Spinal neurenteric cysts: experience with 9 cases via an anterior cervical approach

Zong Xin Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Yueqi Du Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Can Zhang Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Boyan Zhang Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Maoyang Qi Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Hongfeng Meng Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Tianyu Jin Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Chee Kong Chan Department of Neurosurgery, Hospital Sultanah Aminah and Gleneagles Hospital Johor, Malaysia

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Zan Chen Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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Wanru Duan Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China;
Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and

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OBJECTIVE

Intraspinal cysts are uncommon, and the success rate of complete resection is still low for spinal neurenteric cysts (NCs). The aim of this study was to evaluate the efficacies of an anterior microscopic surgical approach in the treatment of ventral and ventrolateral subaxial cervical NCs (SCNCs).

METHODS

Between 2019 and 2022, 9 patients with NCs of the subaxial spine underwent an anterior microsurgical approach. Their clinical presentations, radiological features, operative findings, and follow-up data were retrospectively reviewed and analyzed.

RESULTS

All spinal cysts were intradural and extramedullary in origin. Five patients were first-time cases while 4 patients with recurrence underwent revision surgery. The most common clinical manifestation was pain (77.78%). One patient was found to have a concomitant disorder of Klippel-Feil syndrome. Microscopically confirmed gross-total resection was achieved in 8 patients (88.89%) based on clinical comparisons between pre- and postoperative MRI and intraoperative video. One patient had symptom recurrence 1 year after subtotal resection, while there was no evidence of recurrence during follow-up for the other patients. Dense adhesions within the spinal cord were observed in 8 patients (88.89%) intraoperatively. Most importantly, the surgical outcome was significantly improved in all patients, and the mean (± SE) Japanese Orthopaedic Association score increased from 11.33 ± 0.91 preoperatively to 16.22 ± 0.32 postoperatively (p = 0.008).

CONCLUSIONS

An anterior surgical approach was proven to be both safe and effective in treating the ventral or ventrolateral SCNCs. The authors believe that an anterior microsurgical approach should be considered as a useful approach especially in patients with ventral recurrent SCNCs. Its clinical efficacy compared with a posterior approach in ventral spinal cyst may be better as most of the neurenteric cysts are ventrally or ventrolaterally located.

ABBREVIATIONS

ASA = anterior spinal artery; GTR = gross-total resection; JOA = Japanese Orthopaedic Association; NC = neurenteric cyst; SCNC = subaxial cervical NC; STR = subtotal resection; VA = vertebral artery; VAS = visual analog scale.

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