Brain Tumor Res Treat.  2021 Oct;9(2):106-110. 10.14791/btrt.2021.9.e22.

Anterior Craniocervical Junctional Neurenteric Cyst

• Kim WY
• Lim J
• Cho KG

• KMID: 2522228
• DOI: http://doi.org/10.14791/btrt.2021.9.e22

Abstract

Intracranial neurenteric cyst at the anterior craniocervical junction is very rare, and its treatment and prognosis have not been established. We report a case of neurenteric cyst at the anterior craniocervical junction and review the relevant literature. A 16-year-old girl presented with a 2-month history of slowly progressive headache. MRI revealed a well-defined intradural extramedullary cyst in the anterior medulla and brain stem with C1 cord compression. We performed gross total resection of the cyst using a far-lateral transcondylar approach. Surgical resection is the treatment of choice for neurenteric cysts at anterior craniocervical junction, the far-lateral transcondylar approach might be the optimal surgical approach.

Keyword

Neoplasms; Neurosurgery; Neurenteric cyst

Figure

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  Fig. 1 Preoperative MR images of the craniocervical junction. A: The T2-weighted axial image shows a homogeneously hyperintense cyst (arrowhead) anterior to the medulla. B and C: Pre-gadolinium T1-weighted axial and sagittal images show a homogeneously hyperintense cyst that compresses the brain stem at the anterior craniocervical junction. D: The post-gadolinium T1-weighted axial image shows no enhancement of the cystic lesion. E: Diffusion MR image shows a homogeneously hyperintense cyst without diffusion restriction. F: Perfusion MR images reveal partial uptake of the contrast medium in the anterior part of the cystic lesion.

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  Fig. 2 Intraoperative photographs of neurenteric cyst resection using the far-lateral transcondylar approach. A: The right semispinalis captitis muscle was seen, and the dissection of the superior and inferior oblique muscles was performed. B: To secure the vertebral artery, the groove of the vertebral artery was located and lateral partial suboccipital craniotomy was performed. Condylectomy was performed to optimize the view of the anterior brain stem. C: A well-defined capsulated cyst that adheres to the lower cranial nerve and vertebral artery was seen. Posterior bulging of the medulla and cervical cord were seen. D: The lesion was punctured and filled with yellowish viscous fluid. E: The decompressed and lax cyst was completely resected after dissection of the adhesion, which was approximately 10 mm long. F: The premedullary cistern was subsequently secured. The medulla, cervical cord, low cranial nerve, C1 nerve root, and vertebral artery were intact.

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  Fig. 3 Histopathologic findings. A: The low-magnification image shows mucin (hematoxylin and eosin stain, original magnification ×40). B: The high-magnification image shows non-ciliated, mucin-producing columnar epithelium lining the cyst wall and basal nuclei (hematoxylin and eosin stain, original magnification ×200).

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  Fig. 4 Postoperative MR images of the craniocervical junction. T2, T1-weighted (A and B) and post-gadolinium T1-weight (C) images demonstrate grossly total resection of the cyst and decompression of the anterior part of the premedullary cistern.

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