Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
AUGUST 2012
Next Case of the Month coming September 4...
Neurenteric Cyst
- Neurenteric (NE) cysts—also known as enterogenous cyst or endodermal cyst—are endodermally derived lesions of the CNS. NE cysts are more common in the spine than the brain (3:1). Intracranial NE cysts are rare and are commonly found in the posterior fossa, anterior or anterolateral to the brainstem. Supratentorial NE cysts are rarer. Intracranial NE cysts are typically not associated with bony anomalies.
- Cl pr: headache, vomiting, diplopia, and gait disturbance. No age or gender predilection.
- Key Diagnostic Features: NE cyst typically appears as well defined extra-axial round/ovoid and/or lobulated nonenhancing mass ventral to the medulla. Most are small, measuring less than 2 cm. The signal intensity characteristics vary depending on the protein content of the cysts. Most are proteinaceous with a T1-weighted imaging appearance that is iso- to slightly hyperintense compared with the CSF. Neurenteric cysts are typically hyperintense on T2-weighted and FLAIR images but T2 hypointense NE cysts are also reported in inspissated cysts. NE cysts uncommonly show mild restriction on diffusion- weighted images and very rarely exhibit rim enhancement.
- DDx: Epidermoid cyst (especially white epidermoid), dermoid cyst, arachnoid cyst, schwannoma, ecchordosis physaliphora
- Rx: Surgical evacuation of cyst contents and total excision of the cyst wall. Partial resection of the cyst wall should be done in cases where cyst wall is in intimate relationship with critical vessels and nerves.
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