ABSTRACT
Neurenteric cysts are considered congenital lesions that may slowly expand over time. Although more commonly found in the spinal canal, they may be found intracranially, particularly in the posterior fossa. Here, we present an unusual case of a large, rapidly expanding histologically confirmed posterior fossa neurenteric cyst in a 53-year-old woman, who presented with quadriparesis. Computed tomography imaging done ~1.5 years before admission failed to demonstrate any obvious abnormality; however, the lesion had grown to 4 cm in maximal dimension at presentation with significant mass effect. The lesion was resected microsurgically using a retrosigmoid approach. The patient improved postoperatively and was neurologically intact at last follow-up. We could find no other documented case of marked, rapid expansion of a neurenteric cyst in the literature. We conclude that, although neurenteric cysts are thought to be congenital, they can undergo rapid expansion even in adults. The mechanism of expansion is unknown but may involve increased secretion, hemorrhage, or inflammation. We discuss the surgical management and review the literature in view of this surprising finding.
KEYWORDS
Neurenteric cyst - posterior fossa tumor - microsurgery
REFERENCES
-
1 Gumerlock M K. Epidermoid, dermoid and neurenteric cysts. In: Winn R H, ed. Youmans Neurological Surgery. 5th ed. Philadelphia, PA: WB Saunders; 2004: 1223-1230
-
2
Tan G S, Hortobágyi T, Al-Sarraj S, Connor S E.
Intracranial laterally based supratentorial neurenteric cyst.
Br J Radiol.
2004;
77
(923)
963-965
-
3
Bejjani G K, Wright D C, Schessel D, Sekhar L N.
Endodermal cysts of the posterior fossa. Report of three cases and review of the literature.
J Neurosurg.
1998;
89
(2)
326-335
-
4
Quiñones-Hinojosa A, Chang E F, Lawton M T.
The extended retrosigmoid approach: an alternative to radical cranial base approaches for posterior fossa lesions.
Neurosurgery.
2006;
58
(4, Suppl 2)
ONS-208-ONS-214
discussion ONS-214
-
5
Afshar F, Scholtz C L.
Enterogenous cyst of the fourth ventricle: case report.
J Neurosurg.
1981;
54
(6)
836-838
-
6
Eynon-Lewis N J, Kitchen N, Scaravilli F, Brookes G B.
Neurenteric cyst of the cerebellopontine angle: case report.
Neurosurgery.
1998;
42
(3)
655-658
-
7
Basheer N, Kasliwal M K, Suri A, Sharma M C, Arora A, Sharma B S.
Lateral extradural, supratentorial neurenteric cyst.
J Clin Neurosci.
2010;
17
(5)
639-641
-
8
Ko B S, Jung S, Jung T Y, Moon K S, Kim I Y, Kang S S.
Neurenteric cyst with xanthomatous changes in the prepontine area: unusual radiological findings.
J Neurosurg Pediatr.
2008;
2
(5)
351-354
-
9
Schwartz A M, Jensen M E, Saks D A, Ghatak N R.
Epithelial cyst in cerebellopontine angle with xanthogranulomatous changes simulating cholesterol granuloma.
Surg Neurol.
1989;
31
(6)
454-458
-
10
Ho L C, Olivi A, Cho C H, Burger P C, Simeone F, Tihan T.
Well-differentiated papillary adenocarcinoma arising in a supratentorial enterogenous cyst: case report.
Neurosurgery.
1998;
43
(6)
1474-1477
-
11 Batson R A, Scott R M. Neurenteric cysts, teratomatous cysts, teratomas, giant hairy nevi and their associated anomalies. In: Hoffman H JEF, ed. Disorders of the Developing Nervous System: Diagnosis and Treatment. St. Louis: Blackwell Scientific; 1986: 733-743
-
12
Boto G R, Lobato R D, Ramos A, Ricoy J R, Alén J F, Benito A.
Enterogenous cyst of the cisterna magna.
Acta Neurochir (Wien).
2000;
142
(6)
715-716
-
13
Kincaid P K, Stanley P, Kovanlikaya A, Mahour G H, Rowland J M.
Coexistent neurenteric cyst and enterogenous cyst. Further support for a common embryologic error.
Pediatr Radiol.
1999;
29
(7)
539-541
-
14
Mackenzie I R, Gilbert J J.
Cysts of the neuraxis of endodermal origin.
J Neurol Neurosurg Psychiatry.
1991;
54
(7)
572-575
-
15
Tubbs R S, Salter E G, Oakes W J.
Neurenteric cyst: case report and a review of the potential dysembryology.
Clin Anat.
2006;
19
(7)
669-672
-
16
Kulkarni V, Daniel R T, Haran R P.
Extradural endodermal cyst of posterior fossa: case report, review of the literature, and embryogenesis.
Neurosurgery.
2000;
47
(3)
764-767
-
17
Harris C P, Dias M S, Brockmeyer D L, Townsend J J, Willis B K, Apfelbaum R I.
Neurenteric cysts of the posterior fossa: recognition, management, and embryogenesis.
Neurosurgery.
1991;
29
(6)
893-897
discussion 897-898
-
18
Tucker A, Miyake H, Tsuji M et al..
