Horikoshi Koh, Tsutsumi Satoshi, Ito Masanori, Izumi Hiroshi, Ishii Hisato
Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Department of Pathology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
Radiol Case Rep. 2019 Feb 27;14(5):561-564. doi: 10.1016/j.radcr.2019.02.013. eCollection 2019 May.
A previously healthy 43-year-old man presented with durable occipitalgia for 1 month. Neurological examination revealed severe pain in the right C2 area accompanied by neck stiffness. Magnetic resonance imaging revealed an enhancing, polycystic intradural mass at the C2 level, occupying the left dorsolateral part of the spinal canal. In addition, a rim-like enhancement was found along the surfaces of the spinal cord. Blood tests did not show signs of infection. A lumbar spinal tap revealed albuminocytologic dissociation without cultured organisms. Cranial computed tomography scans taken 20 days later revealed an overt ventriculomegaly. The patient underwent a total tumor resection through hemilaminectomy of the C2. Intraoperatively, the left dorsal C2 roots were found to be extremely redundant due to the tumor and surrounding thickened arachnoids. The roots restored normal morphologies after resection of the arachnoids and tumor. Postoperatively, the patient's symptoms resolved and histological diagnosis was endodermal cyst. Four weeks later, a ventriculoperitoneal shunt was placed to treat progressive ventriculomegaly. A polycystic intradural mass of the upper cervical spine should assume an endodermal cyst that may cause contralateral occipitalgia and aseptic meningitis.
一名既往健康的43岁男性出现持续1个月的枕部疼痛。神经系统检查发现右侧C2区域有严重疼痛并伴有颈部僵硬。磁共振成像显示C2水平有一个强化的多囊性硬膜内肿块，占据椎管左背外侧部分。此外，沿脊髓表面发现环形强化。血液检查未显示感染迹象。腰椎穿刺显示蛋白细胞分离，未培养出微生物。20天后进行的头颅计算机断层扫描显示明显的脑室扩大。患者通过C2半椎板切除术进行了肿瘤全切。术中发现由于肿瘤和周围增厚的蛛网膜，左侧C2背根极度冗长。切除蛛网膜和肿瘤后，神经根恢复了正常形态。术后患者症状缓解，组织学诊断为皮样囊肿。四周后，为治疗进行性脑室扩大放置了脑室腹腔分流管。上颈椎的多囊性硬膜内肿块应考虑为皮样囊肿，其可能导致对侧枕部疼痛和无菌性脑膜炎。
