Uschold Timothy, Xu David S, Wilson David A, Abla Adib A, Nakaji Peter, Spetzler Robert F, Chang Steve W
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2014 Sep-Oct;82(3-4):480-4. doi: 10.1016/j.wneu.2013.10.037. Epub 2013 Oct 16.
Neurenteric cysts (NECs) are uncommonly encountered lesions of the central nervous system with heterogeneous imaging characteristics. The object of this study was to review the preoperative imaging findings represented among a cohort of surgically treated posterior fossa NECs. These findings are considered in the context of surgical technique, and inform an understanding of aberrant neuroembryological development associated with NECs.
A single-institution, multisurgeon series of 7 consecutive patients (5 female and 2 male patients, mean age 36 years, range 19 to 57 years) treated surgically for histopathologically confirmed posterior fossa NECs was retrospectively reviewed. Lesion imaging and anatomic characteristics were noted on preoperative magnetic resonance imaging (MRI). Imaging comparisons were made against an additional cohort of 266 consecutive surgically treated posterior fossa masses to validate unique anatomic findings.
T1 and T2 MRI signal characteristics were variable when compared across lesions. All NECs were found to be anteriorly located within the posterior fossa, but always situated between the brainstem pial surface and the vertebrobasilar system, causing ventral displacement of vertebrobasilar vessels.
Posterior fossa NECs display variable patterns of MRI signal and are commonly considered as part of a broad differential of cystic posterior fossa masses. We identified tumor insinuation between the ventral brainstem and vertebrobasilar system as a highly sensitive and specific radiographic sign for NECs. This finding was not observed among a large cohort of posterior fossa masses representative of other multiple pathologies.
神经肠囊肿（NECs）是中枢神经系统中罕见的病变，具有异质性影像学特征。本研究的目的是回顾一组接受手术治疗的后颅窝NECs患者的术前影像学表现。结合手术技术对这些表现进行分析，以增进对与NECs相关的异常神经胚胎发育的理解。
回顾性分析一家机构由多位外科医生连续治疗的7例患者（5例女性，2例男性，平均年龄36岁，范围19至57岁），这些患者经组织病理学证实为后颅窝NECs并接受了手术治疗。术前磁共振成像（MRI）记录了病变的影像学和解剖学特征。与另外一组连续接受手术治疗的266例后颅窝肿块进行影像学比较，以验证独特的解剖学发现。
不同病变之间T1和T2 MRI信号特征各异。所有NECs均位于后颅窝前部，但总是位于脑干软膜表面和椎基底系统之间，导致椎基底血管腹侧移位。
后颅窝NECs表现出不同的MRI信号模式，通常被视为后颅窝囊性肿块广泛鉴别诊断的一部分。我们发现肿瘤夹在脑干腹侧和椎基底系统之间是NECs高度敏感和特异的影像学征象。在一大组代表其他多种病理类型的后颅窝肿块中未观察到这一发现。