Neurenteric cyst of the lower clivus.
Neurosurgery.
2010;
66
(1)
E224-E225
-
19
de Oliveira R S, Cinalli G, Roujeau T, Sainte-Rose C, Pierre-Kahn A, Zerah M.
Neurenteric cysts in children: 16 consecutive cases and review of the literature.
J Neurosurg.
2005;
103
(6, Suppl)
512-523
-
20 Keating R F, Multani J, Cogan P H. Occult spinal dysraphism and the tethered spinal cord. In: Winn R H, ed. Youmans Neurological Surgery. 5th ed. Philadelphia, PA: WB Saunders; 2004: 3257-3288
-
21
Lee S H, Dante S J, Simeone F A, Curtis M T.
Thoracic neurenteric cyst in an adult: case report.
Neurosurgery.
1999;
45
(5)
1239-1242
1242-1243
-
22
Guilburd J N, Arieh Y B, Peyser E.
Spinal intradural enterogenous cyst: report of a case.
Surg Neurol.
1980;
14
(5)
359-362
-
23
Dias M S.
Enterogenous cyst of the fourth ventricle: case report.
Neurosurgery.
1998;
43
(4)
984
-
24
Zalatnai A.
Neurenteric cyst of medulla oblongata—a curiosity.
Neuropediatrics.
1987;
18
(1)
40-41
-
25
Miyagi A MD, Katayama Y MD.
Neurenteric cyst arising in the high convexity parietal lesion: case report.
Neurosurgery.
2007;
60
(1)
E203-E204
discussion E204
-
26
Scaravilli F, Lidov H, Spalton D J, Symon L.
Neuroenteric cyst of the optic nerve: case report with immunohistochemical study.
J Neurol Neurosurg Psychiatry.
1992;
55
(12)
1197-1199
-
27
Inoue T, Kawahara N, Shibahara J, Masumoto T, Usami K, Kirino T.
Extradural neurenteric cyst of the cerebellopontine angle. Case report.
J Neurosurg.
2004;
100
(6)
1091-1093
-
28
Uematsu Y, Rojas-Corona R R, Llena J F, Hirano A.
Distribution of epithelial membrane antigen in normal and neoplastic human ependyma.
Acta Neuropathol.
1989;
78
(3)
325-328
-
29
Preece M T, Osborn A G, Chin S S, Smirniotopoulos J G.
Intracranial neurenteric cysts: imaging and pathology spectrum.
AJNR Am J Neuroradiol.
2006;
27
(6)
1211-1216
-
30
Cheng J S, Cusick J F, Ho K C, Ulmer J L.
Lateral supratentorial endodermal cyst: case report and review of literature.
Neurosurgery.
2002;
51
(2)
493-499
discussion 499
-
31
Yoshida K, Nakamura S, Tsubokawa T, Sasaki J, Shibuya T.
Epithelial cyst of the fourth ventricle. Case report.
J Neurosurg.
1990;
73
(6)
942-945
-
32
Adams R D, Wegner W.
Congenital cyst of the spinal meninges as cause of intermittent compression of the spinal cord.
Arch Neurol Psychiatry.
1947;
58
(1)
57-69
-
33
Dunham C P, Curry B, Hamilton M.
Malignant transformation of an intraaxial-supratentorial neurenteric cyst - case report and review of the literature.
Clin Neuropathol.
2009;
28
(6)
460-466
-
34
Monaco R, Boscaino A, Di Blasi A et al..
Intraepithelial carcinoma arising in an endodermal cyst of the posterior fossa.
Neuropathology.
2003;
23
(3)
219-224
-
35
Wang W, Piao Y S, Gui Q P, Zhang X H, Lu D H.
Cerebellopontine angle neurenteric cyst with focal malignant features.
Neuropathology.
2009;
29
(1)
91-95
-
36
Ito S, Fujiwara S, Mizoi K, Namiki T, Yosimoto T.
Enterogenous cyst at the cerebellopontine angle: case report.
Surg Neurol.
1992;
37
(5)
366-370
-
37
Shakudo M, Inoue Y, Ohata K, Tanaka S.
Neurenteric cyst with alteration of signal intensity on follow-up MR images.
AJNR Am J Neuroradiol.
2001;
22
(3)
496-498
-
38
Fuse T, Yamada K, Kamiya K, Inagaki H.
Neurenteric cyst at the craniovertebral junction: report of two cases.
Surg Neurol.
1998;
50
(5)
431-436
-
39
Kimura H, Nagatomi A, Ochi M, Kurisu K.
Intracranial neurenteric cyst with recurrence and extensive craniospinal dissemination.
Acta Neurochir (Wien).
2006;
148
(3)
347-352
discussion 352
-
40
Perry A, Scheithauer B W, Zaias B W, Minassian H V.
Aggressive enterogenous cyst with extensive craniospinal spread: case report.
Neurosurgery.
1999;
44
(2)
401-404
discussion 404-405
Ethan A BenardeteM.D. Ph.D.
Instructor, Department of Neurological Surgery, Thomas Jefferson University
909 Walnut Street, Philadelphia, PA 19107-5211
eMail: ethan.benardete@jefferson.edu
