurosurgery, Surgical Research Center, Hospital Affiliated to Nantong University, Nantong, China
  • 2Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
Further Information

Publication History

Publication Date:
09 September 2010 (online)

    Permissions and Reprints

ABSTRACT

Neurenteric cysts in the anterior craniocervical junction (CCJ) region can be found in extremely rare cases. We report one case with craniocervical neurenteric cyst that was excised by the far-lateral transcondylar (FLT) approach. A 43-year-old man presented with a history of recurrent episodes of mild neck pain and dysesthesia in his bilateral hands of 2 years' duration with rapid deterioration 3 weeks prior to admission. Magnetic resonance imaging (MRI) of the CCJ region revealed a well-defined intradural cystic lesion located ventral from the pontomedullary junction to C1 vertebra with medulla and C1 cord compression. This patient underwent total excision of the lesion via the FLT approach without any postoperative neurological deficits, and the histopathologic diagnosis was neurenteric cyst. Follow-up MRI has revealed no evidence of recurrence. The clinical features, imaging studies, and surgical approach options involved in resecting craniocervical neurenteric cysts are discussed, along with a review of the literature.

KEYWORDS

Neurenteric cyst - microsurgery - far-lateral transcondylar approach - craniocervical junction

REFERENCES

  • 1 Fortuna A, Mercuri S. Intradural spinal cysts.  Acta Neurochir (Wien). 1983;  68 289-314
    CrossrefPubMedGoogle Scholar
  • 2 Guilburd J N, Arieh Y B, Peyser E. Spinal intradural enterogenous cyst: report of a case.  Surg Neurol. 1980;  14 359-362
    PubMedGoogle Scholar
  • 3 Sundaram C, Paul T R, Raju B V, Ramakrishna Murthy T, Sinha A K, Prasad V S, Purohit A K. Cysts of the central nervous system: a clinicopathologic study of 145 cases.  Neurol India. 2001;  49 237-242
    PubMedGoogle Scholar
  • 4 Agnoli A L, Laun A, Schönmayr R. Enterogenous intraspinal cysts.  J Neurosurg. 1984;  61 834-840
    CrossrefPubMedGoogle Scholar
  • 5 Breeze R E, Nichols P, Segal H, Apuzzo M L. Intradural epithelial cyst at the craniovertebral junction. Case report.  J Neurosurg. 1990;  73 788-791
    CrossrefPubMedGoogle Scholar
  • 6 Chavda S V, Davies A M, Cassar-Pullicino V N. Enterogenous cysts of the central nervous system: a report of eight cases.  Clin Radiol. 1985;  36 245-251
    CrossrefPubMedGoogle Scholar
  • 7 de Oliveira R S, Cinalli G, Roujeau T, Sainte-Rose C, Pierre-Kahn A, Zerah M. Neurenteric cysts in children: 16 consecutive cases and review of the literature.  J Neurosurg. 2005;  103(6 Suppl) 512-523
    PubMedGoogle Scholar
  • 8 Fan Y K, Huang J K, Sheu C Y, Wong T D. MR imaging characteristic of cervical neurenteric cysts: two cases reports.  Chin J Radiol. 2001;  26 39-44
    PubMedGoogle Scholar
  • 9 Hirai O, Kawamura J, Fukumitsu T. Prepontine epithelium-lined cyst. Case report.  J Neurosurg. 1981;  55 312-317
    CrossrefPubMedGoogle Scholar
  • 10 Hirano A, Ghatak N R, Wisoff H S, Zimmerman H M. An epithelial cyst of the spinal cord. An electron microscopic study.  Acta Neuropathol. 1971;  18 214-223
    CrossrefPubMedGoogle Scholar
