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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2001 December;45(4):220-3


Spinal intra­du­ral endo­der­mal ­cyst locat­ed ante­ri­or to the cer­vi­cal spi­nal ­cord

Agrillo A., Passacantilli E., Santoro A., Delfini R.

Division of Neurosurgery, Department of Neurosurgical Scienc­es, "La Sapienza" University, Rome, Italy

Spinal endo­der­mic ­cysts are ­rare and may be asso­ciat­ed ­with oth­er con­gen­i­tal anom­a­lies (med­i­as­ti­nal ­cysts, ­bony ­defects of the ver­te­bral ­body), ­derive ­from defec­tive dis­place­ment of the endo­derm of the intes­ti­nal ­tract or, ­more rare­ly, the res­pir­a­to­ry one. The ­authors ­describe a ­case of endo­der­mic ­cyst of the cer­vi­cal ­spine local­ized ante­ri­or­ly to the spi­nal ­cord. In the ­case we treat­ed the ­patient was a 17-­year-old ­male who pre­sent­ed hypo­ste­nia of the low­er ­limbs accom­pa­nied by hyper­re­flex­ia and spas­tic­ity; phys­i­cal exam­ina­tion was neg­a­tive. MRI, CT and CT-mye­log­ra­phy doc­u­ment­ed a ­well-­defined ­mass sit­u­at­ed ante­ri­or­ly to the spi­nal ­cord at C2-C4 lev­el. A ­total-­body CT-­scan exclud­ed the exis­tence of oth­er mal­for­ma­tions. Surgery was per­formed via an ante­ri­or ­approach and the ­cyst com­plete­ly ­removed. Histological exam­ina­tion con­firmed the endo­der­mal ­nature of the ­cyst. At ­long-­term fol­low-up exam­ina­tion the ­patient was neu­ro­log­i­cal­ly ­intact. Postoperative MRI ­showed a ­small res­i­due of the ­cyst ­wall with­out spi­nal ­cord com­pres­sion. Endodermic spi­nal ­cysts are ­very ­rare intra­du­ral ­lesions, pre­dom­i­nant­ly ­with an ante­ri­or cer­vi­cal local­iza­tion, ­which ­derive ­from mis­placed embryon­ic and endo­der­mic ­cells. In the major­ity of cas­es, clin­i­cal ­onset is insid­i­ous and has a dis­con­tin­u­ous pro­gres­sion. The ­best diag­nos­tic ­tool is MRI. Treatment of ­choice is ­total sur­gi­cal remov­al or emp­ty­ing of the ­cyst fol­lowed by fen­es­tra­tion.

language: English


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