Yagnik Karan J, Vakharia Kunal, Vaubel Rachael A, Vizcaino M Adelita, Benson John C, Daniels David J, Link Michael J, Van Gompel Jamie J
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States.
Department of Pathology, Mayo Clinic, Rochester, Minnesota, United States.
J Neurol Surg B Skull Base. 2022 Apr 19;84(3):272-280. doi: 10.1055/a-1775-0865. eCollection 2023 Jun.
Neurenteric cysts (NECs) are rare, congenital lesions lined by endodermal cell-derived columnar or cuboidal epithelium. Based on previous studies, gross total removal of the capsule has been presumed to be the ideal surgical goal. This series was undertaken to further understand the risk of recurrence based on the extent of capsule resection. Records were retrospectively reviewed for all patients with radiographic or pathological evidence of intracranial NEC from 1996 to 2021. A total of eight patients were identified; four of eight (50%) presented with headache, and four had signs of one or more cranial nerve syndromes. One patient (13%) presented with third nerve palsy, one (13%) had sixth nerve palsy, and two (25%) with hemifacial spasm. One patient (13%) presented with signs of obstructive hydrocephalus. Magnetic resonance imaging demonstrated T2 hyper- or isointense lesions. Diffusion-weighted imaging was negative in all patients (100%) and T1 contrast-enhanced imaging demonstrated minimal rim enhancement in two patients (25%). In three of eight (38%), a gross total resection (GTR) was achieved, while in four (50%), a near-total resection, and in one (13%), a decompression was performed. Recurrences occurred in two (25%) patients, one with decompression and another with near-total resection, among these 1/2 required repeat surgery after a mean follow-up of 77 months. In this series, none from GTR group demonstrated recurrence, while 40% of those receiving less than GTR recurred, underpinning the importance of maximally safe resection in these patients. Overall patients did well without major morbidity from surgery.
神经肠囊肿（NECs）是一种罕见的先天性病变，由内胚层细胞衍生的柱状或立方上皮细胞衬里。根据以往的研究，完整切除囊肿被认为是理想的手术目标。本系列研究旨在根据囊肿切除范围进一步了解复发风险。回顾性分析了1996年至2021年所有有颅内NEC影像学或病理证据的患者的记录。共确定了8例患者；8例中有4例（50%）表现为头痛，4例有一个或多个颅神经综合征的体征。1例患者（13%）出现动眼神经麻痹，1例（13%）出现展神经麻痹，2例（25%）出现面肌痉挛。1例患者（13%）出现梗阻性脑积水的体征。磁共振成像显示T2高信号或等信号病变。所有患者（100%）的扩散加权成像均为阴性，T1增强成像显示2例患者（25%）有轻微边缘强化。8例中有3例（38%）实现了全切，4例（50%）实现了近全切，1例（13%）进行了减压手术。2例（25%）患者出现复发，其中1例为减压手术患者，另1例为近全切患者，在这些患者中，1/2在平均随访77个月后需要再次手术。在本系列研究中，全切组无一例复发，而接受次全切手术的患者中有40%复发，这突出了在这些患者中进行最大程度安全切除的重要性。总体而言，患者术后恢复良好，未出现重大手术并发症。