  • 11 Kantrowitz L R, Pais M J, Burnett K, Choi B, Pritz M B. Intraspinal neurenteric cyst containing gastric mucosa: CT and MRI findings.  Pediatr Radiol. 1986;  16 324-327
    CrossrefPubMedGoogle Scholar
  • 12 Malcolm G P, Symon L, Kendall B, Pires M. Intracranial neurenteric cysts. Report of two cases.  J Neurosurg. 1991;  75 115-120
    CrossrefPubMedGoogle Scholar
  • 13 Odake G, Yamaki T, Naruse S. Neurenteric cyst with meningomyelocele. Case report.  J Neurosurg. 1976;  45 352-356
    PubMedGoogle Scholar
  • 14 Ray A, Chakraborty A, Donaldson-Hugh M. Enterogenous cyst of the posterior fossa.  Br J Neurosurg. 2000;  14 249-251
    CrossrefPubMedGoogle Scholar
  • 15 Silvernail Jr W I, Brown R B. Intramedullary enterogenous cyst. Case report.  J Neurosurg. 1972;  36 235-238
    PubMedGoogle Scholar
  • 16 Yamashita J, Maloney A F, Harris P. Intradural spinal bronchiogenic cyst. Case report.  J Neurosurg. 1973;  39 240-245
    PubMedGoogle Scholar
  • 17 Abe K, Oyama K, Mori K, Ishimaru S, Eguchi M, Maeda M. Neurenteric cyst of the craniocervical junction—case report.  Neurol Med Chir (Tokyo). 1999;  39 875-880
    CrossrefPubMedGoogle Scholar
  • 18 Brooks B S, Duvall E R, el Gammal T, Garcia J H, Gupta K L, Kapila A. Neuroimaging features of neurenteric cysts: analysis of nine cases and review of the literature.  AJNR Am J Neuroradiol. 1993;  14 735-746
    PubMedGoogle Scholar
  • 19 Ergün R, Akdemir G, Gezici A R, Kara C, Ergüngör F. Craniocervical neurenteric cyst without associated abnormalities.  Pediatr Neurosurg. 2000;  32 95-99
    CrossrefPubMedGoogle Scholar
  • 20 Filho F L, Tatagiba M, Carvalho G A, Weichhold W, Klekamp J, Samii M. Neurenteric cyst of the craniocervical junction. Report of three cases.  J Neurosurg. 2001;  94(1 Suppl) 129-132
    PubMedGoogle Scholar
  • 21 Fuse T, Yamada K, Kamiya K, Inagaki H. Neurenteric cyst at the craniovertebral junction: report of two cases.  Surg Neurol. 1998;  50 431-436
    CrossrefPubMedGoogle Scholar
  • 22 Harris C P, Dias M S, Brockmeyer D L, Townsend J J, Willis B K, Apfelbaum R I. Neurenteric cysts of the posterior fossa: recognition, management, and embryogenesis.  Neurosurgery. 1991;  29 893-898
    CrossrefPubMedGoogle Scholar
  • 23 Koksel T, Revesz T, Crockard H A. Craniospinal neurenteric cyst.  Br J Neurosurg. 1990;  4 425-428
    CrossrefPubMedGoogle Scholar
  • 24 Lazareff J A, Hoil Parra J A. Intradural neurenteric cyst at the craniovertebral junction.  Childs Nerv Syst. 1995;  11 536-538
    CrossrefPubMedGoogle Scholar
  • 25 Lin J, Feng H, Li F, Chen Z, Wu G. Ventral brainstem enterogenous cyst: an unusual location.  Acta Neurochir (Wien). 2004;  146 419-420
    CrossrefPubMedGoogle Scholar
  • 26 Liu J K, Couldwell W T. Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Report of two cases.  Neurosurg Focus. 2005;  19 E9
    PubMedGoogle Scholar
  • 27 Rao M B, Rout D, Misra B K, Radhakrishnan V V. Craniospinal and spinal enterogenous cysts—report of three cases.  Clin Neurol Neurosurg. 1996;  98 32-36
    CrossrefPubMedGoogle Scholar
  • 28 Sakata H, Fujimura M, Iwasaki M, Tominaga T. Neurenteric cyst of the craniocervical junction in an infant.  Neurol Med Chir (Tokyo). 2008;  48 86-89
    CrossrefPubMedGoogle Scholar
