Muthoot Hospital, Kozhencherry, Kerala, India.
Spinal Cord Ser Cases. 2022 Mar 14;8(1):31. doi: 10.1038/s41394-022-00500-2.
Intradural cysts of the spine are arachnoid cysts, neuroenteric cysts, and ependymal cysts. The usual finding in case of a neurenteric cyst is a ventrally located non-contrast-enhancing lesion that is isointense on T1-weighted sequence and hyperintense on T2-weighted imaging. An arachnoid cyst is hypointense in T1-weighted image and hyperintense in T2-weighted image, mimicking cerebrospinal fluid(CSF), and the location is dorsal to the cord. But a neurenteric cyst can mimic an arachnoid cyst in appearance.
A 48-yr old autorikshaw driver presented with weakness of fingers and lower limbs. All sensations were decreased below xiphisternum(T6). The gait was spastic. Magnetic Resonance Imaging(MRI) showed an extramedullary intradural cyst at C7-T1 level. It was hypointense on T1-weighted image and hyperintense on T2-weighted image. There was no enhancement with contrast. C7/T1 Laminectomy was done. On gentle retraction of the cord, a whitish cyst was seen. Some clear fluid was aspirated and cyst was excised en toto. Myelopathy improved over two weeks. Histopathological examination showed a cyst wall composed of fibrocollagenous tissue, and lined by pseudostratified epithelium containing many goblet cells and having focal ciliation. The findings were consistent with neurenteric cyst. Follow-up MRI after five years showed no recurrence.
To our knowledge, the peculiarities of the case are that the radiological features mimicked arachnoid cyst in having the intensity of CSF. But the ventral location was suggestive of a neurenteric cyst. Total excision could be done through the posterior approach after decompressing the cyst by aspiration.
椎管内囊肿包括蛛网膜囊肿、神经肠源性囊肿和室管膜囊肿。神经肠源性囊肿的典型表现为位于腹侧的非增强性病变，T1 加权序列呈等信号，T2 加权成像呈高信号。蛛网膜囊肿在 T1 加权图像上呈低信号，在 T2 加权图像上呈高信号，类似于脑脊液（CSF），位置在脊髓背侧。但是，神经肠源性囊肿在外观上可以模拟蛛网膜囊肿。
一名 48 岁的人力车夫出现手指和下肢无力。剑突以下的所有感觉均减退（T6 以下）。步态痉挛。磁共振成像（MRI）显示 C7-T1 水平的髓外硬脊膜内囊肿。在 T1 加权图像上呈低信号，在 T2 加权图像上呈高信号。对比增强后无强化。行 C7/T1 椎板切除术。轻柔牵拉脊髓时，可见一个白色囊肿。抽吸部分清亮液体后，整块切除囊肿。两周后，脊髓病得到改善。组织病理学检查显示囊肿壁由纤维胶原组织组成，内衬假复层上皮，含有许多杯状细胞，并有局灶性纤毛。这些发现与神经肠源性囊肿一致。五年后的随访 MRI 显示无复发。
据我们所知，本例的特点是影像学特征类似于蛛网膜囊肿，具有 CSF 的强度。但位于腹侧提示为神经肠源性囊肿。通过抽吸减压后，可通过后路完全切除。
