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

Copyright © 2001 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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