  • 29 Mizuno J, Fiandaca M S, Nishio S, O'Brien M S. Recurrent intramedullary enterogenous cyst of the cervical spinal cord.  Childs Nerv Syst. 1988;  4 47-49
    PubMedGoogle Scholar
  • 30 Menezes A H, Ryken T C. Craniocervical intradural neurenteric cysts.  Pediatr Neurosurg. 1995;  22 88-95
    CrossrefPubMedGoogle Scholar
  • 31 Shenoy S N, Raja A. Spinal neurenteric cyst. Report of 4 cases and review of the literature.  Pediatr Neurosurg. 2004;  40 284-292
    CrossrefPubMedGoogle Scholar
  • 32 Gessi M, Legnani F G, Maderna E et al.. Mucinous low-grade adenocarcinoma arising in an intracranial enterogenous cyst: case report.  Neurosurgery. 2008;  62 E972-E973
    CrossrefPubMedGoogle Scholar
  • 33 Perry A, Scheithauer B W, Zaias B W, Minassian H V. Aggressive enterogenous cyst with extensive craniospinal spread: case report.  Neurosurgery. 1999;  44 401-405
    CrossrefPubMedGoogle Scholar
  • 34 Cai C, Shen C, Yang W, Zhang Q, Hu X. Intraspinal neurenteric cysts in children.  Can J Neurol Sci. 2008;  35 609-615
    CrossrefPubMedGoogle Scholar
  • 35 Chang I C. Thoracic neurenteric cyst in a middle aged adult presenting with Brown-Sequard syndrome.  Spine. 2003;  28 E515-E518
    CrossrefPubMedGoogle Scholar
  • 36 Devkota U P, Lam J M, Ng H, Poon W S. An anterior intradural neurenteric cyst of the cervical spine: complete excision through central corpectomy approach—case report.  Neurosurgery. 1994;  35 1150-1154
    CrossrefPubMedGoogle Scholar
  • 37 Kemp S S, Towbin R B. Pediatric case of the day. Neurenteric cyst without associated vertebral anomalies.  Radiographics. 1992;  12 1255-1257
    PubMedGoogle Scholar
  • 38 Klump T E. Neurenteric cyst in the cervical spinal canal of a 10-week-old boy. Case report.  J Neurosurg. 1971;  35 472-476
    PubMedGoogle Scholar
  • 39 Kumar R, Jain R, Rao K M, Hussain N. Intraspinal neurenteric cysts—report of three paediatric cases.  Childs Nerv Syst. 2001;  17 584-588
    CrossrefPubMedGoogle Scholar
  • 40 Lee S H, Dante S J, Simeone F A, Curtis M T. Thoracic neurenteric cyst in an adult: case report.  Neurosurgery. 1999;  45 1239-1243
    CrossrefPubMedGoogle Scholar
  • 41 Miyagi K, Mukawa J, Mekaru S, Ishikawa Y, Kinjo T, Nakasone S. Enterogenous cyst in the cervical spinal canal. Case report.  J Neurosurg. 1988;  68 292-296
    CrossrefPubMedGoogle Scholar
  • 42 Rebhandl W, Rami B, Barcik U, Perneczky G, Horcher E. Neurenteric cyst mimicking pleurodynia: an unusual case of thoracic pain in a child.  Pediatr Neurol. 1998;  18 272-274
    CrossrefPubMedGoogle Scholar
  • 43 Mann K S, Khosla V K, Gulati D R, Malik A K. Spinal neurenteric cyst. Association with vertebral anomalies, diastematomyelia, dorsal fistula, and lipoma.  Surg Neurol. 1984;  21 358-362
    CrossrefPubMedGoogle Scholar
  • 44 Arai Y, Yamauchi Y, Tsuji T, Fukasaku S, Yokota R, Kudo T. Spinal neurenteric cyst. Report of two cases and review of forty-one cases reported in Japan.  Spine. 1992;  17 1421-1424
    CrossrefPubMedGoogle Scholar
  • 45 Itakura T, Kusumoto S, Uematsu Y, Imai H, Nishiguchi T, Hayashi S, Komai N. Enterogenous cyst of the cervical spinal cord in a child—case report.  Neurol Med Chir (Tokyo). 1986;  26 49-53
    CrossrefPubMedGoogle Scholar
