PMC5857326_01
Magnetic resonance imaging (MRI) showing the intradural extramedullary cystic mass lesion. The spinal cord was completely stretched out over this ventral cyst (arrows). (a) T1-weighted sagittal image. (b) T2-weighted sagittal image. (c) T2-weighted axial image.
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MRI of the cervical spine revealed an intradural extramedullary cystic mass lesion ventrally to the spinal cord at the C3 to C4 level with the spinal cord tightly stretched out over this ventral cyst (Figure 1).
Computed tomographic myelography also showing clearly delineated intradural extramedullary mass and the previously placed shunting tube (arrows). (a) Sagittal image. (b) Axial image.
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Computed tomographic myelography also showed clearly delineated intradural extramedullary mass with the previously placed shunting tube (Figure 2).
Intraoperative microscopic view. (a) Expanded and thinned dura. (b) White and glossy inner side and the remaining shunt tube. (c) Cyst wall densely adhering to the surface of the spinal cord. (d) After radical resection of cyst wall.
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The dura was expanded and thin so that we could locate the exact position of the cyst through the dura without ultrasonic confirmation (Figure 3(a)). The shunt tube placed during the first surgical operation was observed in the cyst (Figure 3(b)). We tried to remove the entire cyst wall from surrounding structures, but it could not be dissected off the spinal cord surface completely (Figure 3(c)).
MRI showing neither recurrence of the cyst nor leakage of the cerebrospinal fluid at 24 months after surgery. (a) T1-weighted sagittal image. (b) T2-weighted sagittal image. (c) T1-weighted axial image. (d) T2-weighted axial image.
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The patient showed a progressive recovery of the myelopathic symptoms and eventually regained normal function at the 2-year visit, when she had a solid fusion on radiographs and showed neither signs of a cyst recurrence nor a CSF fistula on MRIs (Figure 4).
Histopathological examination. (a) Cystic wall lined by a cuboidal to columnar epithelial cells (original magnification x400, H&E). (b) Those cells were periodic acid-Schiff (PAS) reaction positive (original magnification x400).
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According to Wilkins and Odom's histopathological classification, this cyst is classified as type A (Figure 5).