Voleti Surya Prakash Rao, Parameswaran Apurve, Nellore Ranjith Mahesh, Kaitepalli Raja Shekar, Kedarisetti Vidya
Department of Orthopaedics, Medicover Hospitals, Hyderabad, Telangana, India.
Department of Neurosurgery, Medicover Hospitals, Hyderabad, Telangana, India.
J Orthop Case Rep. 2025 Sep;15(9):56-61. doi: 10.13107/jocr.2025.v15.i09.6014.
Enterogenous cysts (also known as neurenteric cysts) are rare congenital lesions presumed to arise from an abnormal persistent communication between embryonic ectodermal and endodermal tissues. They may be symptomatic or asymptomatic, and generally have an insidious and prolonged clinical course. They are typically intradural and extramedullary in location. Very few cases of extramedullary enterogenous cysts have been reported in the literature, most of which were cranial. We present a rare case of an anteriorly situated extradural enterogenous cyst at the level of the thoracic spine, mimicking an isolated anterior thoracic meningocele on radiologic evaluation.
A 4-year-old boy was referred to our spine surgery unit for the evaluation and management of an incidentally detected T1 vertebral anomaly. Magnetic resonance imaging revealed the presence of a focal defect over the right half of the T1 vertebral body, through which herniation of a fluid-filled sac into the pre- and right paravertebral regions was noted. A diagnosis of anterior thoracic meningocele was made, and surgery was advised. Following surgical exposure of the entire extent of the sac, needle aspiration to decompress the lesion was performed, which yielded a milky-colored viscous fluid, unlike cerebrospinal fluid. The likelihood of an enterogenous cyst was suspected. The lesion was excised at the level of the base of its peduncle, and the vertebral defect was closed using a small contoured plate. Histopathologic evaluation confirmed the presence of an enterogenous cyst.
Anterior thoracic meningoceles and enterogenous cysts of the spine may be indistinguishable on radiologic evaluation, and a definitive diagnosis may be reached only through histopathologic evaluation. The possibility of an enterogenous cyst must be considered in the differential diagnosis of meningoceles, and vice versa.
肠源性囊肿（也称为神经管肠囊肿）是罕见的先天性病变，推测源于胚胎外胚层和内胚层组织之间异常持续的连通。它们可能有症状或无症状，通常有隐匿且漫长的临床病程。它们通常位于硬膜内和髓外。文献中报道的髓外肠源性囊肿病例极少，其中大多数位于颅骨。我们报告一例罕见的胸椎水平前方硬膜外肠源性囊肿病例，在影像学评估中类似孤立的胸椎前脑脊膜膨出。
一名4岁男孩因偶然发现的T1椎体异常被转诊至我们的脊柱外科进行评估和治疗。磁共振成像显示T1椎体右半部分存在局灶性缺损，可见一个充满液体的囊袋疝入椎前和右侧椎旁区域。诊断为胸椎前脑脊膜膨出，并建议手术。在手术暴露整个囊袋后，进行针吸以减压病变，抽出的是乳白色粘性液体，与脑脊液不同。怀疑是肠源性囊肿。在囊蒂基部水平切除病变，并使用一个小型塑形钢板封闭椎体缺损。组织病理学评估证实为肠源性囊肿。
胸椎前脑脊膜膨出和脊柱肠源性囊肿在影像学评估中可能难以区分，只有通过组织病理学评估才能得出明确诊断。在脑脊膜膨出的鉴别诊断中必须考虑肠源性囊肿的可能性，反之亦然。
