J Korean Neurosurg Soc.  2012 Jul;52(1):67-70. 10.3340/jkns.2012.52.1.67.

Spinal Intramedullary Ependymal Cysts : A Case Report and Review of the Literature

• Park CH
• Hyun SJ
• Kim KJ
• Kim HJ

• KMID: 2190528
• DOI: http://doi.org/10.3340/jkns.2012.52.1.67

Abstract

We report a rare case of a spinal intramedullary ependymal cyst in a 46-year-old female and review the 17 pathologically proven cases in the literature. The patient presented with a two-week history of gradually increasing tingling in her left posterior thigh and calf. A preoperative magnetic resonance image revealed a well-defined intramedullary cystic lesion on the ventral side of the spinal cord at the T11 to T12 levels. The lesion was hyper intense in T2-weighted images and hypointense in T1-weighted. The patient underwent a right-side hemilaminectomy at the T11 to T12 levels and fenestration of the cyst wall. After having the cyst wall partially removed and communication established between the cyst and the subarachnoid space, the patient improved neurologically. A histological study of the surgical specimens revealed that the cyst wall consisted of glial cells lined by a simple cuboidal to columnar epithelium. An immunohistochemical examination of the cells lining the cyst wall was positive for S-100 protein, glial fibrillary acidic protein, epithelial membrane antigen, and cytokeratin. We suggest that the optimal treatment of intramedullary ependymal cysts creates adequate communication between the cyst and the subarachnoid space.

Keyword

Ependymal cyst; Intramedullary; Spinal cord; Immunochemistry

MeSH Terms

Epithelium
Female
Glial Fibrillary Acidic Protein
Humans
Immunochemistry
Keratins
Magnetic Resonance Spectroscopy
Middle Aged
Mucin-1
Neuroglia
S100 Proteins
Spinal Cord
Subarachnoid Space
Thigh
Glial Fibrillary Acidic Protein
Keratins
Mucin-1
S100 Proteins

Figure

• 

  Fig. 1 The magnetic resonance image revealing a well-defined cystic lesion on the ventral side of the spinal cord at the T11 to T12 levels. The lesion is a 36×15 mm oval intramedullary cystic mass. The lesion is hyperintense in T2-weighted images (A and C) and hypointense in T1-weighted images (B and D). In the axial imaging, the cyst is observed to compress the spinal cord on the left dorsal side (C and D).

• 

  Fig. 2 A glistening white cyst without hemorrhage or parenchyma (A). The cyst wall is fenestrated to obtain adequate communication between the cyst and the subarachnoid space (B).

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  Fig. 3 In the H&E staining (A), the cyst wall consists of glial cells lined by a simple cuboidal to columnar epithelium. An immunohistochemical examination of the cells lining the cyst wall is positive for glial fibrillary acidic protein (B), S-100 protein (C), and cytokeratin (D). These findings are consistent with an ependymal cyst diagnosis.

• 

  Fig. 4 A postoperative magnetic resonance image reveals that the cystic lesion's size had decreased to 29×9.6 mm and that the spinal cord had decompressed.

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