Spinal neurenteric cysts are a rare type of foregut duplication cyst, accounting for ~1% of all spinal cord tumors. They are usually classified as spinal or intracranial and are associated with vertebral or CNS abnormalities respectively.
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Pathology
Neurenteric cysts result from incomplete resorption of the neurenteric canal.
Location
The intraspinal cysts are usually intradural extramedullary (80-90%) 4 and ventral in location 5. They most commonly occur in the thoracic region (~40%).
Associations
- vertebral anomalies like Klippel-Feil syndrome, hemivertebra, butterfly vertebra, scoliosis, split cord and spina bifida 5,6
Radiographic features
CT
The cyst is seen as a well-defined hypoattenuating lesion which may show soft-tissue attenuation.
On CT myelography, the cyst does not opacify with intrathecal contrast. However, larger cysts may cause obstruction to the CSF flow; in such cases, intrathecal contrast material forms meniscus shape (meniscus sign) 5.
MRI
It is the investigation of choice and the appearance depends on the variable protein content:
- T1: variable signal intensity
- T2: variable signal intensity
Treatment and prognosis
These lesions can recur and hence MRI is also used for follow up.