Conus medullaris intramedullary arachnoid cyst- case report and review of the literature

Background: Spinal intramedullary cysts present a radiological dilemma. We present a rare case of a conus intramedullary arachnoid cyst and report on its differentiating features and management. Case Description: We report a case of a 30-month-old child who presented with decreased gluteal sensation and urinary dribbling for 6 months. Apart from some slowness in walking, the power was normal in all four limbs. Imaging showed a non-enhancing, T2-weighted hyperintense 12 × 8 mm conus intramedullary cyst without any edema. A T12-L1 laminotomy followed by marsupialization of the cyst was done. Histopathology was suggestive of an arachnoid cyst. The postoperative course was uneventful with improvement in muscle strength and achievement of regular milestones. We also present the pertinent review of the literature to date. Conclusion: Intramedullary arachnoid cysts are a rare entity and should form the differential diagnosis for cysts presenting in the conus medullaris. Simple decompressive options may suffice for symptomatic cases and radical excision may be avoided. A high index of suspicion is essential considering the subtle nature of presenting symptoms.

Surgical Management of Retro-Odontoid Cystic Mass with Cervicomedullary Compression

Retro-odontoid cysts are a rare cause of cervicomedullary compression. The etiology of these lesions is not completely understood. Previous trauma and instability at the cervicomedullary junction may be the precipitating event in the development of retro-odontoid cysts in rare cases. We discussed the neurosurgical evaluation of a patient who presented with progressive and rapid neurological deterioration secondary to cervicomedullary compression. Posterior occipitocervical fusion was performed. The patient made an excellent neurological recovery, and postoperative imaging studies demonstrated resolution of the compression and intramedullary cyst.

Surgical management of caudal duplication syndrome: A rare entity with a centered approach on quality of life

Background: Caudal duplication syndrome (CDS) is associated with complete/partial duplication of the spine, spinal cord, duplication/malformations of other caudal structures, and often neurological dysfunction. Case Description: A 9-month-old with the prenatal diagnosis of multiple fetal malformations was born through cesarean section at 39 weeks. Computed tomography and magnetic resonance imaging revealed a series of abnormalities: intramedullary cyst at the L4 level with tethering of the conus with a lipoma, a duplication of the sacrum, duplication of the intestines, a ventricular septal defect, bladder duplication, four kidneys, two fully formed functional penises, two anuses (imperforate on the left), and a paramedian ossified appendage suggestive of a malformed leg. The child, at an 8 months of age, underwent a laminectomy at the L4 level for resection of the conus lipoma, release of the tethered cord, and resection of the intramedullary cyst. Conclusion: Spine/spinal cord duplication syndromes are typically associated with spine/spinal cord abnormalities and are often associated with moderate/severe neurological deficits. Additional malformations associated with the CDS include duplication of vascular structures/organs (e.g., bladder and distal gastrointestinal tract). Here, we focused on both the patient’s quality of life and the multidisciplinary approach to managing the duplication syndrome associated with multiple system malformations (e.g., neurological/spinal, bladder, and gastrointestinal, others).

Intramedullary Ectopic Choroid Plexus: Report of a Rare Case

OBJECTIVE AND IMPORTANCE: Intracranial cysts containing an ectopic choroid plexus or choroid plexus-like tissue have seldom been described in the literature. However, there has been no report of a spinal intramedullary cyst containing an ectopic choroid plexus. This is the first case report in the available literature of an ectopic choroid plexus tissue in the spinal cord. CLINICAL PRESENTATION: A 30-year-old man presented with complaints of progressive descending weakness of both upper limbs and increasing stiffness of the lower limbs along with numbness of all four limbs without a history of any bowel or bladder disturbances. Examination was suggestive of a C5–T2 intramedullary lesion. Magnetic resonance imaging revealed a C6–T2 intramedullary cystic lesion along with a small anterosuperiorly placed lesion enhancing with contrast. INTERVENTION: A C6–T2 laminotomy and exploration of the intramedullary cyst and gross total microsurgical excision of the reddish vascular frond-like structure resembling the choroid plexus were performed along with a syringostomy. A laminoplasty with miniplates and screws was performed. Histopathological and immunohistochemical studies revealed a normal choroid plexus. The patient has been followed for 1 year and has demonstrated symptomatic improvement. CONCLUSION: Although there have been rare case reports of drop metastasis of choroid plexus papillomas in the spine, this is the first case report in the available literature of normal but ectopic choroid plexus tissue in the spinal cord.