  • 46 Scaravilli F, Lidov H, Spalton D J, Symon L. Neuroenteric cyst of the optic nerve: case report with immunohistochemical study.  J Neurol Neurosurg Psychiatry. 1992;  55 1197-1199
    CrossrefPubMedGoogle Scholar
  • 47 Eynon-Lewis N J, Kitchen N, Scaravilli F, Brookes G B. Neurenteric cyst of the cerebellopontine angle: case report.  Neurosurgery. 1998;  42 655-658
    CrossrefPubMedGoogle Scholar
  • 48 Umezu H, Aiba T, Unakami M. Enterogenous cyst of the cerebellopontine angle cistern: case report.  Neurosurgery. 1991;  28 462-465 discussion 465-466
    CrossrefPubMedGoogle Scholar
  • 49 Kadhim H, Proaño P G, Saint Martin C, Boscherini D, Claguty P, Godfraind C, Duprez T, Raftopoulos C, Sébòre G. Spinal neurenteric cyst presenting in infancy with chronic fever and acute myelopathy.  Neurology. 2000;  54 2011-2015
    PubMedGoogle Scholar
  • 50 LeDoux M S, Faye-Petersen O M, Aronin P A, Vaid Y N, Pitts R M. Lumbosacral neurenteric cyst in an infant. Case report.  J Neurosurg. 1993;  78 821-825
    CrossrefPubMedGoogle Scholar
  • 51 Morita Y, Kinoshita K, Wakisaka S, Makihara S. Fine surface structure of an intraspinal neurenteric cyst: a scanning and transmission electron microscopy study.  Neurosurgery. 1990;  27 829-833
    CrossrefPubMedGoogle Scholar
  • 52 Sahara Y, Nagasaka T, Takayasu M, Takagi T, Hata N, Yoshida J. Recurrence of a neurenteric cyst with malignant transformation in the foramen magnum after total resection. Case report.  J Neurosurg. 2001;  95 341-345
    CrossrefPubMedGoogle Scholar
  • 53 Takase T, Ishikawa M, Nishi S, Aokò T, Wada E, Owaki H, Katsuki R, Fukada H. A recurrent intradural cervical neurenteric cyst operated on using an anterior approach: a case report.  Surg Neurol. 2003;  59 34-39 discussion 39
    CrossrefPubMedGoogle Scholar
  • 54 Prasad V S, Reddy D R, Murty J M. Cervico-thoracic neurenteric cyst: clinicoradiological correlation with embryogenesis.  Childs Nerv Syst. 1996;  12 48-51
    CrossrefPubMedGoogle Scholar
  • 55 Bejjani G K, Wright D C, Schessel D, Sekhar L N. Endodermal cysts of the posterior fossa. Report of three cases and review of the literature.  J Neurosurg. 1998;  89 326-335
    CrossrefPubMedGoogle Scholar
  • 56 Reinders J WC, Wesseling P, Hilkens P HE. Intramedullary enterogenous cyst presenting with spastic paraparesis during two consecutive pregnancies: a case report.  J Neurol Neurosurg Psychiatry. 2001;  71 528-530
    CrossrefPubMedGoogle Scholar
  • 57 Rizk T, Lahoud G A, Maarrawi J et al.. Acute paraplegia revealing an intraspinal neurenteric cyst in a child.  Childs Nerv Syst. 2001;  17 754-757
    CrossrefPubMedGoogle Scholar
  • 58 Lanzino G, Paolini S, Spetzler R F. Far-lateral approach to the craniocervical junction.  Neurosurgery. 2005;  57(4 Suppl) 367-371
    CrossrefPubMedGoogle Scholar
  • 59 Suhardja A, Agur A M, Cusimano M D. Anatomical basis of approaches to foramen magnum and lower clival meningiomas: comparison of retrosigmoid and transcondylar approaches.  Neurosurg Focus. 2003;  14 E9
    PubMedGoogle Scholar

1 These two authors contributed equally to this work

Jian ChenM.D. 

Department of Neurosurgery, Xisi Road 20#

Nantong, Jiangsu Province, China 226001

Email: sw740104@hotmail.com

      >