Abstract
Introduction 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.
Objective This series was undertaken to further understand the risk of recurrence based on
the extent of capsule resection.
Methods Records were retrospectively reviewed for all patients with radiographic or pathological
evidence of intracranial NEC from 1996 to 2021.
Results 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.
Conclusion 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.
Keywords
neurenteric cyst - enterogenous cyst - craniotomy - pontomedullary - foramen magnum
